Chronic Pain and Sleep Issues in Aging Parents

The elderly person feels unwell all over?

Hello Doctor, my father was born in 1931 and retired at the age of 55 due to long bone spurs.
He has chronic hypertension.
In recent years, he has been experiencing widespread pain and has seen doctors who prescribed him a lot of medication.
He also suffers from insomnia and needs to take sleeping pills to fall asleep.
He has a habit of drinking a little alcohol before bed, and sometimes when neighbors visit, he drinks excessively.
After taking sleeping pills, he tends to talk incessantly, gesticulate, and even wakes my mother up in the middle of the night to exercise.
However, in the morning when he wakes up, he has no recollection of these events.
He complains of various pains and continues to see doctors for medication.
One of our family members is a nurse and noted that many of the medications are pain relievers.
He takes a lot of medication daily, and we are concerned about the burden on his kidneys.
We suspect he may have an anxiety disorder.
Does this sound like it could be the case? Should we take him to see a psychiatrist? Thank you in advance.

SANDY, 30~39 year old female. Ask Date: 2007/05/25

Dr. Ouyang Wenzhen reply Geriatrics

Hello Sandy, due to your father's widespread pain and insomnia, it is indeed important to pay attention to both physical and mental health assessments.
If your father is experiencing depression or a low mood, the most common issue is depression.
Additionally, if he exhibits inappropriate behaviors such as restlessness or agitation after consuming alcohol or taking sleeping pills, it indicates that his mental state is also affected.
Therefore, it is advisable for him to seek psychiatric evaluation and treatment when time permits.
The Chianan Psychiatric Hospital under the Ministry of Health and Welfare offers general psychiatric services.
Dr.
Ouyang Wenzhen.

Reply Date: 2007/05/25

More Info

Chronic pain and sleep issues are common concerns for aging parents, and they can significantly impact both their quality of life and that of their family members. Your father's situation, as you described, involves a complex interplay of chronic pain, insomnia, and possibly underlying anxiety or mood disorders.
Firstly, chronic pain can lead to sleep disturbances. Pain often makes it difficult to find a comfortable sleeping position, and the discomfort can wake individuals throughout the night. This can create a vicious cycle: pain leads to poor sleep, and poor sleep can exacerbate pain sensitivity. In your father's case, the fact that he requires sleeping pills to fall asleep suggests that his insomnia is significant and may be related to his chronic pain.
Moreover, the use of alcohol, especially in conjunction with sleep medications, can be particularly concerning. Alcohol may initially help some individuals fall asleep, but it often disrupts the sleep cycle, leading to poorer quality sleep. Additionally, combining alcohol with sedative medications can increase the risk of adverse effects, such as confusion, excessive sedation, and unusual behaviors, which you noted in your father's case. His episodes of talking excessively, moving around, and having no recollection of these actions the next day could indicate a serious interaction between the alcohol and the medications he is taking.

Given your father's history of chronic pain and the current symptoms, it is essential to consider a comprehensive approach to his treatment. Here are several recommendations:
1. Medical Evaluation: It would be prudent to have your father evaluated by a healthcare professional who specializes in pain management. This could help identify the underlying causes of his pain and explore alternative treatments, such as physical therapy, acupuncture, or other non-pharmacological interventions.

2. Medication Review: A thorough review of his current medications is necessary. This includes assessing the necessity of each medication, potential interactions, and the overall burden on his kidneys and liver. A geriatrician or a pharmacist specializing in elderly care can provide valuable insights.

3. Sleep Hygiene: Encourage good sleep hygiene practices. This includes establishing a regular sleep schedule, creating a comfortable sleep environment, and avoiding stimulants and alcohol close to bedtime. Techniques such as relaxation exercises, mindfulness, or cognitive behavioral therapy for insomnia (CBT-I) can also be beneficial.

4. Mental Health Assessment: Given your concerns about anxiety, it may be worthwhile to have your father evaluated by a mental health professional. Anxiety and depression can manifest physically, contributing to chronic pain and sleep disturbances. A mental health professional can provide therapy and, if necessary, medication to help manage these symptoms.

5. Family Support: As a family member, your support is crucial. Encourage open communication about his feelings and experiences. Sometimes, simply having someone to talk to can alleviate feelings of isolation and anxiety.

6. Monitoring and Follow-Up: Regular follow-up appointments with healthcare providers are essential to monitor his condition and adjust treatment as necessary. Keeping a pain and sleep diary can help track patterns and triggers, providing valuable information for his healthcare team.

In conclusion, your father's situation is multifaceted, involving chronic pain, sleep issues, and potential mental health concerns. A collaborative approach involving medical professionals, family support, and lifestyle modifications can significantly improve his quality of life. It is essential to address these issues holistically to ensure he receives the best possible care.

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