Updated at: 23-02-2022 - By: Jane Brody

If you’re unable to fall or stay asleep even when you’re given the chance, you may have insomnia. Excessive daytime drowsiness and other cognitive deficits are directly related to sleep deprivation in people with insomnia. Both sleep-onset insomnia and sleep-maintenance insomnia can affect a person’s ability to fall and stay asleep. Insomniacs can have problems with sleep onset as well as sleep maintenance.

Insomnia affects 10-30% of adults2, according to recent estimates. People over the age of 60 are more likely to suffer from insomnia because of a variety of reasons. People over the age of 65 are more likely to suffer from medical or psychological issues that might cause insomnia or other sleep disorders such as sleep apnea or restless legs syndrome. Circadian rhythms and our sleep-wake cycles can also shift with age, affecting both the length and quality of our slumber. Certain geriatric medical conditions drugs, as well as some over-the-counter sleep aids, might cause insomnia in some people.

Sleep and Aging

As we become older, the quality of our sleep tends to decline. People tend to sleep less and have a greater number of awakenings once they’ve fallen asleep. The time it takes to fall asleep, known as sleep latency, may also lengthen. The average individual loses an average of 27 minutes of sleep per night per decade beginning in middle age, according to some research.

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There is a direct link between these changes in sleep quality and duration and the body’s internal clocks. A lack of ability to absorb circadian cues may lead to earlier bedtimes and earlier waking times in the elderly.

Sleep patterns evolve with each decade of life we live. There are four stages to a typical night’s sleep. There are three distinct stages of sleep: “light” non-rapid eye movement (NREM), “heavy” or “slow-wave” NREM, and rapid eye movement (REM) before the cycle repeats again. Compared to their younger counterparts, older persons in polysomnographic studies exhibit a decreased percentage of slow-wave NREM and REM sleep. They are more prone to waking up in the middle of the night, and this impacts how rested and alert they feel when they get up the next day.

Recognizing and Diagnosing Insomnia in Seniors

Many people suffer from insomnia as they become older. Insomnia can only be diagnosed if a patient’s circadian rhythm and sleep-wake cycle fall outside the normal range for their age. At least one of the following symptoms must be present in order for a person to be diagnosed with insomnia by the International Classification of Sleep Disorders (ICDS):

  • Inability to get to sleep or maintain a regular sleep schedule
  • Wake-ups earlier than desired on a regular basis.
  • Reluctance to go to sleep at a suitable hour.
  • The inability to sleep without the assistance of a caretaker

Insomnia is not just a nighttime problem. These symptoms include increased daytime sleepiness, feelings of exhaustion and malaise, mood swings and irritability, and difficulty concentrating and staying focused. Insomniacs are more likely to be involved in auto accidents, and they often have difficulty relating to others and coping with family life.

At least three times a week and for at least three months, doctors may classify the patient as having chronic insomnia. Until then, sleeplessness is considered a short-term condition.

The key to a correct diagnosis of insomnia in the elderly is to track down the underlying causes. Insomnia that develops on its own, as opposed to secondary insomnia, is defined as a lack of sleep brought on by an underlying medical or psychological disorder. The symptoms of insomnia are the same whether it is a primary or secondary illness. Secondary insomnia is often treated by first addressing the underlying ailment that is causing the patient’s sleep difficulties.

Treatment for Insomnia in Older Adults

As a first step in the treatment of insomnia in the elderly, sleep education and improved sleep hygiene are frequently recommended. A doctor will advise the patient on how to maintain a good sleep environment in their bedroom. A temperature of no more than seventy-five degrees Fahrenheit is ideal for a person’s bedroom (23.9 degrees Celsius). Sleeping on the bed is the only purpose for it, and not for other activities like working or playing video games. An air conditioner could be useful in hotter months of the year. They will also encourage regular exercise and healthy eating, and discourage the use of caffeinated beverages and tobacco.

