an article of Osvaldo J. Hernandez Soto,
Professor of the Education and Physical Education Program
in the
“The body needs rest and sleep is extremely important in any health regimen. There should be three main things: eat, exercise and sleep. All three together in the right balance create a truly healthy lifestyle.”
rohit shetty
It is known that aging is not synonymous with illness. He aging is a normal, natural and heterogeneous process in humans. However, it must be recognized that there are some health problems that increase with age. One of these is the difficulty sleeping (sleep disorder). It is said that when you don’t sleep well regularly, it could be an indicator of a sleep disorder or a chronic form that deprives you of sleep, affecting your health, quality of life and, therefore, healthy aging.
Sleep is part of a biological process of the human being; It is a form of rest and rest allows the body to regenerate. Sleep time varies by age. According to the National Sleep Foundation1, older adults should sleep between 7 and 8 hours. In the United States, it was reported that 73.7% of adults older than 65 years sleep less than 7 hours during the day (CDC, 2016)2. In Puerto Rico, no updated information on the matter was identified. The available published information shows that 21% of those over 69 years of age suffer from insomnia (Schubert, CR, et al., 2002)3.
It is important to recognize and act on sleep disorders and their implications for the health and well-being of the elderly
Are many sleep disorders and the factors that can affect the time and quality of sleep. Some sleep disorders are insomnia, apnea, restless leg syndrome, hyper sleepiness (narcolepsy), etc. Among the risk factors associated with these problems are extrinsic variables such as: stress, anxiety, use of alcohol and/or smoking (before going to bed), use of electronic equipment late at night; Some conditions such as heartburn, diabetes, hypertension, depression, urinary tract infection, post-traumatic stress, experiences of joint pain or other ailments, schizophrenia, memory impairment, decreased cognitive ability are also recognized; side effects from the use of medications, multiple medications, interaction between drugs. Also, genetic and anatomical variables are identified.
the existence of a chronic sleep problem can affect the individual in a multidimensional way (biopsychosocial). The problem can trigger a increased frequency of falls (older adult wakes up during the night or during the day with drowsiness), fractures, affects cognitive functioning (attention and memory) and the motor function. Sleep disorders represent a public health problem that, in addition to affecting the health of the elderly, affects the costs of health services (personal insurance policies or government insurers).
They recognize different types of interventions and/or treatments (pharmacological and non-pharmacological) to treat sleep disorders. Only a few natural strategies will be highlighted in this review (measures in sleep hygiene, music therapy, tai chi, physical exercise, etc.) or non-pharmacological recognized and used with older adults.
Some recommendations to improve the sleep hygiene They are related to habits that promote sleep quality. It is recommended:
- Create a daily habit with a regular bedtime (try to go to bed and get up at the same time)
- Try to be in bed only the appropriate time; avoid extended naps (more than 25 minutes)
- Reduce and/or eliminate practices of consuming beverages with a high caffeine or alcoholic content, not smoking, and not eating before going to bed (at least 2 hours before).
- Avoid distractions that are obtained through the use of televisions, cell phones, computers, use of bright lights in the rooms. The bedroom must be used to rest, sleep; not like an activity room
- Find a room with an adequate temperature, minimizing stimuli (lights, colors, sounds) that cause distraction to fall asleep.
The music therapy in one of the most scientifically studied forms and recommended for its effects. The promoter of this type of therapy was Dalcroze. However, Aristotle and Plato referred to music for fears (phobias). The idea comes from joining musical and body rhythms. It is said to be a complementary therapy to pharmacological, but it does not have harmful side effects.
The American Music Therapy Association maintains that music therapy interventions can address multiple goals such as: promote well-being, control stress, relieve pain, anxiety, depression, fear, express feelings, improve memory and stimulate communication, neurological functions, strengthen muscles, and among others, promote rehabilitation physical. Music therapy can even help to overcome diseases through encouragements that reach the depths of the subconscious; is a tool that can help sleep sweetly or calm down after a hectic day (Évora Soldo, S., 2017)4.
