What should you do if an older person complains of not sleeping well at night?
Experts do believe that “normal aging” brings on some changes to sleep. (Seethis postfor more on how sleep changes with aging.) Basically,older adults tend to get sleepy earlier in the evening,and tend to sleep less deeply than when they were younger.
So it’s probably not realistic to expect that as you get older, you’ll sleep as long or as soundly as when you were younger.
That said, although aging by itselfdoes change sleep, it’s also quite common for older adults to develop healthproblems that can cause sleep disturbances. So when your older relatives say they aren’t sleeping well, you’ll wantto help them check for these. Figuring out what’s going on is always the first step in being able to improve things.
And remember, getting enoughgood quality sleep helps maintain brain health, physical health, and mood.
In this article, I’ll cover the top causes of sleep problems in older adults. I’ll also tell you about what approaches have been proven to work, to help treat insomnia and sleep problems in older adults.
Last but not least, if you (or your older relative) have experienced the very common combination of waking up to pee at night and difficulty sleeping, I highly recommend listening to this podcast episode, which features a geriatrician who is an expert on this:
5 Common Causes of Sleep Problems in Older Adults
1. Sleep problems due to an underlying medical problem.Although older adults do often suffer from what’s called “primary” sleep disorders, many sleep problems they experience are “secondary” sleep problems, meaning they are secondary to an underlying medical condition whose main symptoms are not sleep related.
Common health conditions that can disrupt sleep in older adults include:
- Heart and lung conditions which affect breathing, such as heart failure and chronic obstructive pulmonary disease
- Gastroesophageal reflux disease, which causes heartburn symptoms and can be affected by big meals late at night
- Painful conditions, including osteoarthritis
- Urinary problems that cause urination at night; this can be caused by an enlarged prostate or an overactive bladder
- Mood problems such as depression and anxiety
- Neurodegenerative disorders such as Alzheimer’s and Parkinson’s
- Medication side-effects
If an older person is having difficulty sleeping, it’s important to make sure that one of these common conditions isn’t contributing to the problem. Treating an underlying problem — such as untreated pain at night — can often improve sleep. It can also help to talk to a pharmacist about all prescription and over-the-counter drugs, to make sure that these aren’t contributing to insomnia.
Alzheimer’s and related dementias pose special considerations when it comes to sleep, which I write about in this post: How to Manage Sleep Problems in Dementia.
2. Snoring,Sleep Apnea, and other forms of Sleep-Related Breathing Disorders. Sleep-related breathing disorders (“SRBD”; it’s also sometimes called sleep-disordered breathing)is an umbrella term covering a spectrum of problems related to how people breathe while asleep.
Sleep apnea is a common condition which is important to diagnose since it’s been associated with many other health problems (especially in middle-aged adults). In sleep apnea, a person has frequent pauses in their breathing during sleep. The most common form is obstructive sleep apnea (OSA), in which the breathing pauses are due to obstructions in the breathing passages. OSA is often associated with snoring. A less common form is central sleep apnea, in which the breathing pauses are related to changes in the brain.
How common it is: The likelihood of having sleep-disordered breathing disorders goes up with age. It’s also more common in men, and in people who are overweight. In one study of 827 healthy older adults aged 68, 53% were found to have signs of SRBD, with 37% meeting criteria for significant sleep apnea. Interestingly, most participants did not complain of excess sleepiness.
Why it’s a problem:Studies have found that untreated OSA is associated with poor health outcomes including increased mortality, stroke, coronary artery disease, and heart failure. However, studies also suggest that theseassociations are strongest in people aged 40-70, and weaker in older adults. For older adults with symptomatic OSA, treatment can reduce daytime sleepiness and improve quality of life.
What to do if you’re concerned: Helpguide.org’spage on sleep apnea has a useful list of common symptoms and risk factors for sleep apnea. You can also ask the doctor about further evaluation if you’ve noticed a lot of daytime sleepiness. To be diagnosed, you’ll need to pursue polysomnography (objective sleep testing) either in a sleep lab or with a home sleep testing kit.
Whether or not you pursue an official diagnosis for SRBD, avoiding alcohol (and probably other sedatives) is likely to help.