Without the use of prescription drugs, other non-pharmacological methods can aid seniors who are suffering from sleep disorders. Among them:

  • It is based on the belief that patients should only go to bed when they are exhausted, and that laying awake can be damaging to a good night’s sleep. The person should get up and do something else until they fall asleep if they have been awake in bed for more than 20 minutes without nodding off. In addition, they should refrain from taking naps during the day and set a consistent wake-up time each day.
  • Insomnia patients are often advised to keep a sleep diary in which they record their sleeping and waking times, as well as the length of time it takes them to fall asleep each night. A doctor may urge a patient to limit their time in bed each night until their sleep efficiency improves, based on the patient’s sleep diary records. Each night’s sleep efficiency is calculated by dividing the amount of time spent sleeping by the amount of time spent awake in bed. Sleeping at least 90 percent of the time in bed is required before a person can begin snoozing earlier.
  • As a result of cognitive behavioral treatment for insomnia, seniors are able to identify and then replace their negative attitudes and inaccurate ideas about sleep.
  • Timed exposure to bright lights in the evening can help seniors who go to bed and wake up early stay up longer and fall asleep at a later hour.

If none of the non-pharmacological approaches work, the doctor may turn to prescription sleep aids. When it comes to treating insomnia in the elderly, it’s very important to take your time and do your research before making a decision. Older persons may be at greater risk of falling if they take benzodiazepines (BZDs) and non-benzodiazepines (Z-drugs). Doctors should also keep in mind that these medicines have a significant tolerance, dependence, and withdrawal risk, so they should be careful when prescribing them to their patients.

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With caution, other insomnia drugs can be administered despite their lower dangers. By interacting with natural hormones, several drugs can induce sleepiness. Ramelteon, a melatonin receptor agonist, and suvorexant, a neuropeptide suppressant, are two examples. Ramelteon functions as an agonist for receptors of melatonin, a pineal gland hormone that induces sleepiness as the sun sets. Antihistamines that can be purchased over the counter may also be prescribed.

Before taking any medication or non-pharmacological insomnia treatment, you should consult with a doctor.

Other Common Sleep Disorders for Seniors

Studies have indicated that seniors are more likely to suffer from different types of sleep disturbances as well as insomnia. Insomnia and other sleep disturbances might complicate treatment efforts for older individuals. Among the many types of sleep problems that are more common among the elderly, the following are particularly problematic:

Circadian Rhythm Sleep Disorders

Sleep disorders can occur when a person’s circadian rhythm is out of sync with their environment. Because the biological mechanisms that govern the circadian rhythm weaken with age, older persons are more susceptible to these illnesses.

People over the age of 65 are more likely to suffer from advanced sleep-wake phase disorder than younger people. In the early evening, people with this chromosome have a tendency to feel sleepy and naturally awaken between 3 and 5 a.m., depending on their circadian rhythms. Although they may go to bed later than usual, their sleep-wake cycle causes them to wake up early. Some older people may benefit from the use of nighttime light exposure therapy to combat these conditions. As an alternative, a well-structured sleep pattern can be beneficial.

The irregular sleep-wake rhythm disorder, which is more common in people with neurological and neurodegenerative diseases like Parkinson’s and Alzheimer’s, is another illustration. Fragmented sleep patterns, rather than a 24-hour day-night cycle, describe this condition.

Despite the fact that melatonin supplements can be used to treat circadian rhythm sleep disturbances in younger people, physicians should be cautious when prescribing this drug to elderly patients. It is not regulated by the FDA, and long-term effectiveness and safety of melatonin supplements are regarded doubtful.

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Sleep-Related Breathing Disorders

Obstructive sleep apnea and central sleep apnea are common sleep breathing problems in the elderly. Elderly adults with dementia are more likely to suffer from these conditions. Smoking, drinking alcohol, and being obese are all risk factors that accumulate over time.

It is common for elderly people with sleep-related respiratory issues to snore excessively because of their sleep-disordered breathing, which can contribute to nightly arousals and excessive daytime sleepiness. Predictors of congestive heart failure, myocardial infarctions and strokes can also be found in the diseases.

Continuous positive air pressure (CPAP) therapy is commonly used to treat sleep apnea in the elderly, in which patients are given pressurized air through a breathing mask as they sleep. Those who adhere to CPAP treatment tend to snore less and have fewer episodes of apnea during the night, as compared to those who don’t.

Periodic Limb Movements and Restless Legs Syndrome

Motions of the arms and legs during sleep that occur more than 15 times an hour are known as periodic limb movements. RLS, a neurologic condition, is characterized by an excessive desire for movement of the legs while the body is in rest. Both of these disorders have the potential to trigger nightly awakenings that result in daytime fatigue. Studies have revealed that the prevalence of these illnesses virtually doubles as we become older. ‘

Medication is often necessary for younger persons with periodic limb movements or restless legs syndrome. If an elderly person is already taking medication or has a pre-existing disease, the process of implementing an intervention can be more difficult.

