Many people with physical disabilities suffer from sleep disturbances, and sleep tends to become more disrupted as we get older.
Not sleeping well can negatively impact your sense of well-being and make other conditions worse including:
Sleep difficulties can also lead to poor work performance and traffic or workplace accidents.
Sleep is a complex process that involves many parts of the brain. For this reason, and depending on a person’s specific disability as well as their general sleep habits, many different kinds of sleep disturbances can occur in persons aging with a disability.
Sleep problems can be caused by many different factors, including physical and chemical changes associated with disabilities and the aging process.
Physical and chemical changes associated with injury and aging: The “internal clock” in the brain controls when people sleep and wake every day. For individuals who have a disability associated with a brain injury or ongoing nervous system lesions like multiple sclerosis, their brain may be less able to tell the body to fall asleep or wake up. Injuries to the brain can also affect the chemicals in our body that help us to sleep, and brain mechanisms for starting and stopping sleep.
Changes in breathing control: Sometimes the brain’s ability to control breathing during sleep becomes altered after an injury, or because of weight gain associated with inactivity, resulting in sleep apnea.
Daytime sleeping (napping) and physical inactivity: Napping during the day is likely to disturb sleep at night. Inactivity or lack of exercise can also worsen sleep.
Pain: Many people with physical disabilities also experience chronic pain. This discomfort may disturb sleep. Medications taken to relieve pain may also affect sleep.
Depression and anxiety: Depression is more common in persons with disabilities than in the general population. Also, we know that signs of distress and depression tend to increase as people with disabilities age from young adulthood (18 to 44 years old) into middle age (45 to 64 years old), although we also often see improvement in depression as people age from middle age into older ages (65 years and older). Sleep problems such as difficulty falling asleep and early morning waking are common symptoms of depression, anxiety, and other mood problems.
Alcohol: While alcohol may help bring on sleep, drinking alcohol before bedtime is likely to interfere with normal sleep rather than improve it. As a result, people who drink alcohol to help them get to sleep are at greater risk to wake up in the middle of the night, and to not feel rested in the morning.
Caffeine and nicotine: Nicotine from tobacco may cause sleep disturbances and is often overlooked. Caffeine can disturb sleep when consumed in the afternoon or evening. Many soft drinks contain excessive amounts of caffeine.
Medications: A number of medications taken to treat other conditions, such as pain or anxiety, can also alter a person’s ability to get to sleep or stay asleep. Other medications can make people sleepy during the day and unable to participate in activities.
If you have concerns about how your medication is affecting your sleep, consult your health care provider to discuss alternatives.
Although sleep medications can help you to get to sleep at night, they disrupt the sleeping cycle and interfere with the body’s ability to achieve deep and restful sleep.
Many sleep medications are also addictive and your body builds a tolerance to them. This is especially true of the benzodiazapines, such as Xanax©, Librium©, Valium© and Ativan©.
If you are taking a strong sedative for sleep, you should talk to your health care provider about tapering it. Getting off these drugs must be done gradually and with medical supervision. Stopping abruptly can be very dangerous.
Changes in behavior and environment are the first step to treating sleep difficulties. If you live with others, you may want to discuss ways that they can help you improve your sleep.
If your sleep problems persist, talk to your health care provider to explore safe and effective solutions. Evaluation of sleep problems should include a thorough history of such problems, medication review, an assessment of your bedtime routines, and a comprehensive medical evaluation.
Before recommending any action, your health care provider will explore with you a variety of possible causes for your sleep problems, including pain or depression. If necessary, he or she may recommend a sleep test (also known as a polysomnographic evaluation or sleep lab). Based on your symptoms, medical history and specific needs, your health care provider will be able to make a personalized treatment plan to help you achieve restful sleep.
Ask your health care provider about medications that can help you sleep through the night or keep you awake during the day.
Special care is necessary when choosing a medication in order to avoid daytime sedation or worsening of cognitive and behavior problems.
Some consumers have found herbal teas, melatonin and valerian useful for sleep problems, and these are sold in health food and drug stores with no prescription needed. However, these remedies have multiple drug interactions, and you should tell your health care provider if you are using them.
This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.
How to Sleep Better was developed by Mark Jensen, PhD and Alexandra Terrill, PhD, and published by the University of Washington Aging and Physical Disability RRTC. Content is vased on research evidence and/or professional consensus.
This factsheet may be reproduced and distributed freely with the following attribution: Jensen, MP and Terrill, A. (2012). How to Sleep Better [Factsheet]. Aging and Physical Disability Rehabilitation Research and Training Center. University of Washington. http://agerrtc.washington.edu/