3. Restless leg syndrome (RLS).This condition causes sensations of itching, crawling, or restlessness as a person is trying to fall asleep. The symptoms are unpleasant but not usually painful, and improve with movement. The exact biological underpinnings of this problem remain poorly understood, but it seems to be related to dopamine and iron levels in the brain. Most cases are notnot thought to be related to neurodegeneration.
How common it is: Studies suggest that 5-15% of the general population meet criteria for RLS, but only 2.5% of people are thought to have clinically severe symptoms. Poor health, older age, low iron levels, and being female are some risk factors. It also tends to run in families.
Why it’s a problem:RLS has been associated with depression, anxiety, and sleep-onset insomnia. It can also get worse with certain types of medication.
What to do if you’re concerned:Read up on RLS (Helpguide.org’s page seems very good) and then talk to a doctor. Generally, you don’t need polysomnography but you should probably be checked for low iron levels. You can read about possible non-drug and pharmacological treatment options at Helpguide.org.
4. Periodic Limb Movements of Sleep (PLMS). This condition is not easily treatable, but I’m listing it since I’ve discovered it’s much more common than I realized. PLMS causes intermittent movements while asleep, usually in the lower limbs. It can affect the toes, ankles, knees, or hips. The movements may or may not wake the person up; they can be annoying to a bed partner.
How common it is: Studies estimate that 45% of older adults experience PLMS. Many such older adults are otherwise healthy. However, PLMS is also often associated with other sleep problems, such as restless legs and sleep apnea. Experts believe that it’s fairly rare for people to experience clinically significant sleep disturbances solely due to PLMS.
Is it a problem?PLMS can be an issue mainly because it’s associated with other sleep problems. Most people who experience PLMS don’t notice it much, although some do find it bothersome. Only a few studies have attempted to treat isolated PLMS, and it’s not clear that there is a reliable way to treat this. In its 2012 guideline on treating restless leg syndrome and PLMS, the American Academy of Sleep Medicine concluded that there was “insufficient evidence” to recommend pharmacological treatment.
5. Insomnia.Insomnia meanshaving difficulty falling asleep or staying asleep, despite the opportunity to do so (e.g. being in bed), and experiencing decreased daytime function because of this. I consider this the grand-daddy of all sleep problems, because it affects so many people in middle-age and older age.
How common is it: Very common, and it becomes even more common with aging. One study found that 23-24% of older adults reported symptoms of insomnia.
Why it’s a problem: Insomnia has been associated with anxiety, depression, fatigue, worse quality of life, cognitive decline, and a variety of other worse long-term health outcomes.
What to do if you’re concerned:The main thing to do is assess the problem, by tracking sleep and using a sleep journal. And then seek help. For older adults, it is especially important to not simply rely on prescription or non-prescription (e.g. alcohol, over-the-counter pills) substances to help with sleep. That’s because all such substances worsen brain function and increase the risk of cognitive decline. (See “4 Types of Brain-Slowing Medication to Avoid if You’re Worried About Memory” for more details.)
Proven Ways to Treat Insomnia in Older Adults
Insomnia is a very common complaint among family caregivers and older adults. Fortunately, research has shown that it’s possible to treat insomnia effectively, although it does often take a little time and effort.
Why Sedatives Aren’t the Way to Go and Proven Ways to Taper Off Them
Before I go into the recommended treatments, let me say it again: you should only use sedatives as a last resort.That’s because most medications that make people sleepy are bad for brain function, in both the short-term and long-term.
Benzodiazepines such as lorazepam, alprazolam, diazepam, and temazepam (Ativan, Xanax, Valium, and Restoril) are also habit-forming. It can be a lot of work to wean people off these drugs, but research has proven it’s possible.
For instance, inthis randomized control study, many older adults who had been on benzodiazepines for sleep (mean duration of use was 19.3 years!)were able to taper off their sleeping pills. 63% were drug-free after 7 weeks. (Yeah!)
Plus, in my own personal experience, it becomes extremely difficult once a person has started to develop a dementia such as Alzheimer’s, because then their behavior and thinking can get a lot worse if they are a little sleep-deprived or anxious. (In the short-term, almost everyone who tapers off of sedatives has to endure a little extra restlessness while the body adapts to being without the drug.) But letting them continue to use their benzodiazepine puts us in a pickle, because it also keeps them from having the best brain function possible, is associated with faster cognitive decline, AND increases fall risk.