REM Sleep Behavior Disorder

During REM sleep, people tend to have the most vivid dreams. Physically acting out one’s dreams is a symptom of REM sleep behavior disorder (RBD). Violent movements may be involved, putting both the sleeper and their companion at danger of injury.

Older males have an unusually high incidence of RBD. Degenerative neurologic disorders including Parkinson’s disease and Lewy body dementia are linked to this ailment.

RBD is frequently treated with BZD medicines, which might be difficult for older individuals to tolerate. As a precaution for those who suffer from RBD, they might make their sleeping area more secure. Locking the windows, putting the mattress on the floor, and removing dangerous items from the room are all examples of precautionary measures.

How Much Sleep Do Seniors Need?

In order to feel refreshed and aware the next day, the average senior needs seven to nine hours of sleep per night. Insomnia and other sleep problems can seriously disrupt your sleep schedule. If you’re having trouble falling asleep, try one of these methods to wake up feeling rested and energized:

  • Set tight bedtimes and wake-up schedules for your children, and enforce them even while you’re away from home.
  • Avoid snoozing right before bed. Try to limit your naps to the morning or early afternoon if you require a few minutes of shut-eye.
  • Establish a nighttime ritual that will help you relax. It may be helpful to relax by reading or listening to soothing music.
  • Electronic gadgets, including as televisions, phones, and computers, should not be used in the room where you sleep. The blue light emitted by these gadgets can make it more difficult to drift off to sleep.
  • Temperature and light levels in your bedroom should be kept at a level that is neither too hot nor too dim.
  • Avoid working out within three hours of going to sleep during the day.
  • The late afternoon and nighttime are the worst times to have a cup of coffee.
  • Do not use alcohol as a sedative to induce sleep. Despite the fact that alcohol is a depressant, it has the potential to disrupt sleep.

If you’re still having trouble falling asleep or staying asleep after implementing these strategies, you may be suffering from a sleep disorder. Consult your doctor to determine the cause of the problem and how to best treat it based on your medical history.

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Insomnia and aging tip 1: Understand how sleep changes as you age

Slow wave or deep sleep may be less frequent when your body’s production of growth hormone declines with age (an especially refreshing part of the sleep cycle). When this happens, your body produces less melatonin, resulting in a less restful night’s sleep and more frequent awakenings. As a result, many of us are referred to as “light sleepers.” You could also:

  • Would like to sleep earlier at night and wake up earlier in the mornings.
  • If you don’t get enough sleep at night, you’ll either have to stay up later or catch up with a nap throughout the day.

The majority of the time, such shifts in sleep patterns are not indicative of a sleep disorder.

Sleep problems not related to age

It’s normal to have occasional sleep issues at any age. On the other hand, if you suffer any of the following symptoms on a regular basis:

  • Even though you’re exhausted, you’re having problems drifting off to sleep.
  • When awakened, it’s difficult to fall back to sleep.
  • Sleeping doesn’t seem to have done anything for you.
  • During the day, you may be angry or tired.
  • Sitting idle, watching TV, or even driving can cause you to fall asleep.
  • The ability to focus during the day is a problem.
  • Snuggle up with a bottle of wine or some sleeping tablets
  • Have a hard time keeping your emotions in check.

Tip 2: Identify underlying causes for your insomnia

There are several underlying but curable reasons of insomnia and sleep problems. In order to provide the most effective care, you must first rule out any underlying conditions.

  • If so, how much stress are you under?
  • What’s wrong with you? Do you feel hopeless and depressed?
  • Are you plagued by a constant sense of worry or anxiety?
  • Are you currently dealing with a difficult situation?
  • Does your sleep seem disturbed as a result of any medications you’re taking?
  • Do you have any health issues that could keep you from getting a good night’s rest?

Common causes of insomnia and sleep problems in older adults

Insomnia and an unsuitable sleeping environment are to blame. Uneven sleep schedules and consuming alcohol before night are among the most common causes of insomnia. Establish sleep-promoting rituals and ensure your sleeping environment is favorable to restful sleep.

The presence of discomfort or disease. Asthma, arthritis, diabetes and osteoporosis are just some of the health conditions that might make it difficult to get a restful night’s sleep. Consult your physician if you have any health concerns.

