Insomnia in Elderly Adults: Causes, Prevention, and Treatments

A poor and inconsistent sleep routine can be detrimental to seniors. Older adults need the same amount of sleep as younger people to restore their bodies. Experts recommend seven to nine hours of quality sleep for seniors each night. Long-term poor sleep can lead to a decline in overall physical and mental health, increasing the risk of cognitive decline as well as falls.^[01,02]

“In addition to a reduced quality of life, long-term health consequences of poor sleep include high blood pressure, weight gain, stroke, heart attack, diabetes, memory problems, and even an increased risk of death,” says Deborah Freeland, M.D., assistant professor of internal medicine and a member of University of Texas Southwestern’s Division of Geriatric Medicine.^[03]

Sleep patterns tend to change in older adults

Sleep patterns change with age. As people grow older, their internal clock tends to advance, causing seniors to feel tired earlier in the evening and wake earlier in the morning. This can cause seniors to take more naps during the day, which may make it more difficult for them to fall and stay asleep at night.

Sleep occurs in four stages: light, deep, deepest, and REM (rapid eye movement) sleep. Starting in middle age, adults begin spending less time in the last two stages of sleep. This means sleep can become less deep and restful as you age.

Research also shows that seniors tend to sleep lighter and for shorter spans. This change may be a part of the normal aging process, but it can also result from other health problems, lifestyle habits, or side effects of medications.^[02]

It’s important to keep a sleep diary or track changes in your or your loved one’s sleep-wake cycle — also known as the circadian rhythm — to ensure that sleep health remains on track. Even small changes can lead to bigger problems over time, as it takes time for cycles to become unbalanced.

Watch out for these signs of insomnia in you or your loved one’s sleeping patterns:^[04,05]

• Difficulty falling or staying asleep at night
• Not getting the recommended hours of sleep
• Daytime fatigue and grogginess indicate a lack of sleep quality
• Difficulty sleeping without drug sleep aids or caregiver assistance

Many factors can contribute to insomnia in elderly adults, including:

• Normal changes in sleep patterns that occur with aging
• Medications, including antidepressants, medicines to treat high blood pressure, or nasal decongestants
• Other health conditions, like dementia, Alzheimer’s disease, chronic pain, diabetes, or respiratory diseases
• Mental illness, including depression and anxiety
• Lifestyle habits, such as napping or lack of physical activity
• Caffeine or alcohol when consumed excessively or before bedtime
• Smoking, especially before bed
• Chronic stress or stress that lasts for a long time

Conditions related to senior insomnia

Sometimes the cause of a sleeping disorder is more medically complicated than the examples above. For instance, some undiagnosed medical conditions, common to elderly people, may also cause problems with sleep health.

Some medical causes of insomnia in the elderly include:^[03,04]

• Circadian rhythm sleep disorders
• Breathing disorders, like sleep apnea
• Restless leg syndrome
• REM sleep disorder
• Chronic heart and lung diseases
• Arthritis
• Acid reflux
• Nighttime urination

Let our care assessment guide you

Treatment for insomnia usually starts with addressing issues that may be causing sleep disruptions, such as medication side effects or other medical conditions, and changing sleep habits to promote better sleep. Because the elderly are at an increased risk of negative side effects from sleep-inducing drugs and medications, behavioral treatments are the safest approach for improving sleep health in seniors.

The following methods are typically recommended by doctors to help treat insomnia in seniors.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) for insomnia works to change a person’s beliefs and behaviors surrounding bedtime to make sleep come easier. There are many approaches to CBT, and a therapist should tailor treatments to the person for the best outcome.

The following are common techniques used in CBT for insomnia:^[06]

• Stimulus control coaches the patient to identify stimuli that keep them from being sleepy in their bed to reduce the body’s resistance to falling asleep. Therapists might even coach the person to leave their bed if they’ve not fallen asleep within 20 minutes of lying down.
• Light therapy can correct a person’s abnormal sleep schedule by exposing them to natural sunlight at certain times or incorporating light boxes into their daily routine. This exposure helps the brain know when to produce sleep chemicals, like melatonin.
• Relaxation techniques help people wind down before bed, including breathing and biofeedback exercises aimed at lowering heart rate and reducing muscle tension.
• Sleep restriction helps to correct a chaotic sleep schedule by restricting sleep until absolutely necessary, reducing time in bed so that you’re more tired as the day goes on. As sleep becomes easier, a person can slowly increase their time spent in bed.
• Remaining passively awake aims to reduce a person’s anxiety about falling asleep. Therapists coach the person to actually try not to sleep while lying in bed until sleep comes naturally.