I hope you see what I’m getting at. If either you or someone you care for are taking benzodiazepines for sleep or anxiety, and you aren’t dealing with a dementia diagnosis, now is the time to do the work of trying to get off these drugs. (If you are dealing with a dementia diagnosis, you should still ask the doctors for help trying to reduce the use of these drugs, but it will all be harder. It’s still often possible to at least reduce the doses being used.)
The key to successfully stopping sedatives for sleep is to very slowly taper the drug under medical supervision, plus add cognitive-behavioral therapy or other sleep-improving approaches if possible.
For more on this topic, and for a handy (and research-proven) consumer handout that helps older adults stop benzodiazepines, see “How You Can Help Someone Stop Ativan.” This article also addresses the question of whether it’s ever okay for an older person to be on benzodiazepines.
Now, let’s review some proven approaches to improving sleep in older adults.
Proven ways to treat insomnia in older adults:
- Cognitive-behavioral therapy for insomnia (CBT-I).This means special therapy that helps a personavoid negative thought patterns that promote insomnia, along with regular sleep habits, relaxation techniques, and other behavioral techniques that improve sleep. It has a good track record in research, as described in this NPR story. A new study also confirmed that CBT-I also benefitspeople who have insomnia combined with other medical or psychiatric conditions.
- CBT-I can be done in person, and is also effective when done through online programs. Two online programs with proven clinical efficacy are Sleepio (see here for the study) and SHUTi.
- CBT-I may incorporate several techniques such as stimulus control, and sleep restriction therapy. This Mayo Clinic page has a nice list of specific behavioral therapy components that might be included in CBT-I for insomnia.
- Brief behavioral treatment of insomnia (BBTI). This is a shorter variant of CBT-I; it’s designed to be delivered in 4 weeks. It also has a good track record in research.
- A study also found that BBTI was effective in reducing nighttime urination.
- Mindfulness meditation. A randomized control trial published in April 2015 found that mindfulness meditation was more effective than “sleep hygiene,” to improve the sleep of older adults with a variety of sleep disturbances. Older adults assigned to mindfulness completed a weekly 2-hour, 6-session group-based course.
- Local in-person courses to learn mindfulness are often available; search online to find one near you. They may also be available at certain senior centers.
- An online version of the course used in the study is available here.
- Several smartphone based apps propose to help people with mindfulness. They are reviewed in the scholarly literature here. I personally have used Headspace in the past and liked it.
- Exercise. Exercise is often thought of as a treatment for insomnia, but the evidence seems weaker than for CBT-I. A review article published in 2012 concluded that the effect is modest. A more recent randomized trial comparing CBT-I to tai chi, for insomnia in older adults, found that CBT-I was more effective.
- Although exercise is obviously very important to health, don’t rely on it as the primary way to try to solve sleep problems.
- It’s also possible that exercise may help insomnia, but a fascinating small study suggested that in people with chronic insomnia, it can take a few months for exercise to have an effect on sleep.
Are there any medications or supplements that are safe and effective?
Benzodiazepine drugs and sleeping medications such as zolpidem (brand name Ambien) are definitely risky for older adults, as they dampen brain function and worsen balance. If you or your loved one is depending on such medications to sleep, I recommend you get help tapering off, as described above. Most older adults can learn to sleep without these medications, although it can take a little effort to wean off the drug and learn to get to sleep without them.
Many over-the-counter (OTC) medications that make people sleepy are also a problem, because most of them are “anticholinergic,” which means they interfere with a key neurotransmitter called acetylcholine. A very commonly used anticholinergic is diphenhydramine (brand name Benadryl), a sedating antihistamine that is included in most night-time analgesics, but many prescription medications are anticholinergic as well.
Older adults should be very careful about using anticholinergics often for sleep, or really for anything. That’s because they worsen brain function, and in fact, chronic use of these medications has been associated with developing Alzheimer’s and other dementias. (For more on this, see 7 Common Brain-Slowing Anticholinergic Drugs Older Adults Should Use With Caution.)
Virtually all sedatives are included in the American Geriatrics Society Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.
