Saint Louis University geriatricians say that many older adults who find difficulty sleeping and who have philosophically accepted that their problem has no// solution need not fret any longer.

"Sleep requirements and patterns change throughout life, but sleep problems in the elderly are not a normal part of aging," says Julie Gammack, M.D., assistant professor of geriatrics at Saint Louis University, and an author of a review published in the American Journal of Medicine.

"Sleep disturbance in the elderly is associated with decreased memory, impaired concentration and impaired ability to function. It contributes to an increased risk of accidents, falls and chronic fatigue."

It's important to address sleep problems, which can make life miserable and frequently can be solved, Dr. Gammack says.

She suggests patients with sleep problems keep a diary for a week or two that includes tracking usual wake-up and bedtimes, timing and size of meals, amount of exercise, medications and descriptions of how much and how restful sleep was each day.

"The first step in evaluating sleep problems in the elderly is to establish that the person truly has insomnia," Dr. Gammack says.

She suggests doctors try treating sleep problems by changing the routines of patients before prescribing medications. Lifestyle changes also can be beneficial even if sleep medicines are given.

"A daytime walk with correctly timed daylight exposure is useful for insomnia," she says. "Appropriate temperature control, adequate ventilation, and dark sleep environment may also lead to dramatic improvement in sleep quality."

Among the other lifestyle medications she suggests:

* Increase exposure to bright light and natural light during the day and early evening.

* Avoid napping after 2 p.m. and allow yourself at most one half-hour nap a day.

* Check the effect of the med
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