Exercise

Current research shows that physical exercise can have a dramatic impact on sleep health for the better. This approach is especially helpful for seniors, as exercise increases mobility and supports long-term cognitive health.

For best results, the exercise routine should occur at a set time each day and not be done within three hours of bedtime.^[07,08]

Drug sleep aids for elderly adults

Common over-the-counter drugs and prescription medication sleep-aid options are readily available at most pharmacies or through a prescription. These synthetic drugs may relieve sleep issues temporarily, but long-term use of them has been linked to dementia in older adults. Even immediate side effects can be serious in seniors, like an increased risk of falls and hip fractures since it appears seniors are more susceptible to the negative side effects of these drugs.^[09,10]

Because of this, these medications aren’t usually recommended for long periods of time. Talk to your or your loved one’s doctor about the best option for long-term sleep and overall health.^[06] They may recommend you try natural sleep aids first, which can be taken in the long term with very little risk.

Read more:A List of Drugs Linked to Dementia Risk

Natural sleep aids for the elderly

You or your senior loved one can treat insomnia with certain supplements like melatonin and valerian root, which can be found at a health food store. Melatonin is a hormone that plays a key role in regulating the sleep-wake cycle. It can be sourced from animal, synthetic, or plant sources. Doctors can also prescribe melatonin medications.

Melatonin and herbs like valerian root come with very few significant side effects in seniors. The plant-sourced melatonin (phytomelatonin) has even been shown in clinical trials to reduce inflammation overall and promote brain health in seniors.^[11] Be sure to check with your doctor before adding any new supplements to your routine, especially if you take prescription medications.

Talk with a Senior Living Advisor

It’s a good idea to see a doctor if regular sleep problems occur. If another condition or medication is causing insomnia, it’s important to address that first. You can also talk to your parent about ways to promote healthy sleeping habits and ways to create a soothing and restful environment.

Here are few things seniors can do to help prevent insomnia:

• Establish a regular sleep schedule. Go to bed and wake up at the same time each day.
• Be active daily. Exercise earlier in the day and no later than four hours before bed.
  Sleep in a dark, quiet, and cool room. The temperature should be between 60 and 67 degrees Fahrenheit.
• Take a warm bath before bed. You can also practice relaxation techniques, such as meditation or breathing exercises.
• Enjoy a relaxing activity. If you can’t fall asleep after 20 minutes, get up, go to another room, and find a relaxing activity, like listening to calming music.

The following tips describe habits seniors should avoid if they want to improve sleep:

• Don’t consume caffeine or alcohol three hours before bed. Caffeine and alcohol may make you feel too stimulated, and they also make it difficult for our brains to access deep sleep levels.
• Don’t eat heavy meals or spicy food before bed. It can be difficult to sleep with a digesting stomach, especially if the food causes an upset stomach.
• Don’t drink excessive amounts of liquid before bed. A glass of warm milk or water is OK, but too much can have you waking in the middle of the night to go to the bathroom.
• Don’t nap excessively during the day. Too much sleep can prevent you from falling asleep at night.
• Don’t use bright lights before bedtime. Turn off your TV or cellphone 30 minutes to one hour before bedtime, as blue light stops the production of melatonin in your brain.^[12]

Read more:5 Foods That Help You Sleep Through the Night as You Age

Sleep cycle maintenance is an important healthy habit for seniors. If the techniques and advice provided above don’t help, talk with your doctor about seeing a sleep specialist or somnologist, a doctor who specializes in sleep disorders.

These doctors help patients understand the root cause of their insomnia. They can also perform sleep studies to find tailored solutions. The doctor should consider your or your loved one’s age, medical history, lifestyle habits, and overall health condition before creating a treatment plan to resolve the insomnia.