So those are the medications to avoid if possible.
Now here are a few medications that seem to be less risky, and are sometimes used:
- Melatonin:Melatonin is a hormone involved in the sleep-wake cycle. A 2007 study found that melatonin improved the sleep of older adults and did not seem to be associated with any withdrawal symptoms. However, in the U.S. melatonin is sold as a poorly-regulated supplement, and studies have found that commercially sold supplements are often of questionable quality and purity. So melatonin may work less reliably here than in Europe.
- Ramelteon: Ramelteon is a synthetic drug that mimics the effect of melatonin. A 2009 study reported that ramelteon did not impair middle-of-the-night balance or memory in older adults. However, its efficacy has been questioned; a 2014 meta-analysis concluded that the clinical effect appeared to be “small.”
- Trazodone:Trazodone is an older weak anti-depressant that is mildly sedating. It has long been used by geriatricians as a “sleeping pill” of choice, as it is not anticholinergic and seems to be less risky than the alternatives. A small2014 studyfound that trazodone improved sleep in Alzheimer’s patients.
For a detailed and technical review of sleep medicines in older adults, this article is good:Review of Safety and Efficacy of Sleep Medicines in Older Adults.
And again, if you or your older relative has been bothered by the need to urinate at night, I also want to recommend this BHWA podcast episode:
Now that we’ve covered the top causes of sleep problems in older adults and some proven ways to treat insomnia, I’d love to hear from you.
What sleep problems have you been concerned about? And what’s helped you improve them so far?
For information on evaluating and managing sleep problems in people with Alzheimer’s or other dementias, see this article: How to Manage Sleep Problems in Dementia.
This article was last updated by Dr. K in August 2022.
Physiologic changes of aging, environmental conditions, and chronic medical illnesses contribute to insomnia in the elderly. Sleep disturbance in the elderly is associated with decreased memory, impaired concentration, and impaired functional performance.What is the best treatment for insomnia in older adults? ›
- Stick to a sleep schedule. Keep your bedtime and wake time consistent from day to day, including on weekends.
- Stay active. ...
- Check your medications. ...
- Avoid or limit naps. ...
- Avoid or limit caffeine and alcohol and don't use nicotine. ...
- Don't put up with pain. ...
- Avoid large meals and beverages before bed.
Insomnia is one of the most common medical complaints, especially in older adults. It often coexists with medical, psychiatric, sleep, or neurological disorders. Insomnia may also be associated with stress, medications, poor sleep habits, or changes in the sleep environment, according to research .What helps elderly with sleeping problems? ›
Research backs these tips: Keep the same sleep schedule every day, even on weekends and when you're traveling. Stick to a bedtime routine: Use reading, soothing music or a warm bath or face-washing to cue your body and brain that it's time to wind down.What are the 5 most common causes of insomnia? ›
- stress and anxiety.
- a poor sleeping environment – such as an uncomfortable bed, or a bedroom that's too light, noisy, hot or cold.
- lifestyle factors – such as jet lag, shift work, or drinking alcohol or caffeine before going to bed.
- mental health conditions – such as depression and schizophrenia.
Avoid chemicals that disrupt sleep, such as nicotine, caffeine, and alcohol. Eat lighter meals at night and at least two hours before bed. Stay active, but exercise earlier in the day. Take a hot shower or bath at the end of your day.How do I get rid of insomnia permanently? ›
Cognitive behavioral therapy (CBT)
Research has shown CBT to be as effective, or more effective, than sleep medications in treating chronic insomnia. It involves educating you on sleep and better sleep habits, while teaching you to change the beliefs and behaviors that interfere with your ability to sleep.
Can My Insomnia Be Cured? Absolutely. It may not be easy though, as curing insomnia often means improving your sleep hygiene and establishing habits that are more conducive to good sleep. And habits, especially routines you follow every day, can be tough to break.What is the safest treatment for insomnia? ›
Behavior changes learned through cognitive behavioral therapy are generally the best treatment for ongoing insomnia. Sleeping on a regular schedule, exercising regularly, avoiding caffeine later in the day, avoiding daytime naps and keeping stress in check also are likely to help.What are the most common causes of sleep problems? ›
- Physical (such as ulcers).
