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Page THE HERALD OUTLOOK August Elderly citizens report sleep disturbance DR GOTT About percent of people over 65 complain about difficulty falling asleep staying asleep or about get ting less sleep than they did when they were younger Many elderly people believe they obtain less refreshing sleep than they wish More than 10 percent of geriatric patients use seda tives to sleep Conversely these people tend to be come sleepy during the day when they may nap or briefly nod off Older patients seem to be awakened more often by a snoring partner palpita tions aches and pains difficulty breathing outside noise or a desire to urinate Recent studies of agerelated sleep patterns have documented that in deed older folks do have sleep prob lems This scientific may come as no surprise to millions of ge riatric insomniacs who have learned by their own unequivocal experiences that the older you get the less soundly you sleep Graphs of sleep behavior show that the aging process is associ ated with less deep sleep more light sleep and a steep increase in wake- time Because geriatric insomnia may be associated with diseases common to the aged most experts recommend that patients with sleep problems un dergo complete examinations to iden tify treatable medical conditions in terfering with sleep For example chronic pain from arthritis can cause sleeplessness that disappears once the underlying condition is treated Con gestive heart failure often causes dif ficulty breathing which interferes with appropriate rest It is treatable Men who repeatedly awaken at night to urinate may have enlarged pros tate glands that can be surgically removed I do not recommend the chronic use of hypnotics and sedatives for the el derly Almost all these drugs are hab itforming and are associated with a rebound phenomenon that causes wakefulness in the wee hours Alco hol too disrupts the normal sleep pattern and can lead to early awaken ing after an unsatisfactory steep Because the elderly can do much to improve their sleep patterns without medication experts suggest the fol lowing behavioral changes 1 Avoid stimulants before bedtime Obviously beverages should be prohibited as should alco hol Because nicotine is a stimulant that disrupts sleep smoking should also be avoided 2 Dont nap during the day stay up longer before retiring Naps can de stroy the normal nighttime sleep pat tern Its better to go to bed tired es pecially if you can engage in undemanding activity such as read ing or listening to music before retir ing Many older people go to bed early because they are bored then they awaken too early and feel unrested 3 Obtain treatment for underlying medical conditions such as arthritis muscular cramps from poor circula tion and restless legs syndrome which may be due to mineral deficiencies Make sure that the bedroom is conducive to sleep It should be cool dark comfortable and free of extra neous noise A whitenoise genera tor or electric fan can mask external noises Hide the clock it may serve as a constant reminder of sleeplessness Use blinds or shades to darken windows Decide on a time to awaken and stick to It no matter what the conse quences If you fix the times of retir ing and arising you may be able to re- program your mental sleep center to behave itself 6 Dont sleep during the day If you are uncontrollably weary In the after noon limit your nap to 30 minutes Try to engage in daytime physical ac tivity Avoid violent TV shows and conflict before bed Dont eat in the bedroom and stop making decisions at bed tlide Sex at bedtime often relaxes people and helps bring on sleep Above all dont worry about not sleeping Over time you will get enough sleep for your needs about sleepless nights only rein forces the pattern of insomnia 8 Check with your doctor if you continue to have trouble despite these suggestions DEAR DR GOTT Im a 66-year- old female and received a treadmill with a pulse monitor for Christmas For the first 18 to 20 minutes my pulse stays at about 135 then it drops to 120 or below Is something wrong my heart Im about pounds overweight and like to work out for 30 minutes DEAR READER When healthy people engage in progressively stren uous exercise their pulse rates rise in conjunction with the level of activity This Is the basis for the stress test which monitors the patients cardio vascular system during increasingly difficult exertion Under these cir cumstances the heart rate will grad ually accelerate until it reaches a peak beyond which the pulse will not increase and the person experi ences exhaustion In your case you are probably not pushing yourself too hard on the treadmill If youre like most home- exercisers youre not reaching the point of exhaustion rather youre ex ercising at a comfortable rate and checking your pulse Your drop in heart rate may be due to adaptation As your body becomes used to a certain level of activity your muscles are warmed up your metabolic needs are being adequately met and your heart paradoxically has to work less hard than it did when you began This Is a normal physiological re sponse Thus your pulse decrease may reflect healthy heart muscle On the other hand it is possible that you are overdoing it When an un healthy heart is stressed with exer tion both the pulse and the blood pres sure may fall This could be an early indication that the coronary circula tion is inadequate for your needs in a phrase you may have arterioscle rotic heart disease Based on the limited Information you have provided cannot judge the situation I believe you should have a stress test Under close medical moni toring your hearts reaction to exer cise can be measured using a cardio gram readout while youre on a treadmill Ask your doctor to examine you and perform the necessary tests to make sure that your workout Is appropri ate If as you say you ire 30 pounds overweight you would probably fee more comfortable and exercise more easily if you lost weight A Directory of Services Offered in 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