In a recent systematic review (Petrovsky, DV., et al., 2021)5, researchers argued that interventions using personalized music showed greater efficacy. In the same way, the use of music was recommended for the meditation and relaxation. It was found that those who listened to music before going to sleep reported a better state of mind, therefore, it is perceived as a pleasant experience.
Another study argued that music not only helps to sleep and improve sleep quality. The researchers identified areas where people understand that this form of therapy helps: music therapy provides unique sleep-promoting properties; it is part of a normal sleep routine; induces a dream state of mind; blocks external and internal stimuli that disrupt sleep; the guiding question of the study was How does it help you sleep?; some answers were:
- “It helps with my mood before I fall asleep, which I think is a big factor in my ability to fall asleep”
- “Music helps me clear my mind and help me fall asleep, and not notice the amount of time it takes to do it”
- “It works like a lullaby: if the music is right, it can lure me into a lovely sleepy state that makes it easier for my body to relax into sleep.”
- “I feel like the repetition is relaxing. I believe this repetition is translated during deep sleep. Maybe the rhythm will help in this process»
- “I think it’s reassuring that I won’t go into the complete subconscious vacuum, sound waves can comfort me while I sleep”
- “It distracts me from thinking, which often prevents me from sleeping”
- “It allows me to block out noises that prevent me from sleeping, for example, clocks, snoring, fans” (Trahan, T,. et al., 2018)6
It is important to note that music is an experience close to the elderly; it is part of the educational, social and cultural experience. Therefore, it is a safe, easy to use and low cost rewarding alternative. The music therapy activities to be used must consider that the type of music is to the liking of the older adult.
Use of Tai Chi or tai chi chuan, is a form of graceful movements or non-competitive exercises. The movements and stretches involved in the technique are executed slowly, with high concentration and breath control. Each person runs at their own particular pace. In this form of movement, postures are assumed and flow into another without pausing. The body is in constant motion. There are different techniques. It is work of low impact and cost, no matter the age. A routine can be done inside or outside the home.
According to the Mayo Clinic7, this form of movement is recommended for reduce stress, improve mood, depression, reduce pain and among others improve sleep quality. Some investigations using tai chi to treat sleep disorders show: that tai chi has beneficial effects by improving the quality of sleep; It is recommended as an alternative, complementary and effective approach for older adults with sleep problems (Du, S., et al., 2015)8.
Another study that included more than 100 seniors between the ages of 60 and 92 in a low-impact tai chi program lasting 60 minutes 3 times a week; 24 weeks after the intervention, there was evidence of a improvement in the sleep of the elderly (Li, F., et al., 2004)9. Some recommendations on a routine establish wearing comfortable clothes, sessions between 30 and 60 minutes, at least 3 times a week; It is suggested to include breathing exercises, circular movements, union of hands, etc.
He physical exercise as a strategy to mitigate sleep disorders are also documented in the scientific literature. In a systematic review it was reported that the general aerobic exercise is an alternative to treat sleep disorders in older adults. This type of exercise was found to help improve sleep quality (Wu, YH., et al., 2021)10.
As for aerobic exercise, you can create dance routines, aquaerobics, flexibility, riding an exercise bike, walking, etc. Sessions can be 15-30 minutes on alternate days of the week. The exercise alternative that was selected must have as a priority the preference and enjoyment of the older adult who will execute it. It should not be forgotten that exercise is a natural medicine. As a result of its multidimensional benefits, it is recommended from childhood throughout the life course. For this reason, it should be more prescribed and used as a central axis for health promotion and disease prevention.
To conclude, it is important not only the recognize the magnitude of the problem of sleep disorders and its implications for the health and well-being of the elderly. Of equal or greater importance is act to mitigate it. It is important to disseminate information as a way to educate.
It is essential to highlight the risks involved in sleep disorders and in turn present the appropriate strategies (primary and secondary prevention) for their care. Scientific evidence shows effective natural alternatives; these can be used as complementary alternatives or in multi-component format of different programs. They should be part of the prevention and health promotion services aimed at the elderly.
Therefore, it is imperative train through educational measures (continuing education, loose sheets, educational capsules, alternative medicine postcast, etc.) both to the elderly, caregivers and health personnel regarding the various existing alternatives; these can be used as non-pharmacological strategies to address the problem in question.
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