- Medical (such as asthma).
- Psychiatric (such as depression and anxiety disorders).
- Environmental (such as alcohol).
- Working the night shift (this work schedule messes up “biological clocks.”)
- Genetics (narcolepsy is genetic).
- Medications (some interfere with sleep).
Older adults need about the same amount of sleep as all adults—7 to 9 hours each night. But, older people tend to go to sleep earlier and get up earlier than they did when they were younger. There are many reasons why older people may not get enough sleep at night.Does magnesium before bed help you sleep? ›
One study of older adults with insomnia found that magnesium supplementation at a dose of 500 milligrams daily for eight weeks helped them fall asleep faster, stay asleep longer, reduced nighttime awakenings, and increased their levels of naturally circulating melatonin.What is the best sleeping position for the elderly? ›
To relieve back pain, it's best to sleep on the side or back, following the tips in #1 and #2 above. Some older adults might just prefer to sleep in a reclining chair. Sleeping in a reclined position is also helpful for a spinal condition called isthmic spondylolisthesis.What is the number one cause of insomnia? ›
As a matter of fact, stress is the No. 1 reason people report a lack of sleep. But it's not the only insomnia trigger. Many things can cause insomnia, including poor sleep hygiene, illness, drug side effects, chronic pain, restless legs syndrome, or sleep apnea.What are three factors that cause insomnia? ›
- Stress. Concerns about work, school, health, finances or family can keep your mind active at night, making it difficult to sleep. ...
- Travel or work schedule. ...
- Poor sleep habits. ...
- Eating too much late in the evening.
The major risk factors for insomnia are advancing age, family history of insomnia, female sex, lifestyle, and stress or worrying. Insomnia is a common condition with several risk factors.What is the strongest herb for sleep? ›
- According to a 2013 review , valerian root is the herb that people most commonly use to reduce insomnia. ...
- A 2020 review and meta-analysis investigated the efficacy and safety of valerian root as a treatment for certain sleep disorders.
Gamaldo recommends warm milk, chamomile tea and tart cherry juice for patients with sleep trouble. Though there isn't much scientific proof that any of these nighttime drinks work to improve your slumber, there's no harm in trying them, Gamaldo says.What food can cure insomnia? ›
- Almonds. Almonds are a type of tree nut with many health benefits. ...
- Turkey. Turkey is delicious and nutritious. ...
- Chamomile tea. ...
- Kiwi. ...
- Tart cherry juice. ...
- Fatty fish. ...
- Walnuts. ...
- Passionflower tea.
Eating a well balanced diet, getting regular exercise, staying mentally active, and keeping your blood pressure and cholesterol levels in check will improve sleep as well. You can also tackle any sleep problems by training your brain for better sleep.
- Lower the temperature. ...
- Use the 4-7-8 breathing method. ...
- Get on a schedule. ...
- Experience both daylight and darkness. ...
- Practice yoga, meditation, and mindfulness. ...
- Avoid looking at your clock. ...
- Avoid naps during the day. ...
- Watch what and when you eat.
Contrary to popular opinion, insomnia doesn't shorten lifespan, new research finds. Furthermore, the research found that cognitive therapy, within a CBTi framework (Cognitive Behavioral Therapy for Insomnia), is an effective treatment for insomnia.How do you break the insomnia cycle? ›
- Avoid electronics at night. And if possible, keep your phone or other devices out of the room you're sleeping in.
- Keep cool. ...
- Exercise. ...
- Get plenty of natural light during the day. ...
- Avoid caffeine, alcohol, and cigarettes. ...
- Use soothing sounds.
Actigraphy can help your doctor diagnose insomnia, sleep apnea, and other types of sleep disorders. Blood tests. Your doctor may take a sample of blood to test for thyroid disease, low iron levels, or other conditions that can cause sleep problems.What is the most successful treatment for insomnia? ›
Cognitive behavioral therapy for insomnia, sometimes called CBT-I, is an effective treatment for chronic sleep problems and is usually recommended as the first line of treatment.What is the first line treatment of insomnia? ›
Cognitive behavioral therapy for insomnia (CBT-I) is the preferred first-line treatment for chronic insomnia in adults and has been endorsed as first-line therapy by multiple societies and guideline panels [1-5]. Overall, the evidence base is stronger for CBT-I than for medications.What is the first drug of choice for insomnia? ›
Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)
A sedative-hypnotic of the imidazopyridine class, zolpidem has a rapid onset and short duration of action. It is a good first choice for treatment of sleep-onset insomnia and produces no significant residual sedation in the morning.