Menopause and the years following it. Hot flashes and nocturnal sweats are common side effects of menopause for many women. Even after menopause, sleep issues can persist for some women. A healthier diet and regular exercise during the day can assist.

Medications. Elderly persons are more likely to be prescribed multiple medications, and the combination of these medications and their side effects can disrupt sleep. Changing your medicine may help you get a better night’s slumber.

Physical inactivity. As a result of being overly sedentary, you may never fall asleep, or you may always be tired. As a result of regular aerobic exercise throughout the day, sleep will be better at night..

Stress. Stress can be caused by major life transitions, such as retirement, the death of a loved one, or moving from a family home. A face-to-face conversation can do wonders to lift your spirits.

[Read: Coping with the Stress and Anxiety of Retiring]

Inability to interact with others on a personal level. It is important to maintain a healthy level of activity in order to prepare your body for a good night’s rest. Take an adult education class if you’re retired and want to keep your mind active.

Anxiety caused by lack of sleep. Restless Legs Syndrome (RLS) and sleep apnea (snoring and snoring) are more common among the elderly.

Sunlight is scarce. Melatonin and your sleep-wake cycles are regulated by bright sunlight. Make an effort to spend at least two hours a day outside in the sun. When it’s daylight, keep the windows open. Alternatively, you can utilize a light therapy box.

Tip 3: Improve sleep habits

When it comes to enhancing your sleep, addressing emotional difficulties, altering your sleep environment, and adopting healthy daytime routines are all ways to do it. It may take some trial and error to identify the particular alterations that work best for you to get a better night’s sleep.

Encourage better sleep at night

Elevate your body’s melatonin production naturally. The hormone melatonin, which induces sleep, can be suppressed by exposure to artificial light late at night. Turn off the TV and computer at least an hour before going to bed, and use low-wattage lighting when possible.

Avoid using a backlit device to read at night (such as an iPad). Switch to an eReader that requires a separate light source if you want to read from a tablet or other electronic device.

A comfy bed and a peaceful, dark, and cold bedroom are a must. As we grow older, our sensitivity to noise, light, and heat may diminish. The use of a sound machine, ear plugs, or a sleep mask can all be helpful.

Do not use your bedroom for anything other than sleeping and having sex. You can train your brain to link the bedroom solely with sleeping and having sex by not engaging in any of these activities while in bed.

Remove the clocks from the bedroom. Insomnia is a foregone conclusion if you keep an eye on the clock while you’re trying to get some shut-eye.

Keep a regular bedtime routine for better sleep

Keep a regular sleeping routine. Even on the weekends, maintain a consistent bedtime and wake-up routine.

Stop snoring. Try earplugs, a white-noise machine, or different bedrooms if snoring is keeping you awake.

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Take a nap early in the day. Even if that means going to bed an hour earlier than usual, go with the flow and set your alarm for when you feel like it.

Create routines that help you relax before you go to sleep. A warm bath, listening to music, or using a relaxation method such as progressive muscle relaxation, mindfulness meditation or deep breathing can help you wind down before bed.

Sleeping medications and aids should be used sparingly. Using sleep aids for a prolonged period of time is not recommended due to the potential for negative side effects. There is no long-term benefit to taking sleeping drugs because they don’t treat the root reasons of insomnia.

Sex and sleep go hand in hand. Physical affection, such as a hug, can help you sleep better.

How to nap

Taking a short nap during the day can help you stay awake and focused for the rest of your workday. It’s up to you to see if it works for you.

Tips for a good nap:

  • Don’t go on and on. Even five-minute naps have been shown to increase alertness and certain aspects of memory. Napping should be limited to 15-45 minutes for the majority of people. After a prolonged nap, you may feel drowsy and hard to concentrate.
  • Take a nap early in the day. Take a nap before the midday rush. Your overnight sleep may be disrupted if you take a late afternoon nap.
  • Be at ease. Take a snooze in an atmosphere that is free of light and noise.

Tip 4: Use diet and exercise to improve sleep

Diet and exercise are two of the most important daytime habits when it comes to getting a good night’s sleep. A healthy diet throughout the day is vital, but it is especially crucial to monitor what you consume in the hours leading up to night.

Diet tips to improve sleep

Late in the day, try to limit your intake of caffeine as much as possible. Drinking coffee, tea, soda, and chocolate late in the day is not a good idea for a variety of reasons.