Sleep deprivation is common with depression, schizophrenia, chronic pain syndrome, cancer, stroke, and Alzheimer disease. Other factors. Many people have occasional sleep deprivation for other reasons. These include stress, a change in schedule, or a new baby disrupting their sleep schedule.How often should the elderly bathe? ›
Usually, personal hygiene (specifically bathing) is one of those things that gets neglected. So how often should an elderly bathe? To avoid any skin conditions or infections, a senior should bathe at least once or twice a week.What is the average bedtime for seniors? ›
“The stereotype of most seniors going to bed at 8 p.m., sleeping very lightly, and being unduly sleepy during the day may be quite inaccurate, suggesting that 60 really is the new 40.” Researchers based the study on extensive telephone interviews with nearly 1,200 retired seniors in western Pennsylvania.
Older adults also take naps to counter excessive sleepiness and fatigue from comorbidities or medications . The features of daytime napping are important determinants of health in older adults.What food is highest in magnesium? ›
- pumpkin seeds, 30g (156mg)
- chia seeds, 30 g (111mg)
- almonds, 30g (80mg of magnesium)
- spinach, boiled, ½ cup (78mg)
- cashews, 30g (74mg)
- peanuts, ¼ cup (63mg)
- soymilk, 1 cup (61mg)
- oatmeal, 1 cup cooked (6 mg)
Without question, magnesium glycinate is the best form of magnesium for sleep. Magnesium glycinate is a combination of magnesium and the non-essential sleep-inducing amino acid, glycine.What time should I take magnesium for sleep? ›
Umeda recommends taking the supplement about 30 minutes before bedtime. And don't take more than the recommended amount. More won't help you sleep better, but it may cause stomach upset. While magnesium might improve your slumber, it's no substitute for a good sleep routine, Dr.What two positions are not recommended for the elderly while in bed? ›
Arms are to be spread to the side or tucked below your body and legs straight. Sleeping on your stomach is also among the worst positions. This position interferes with the alignment of your spine when you are sleeping. You will also be forced to turn your head to the right or left, causing your neck to stay bent.Is sleeping without a pillow good for you? ›
Sleeping without a pillow can help some people who sleep on their stomach, but it is not a good idea for everyone. People who sleep on their side or back will usually find that sleeping without a pillow puts pressure on their neck. By doing this, it can ruin a person's quality of sleep and lead to neck and back pain.Is sleeping on your left side good for your heart? ›
Similarly, sleeping on your left side, specifically, could help the flow of blood to your heart. When your heart pumps blood out to your body, it gets circulated and then flows back to your heart on the right side, Winter explains.What are the 3 types of insomnia? ›
Insomnia is most often classified by duration: Transient insomnia - Less than one month. Short-term insomnia – Between one and six months. Chronic insomnia – More than six months.Is insomnia a chemical imbalance? ›
Depression is a common source of insomnia. This may be due to a chemical imbalance in the brain that affects sleep patterns. Alternately, you may be too distressed by fears or troubling thoughts, which may prevent you from getting a good night's sleep. Insomnia can be a common symptom of other mood disorders.Which gland is responsible for insomnia? ›
Melatonin. Melatonin is a hormone produced by the pineal gland that's associated with the body's sleep-wake cycle. It helps regulate the body's circadian rhythm, so you can fall — and stay — asleep. Disrupted or poor sleep can have impacts on melatonin and its role in promoting sleep in the brain.
Studying a group of 192 patients with focal brain lesions, we show a significant association between insomnia and left dorsomedial prefrontal damage.How do you break the cycle of insomnia? ›
- Avoid electronics at night. And if possible, keep your phone or other devices out of the room you're sleeping in.
- Keep cool. ...
- Exercise. ...
- Get plenty of natural light during the day. ...
- Avoid caffeine, alcohol, and cigarettes. ...
- Use soothing sounds.