Avoid drinking alcohol before going to bed. Alcohol may make you feel drowsy, but it will really interfere with your ability to get a good night’s rest.

Before going to bed, make sure you’ve had enough to eat. Eat something light, such a bowl of low-sugar cereal, a cup of warm milk, or some yogurt.

Reduce your intake of sugary food. Refined carbs like white bread, white rice, spaghetti, and French fries, which are high in sugar, might keep you awake at night and prevent you from getting a good night’s rest.

Big meals and spicy foods should be avoided soon before going to bed. Indigestion or discomfort can be caused by large or spicy meals. Eat a light dinner at least three hours before going to bed.

Before going to bed, drink as little as possible. Avoid drinking anything within an hour and a half of going to bed in order to reduce the number of times you have to get up in the night for the restroom.

Exercise for overcoming sleep problems in older adults

When you exercise, especially if you do it aerobically, your body generates chemicals that help you sleep better at night. A good night’s sleep is within reach for everybody, regardless of their physical limitations. Before beginning any new exercise regimen, always consult with your doctor.

Try:

Water exercises, such as swimming, are sometimes known as aquatic exercises. Swimming laps is a low-impact, low-impact exercise that is ideal for people with joint or muscular pain. In addition to water-based training sessions, several municipal or YMCA facilities offer swim programs specifically for older persons.

Dancing. Go dancing or sign up for a dance class if you’re a fan of the music and want to express yourself via movement. Taking dance classes is a terrific way to meet new people and build a social circle.

Pétanque or boules on the lawn. Playing these games is a low-impact approach to stay active. If you walk more frequently and at a faster speed, you’ll get more of an aerobic workout.

Golfing. Another sport that doesn’t necessitate a lot of movement is golf. Walking increases your aerobic capacity, while socializing with your fellow golfers elevates your mood.

Running or cycling. Late in life, if you’re in good form, you can still go for a run or ride a bike. Both can be done on a bike or treadmill, either outside or indoors.

Tip 5: Reduce mental stress

Sleep can be disrupted by the accumulation of stress and anxiety during the day. At bedtime, it’s critical to master the art of detaching from thoughts and worries.

  • Before you retire, write down all of your concerns in a journal.
  • Check off the chores you’ve finished and write down your goals for the next day on your to-do list before letting them go.
  • Music that soothes the soul can be listened to.
  • Relax and unwind by reading a book that you enjoy.
  • Make an appointment for a massage with a friend or a loved one.
  • To get your body ready for sleep, try a relaxation technique.
  • Talk to a friend face-to-face during the day about what’s on your mind.

Getting back to sleep at night

It’s common to experience more nighttime awakenings as you age. These strategies may assist if you’re struggling to get back to sleep:

Don’t worry about it. Stressing over the fact that you can’t get back to sleep only encourages your body to stay awake. Instead than dwelling on thoughts, pay attention to how you feel physically.

Don’t worry about it. Stressing over the fact that you can’t get back to sleep only encourages your body to stay awake. Instead than dwelling on thoughts, pay attention to how you feel physically.

There is no need to be alarmed. As a result of worrying about not being able to sleep, your body is more likely to stay up as well. Instead of dwelling in your mind, pay attention to the sensations and feelings you’re having in your body.

Put off the concern. Whenever you wake up in the middle of the night worried about something, write it down on a piece of paper and put it off until the following day, when it will be simpler to deal with.

When to talk to a doctor about sleep problems

In the event that your efforts to resolve your sleep issues have been ineffective, you should keep a sleep diary and present it to your doctor. Keep a diary of your alcohol, caffeine, and nicotine consumption, as well as a record of your prescriptions, workouts, dietary adjustments, and any recent life changes and stressors. If insomnia is affecting your emotions and physical health, your doctor may suggest that you seek additional treatment from a sleep specialist or cognitive behavioral therapist.

Therapy vs. sleeping pills for insomnia in seniors

Even though sleeping tablets and other sleep aids can be helpful in the short term, such as after a medical treatment, they won’t be able to cure your insomnia permanently. In the long run, they can actually worsen sleeplessness.

As a kind of psychotherapy, cognitive-behavioral therapy (CBT) addresses the ideas, anxieties, and behaviors that keep you awake at night. Chronic insomnia can be treated more effectively with cognitive behavioral therapy (CBT) than with prescribed sleep medications, according to a Harvard Medical School study. Individual, group, or even online CBT can be used.

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