Sleep Problems in the Elderly

Sleep disorders are fairly common in older adults, resulting in many getting less sleep than they need. This may be due to reasons including:

medications

health issues

underlying sleep disorders

Poor sleep can be a precursor to serious health problems, such as an increased risk of obesity, cardiovascular disease, and diabetes

Although sleep patterns change as people age, disturbed sleep and waking up tired are not part of normal aging.

Older adults may have trouble falling asleep, sleep fewer hours, and wake up frequently in the night or early morning, all of which can lead to them getting less quality sleep.

This can lead to health concerns like increased risk of falling and daytime fatigue.

About 50 percent of people over 55 years old have difficulty falling asleep and maintaining a good night’s rest.

Most studies conclude that cognitive behavioral therapy for sudden and chronic insomnia is preferable to medications, which can have unwanted side effects like nausea.

Talk with a doctor if you or someone you know has trouble sleeping. You may see benefits from lifestyle changes or medication, depending on the cause.

A primary sleep disorder means there is not another medical or psychiatric cause. Individuals of all ages can be affected by sleep disorders, including older adults.

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.

A study about sleep problems in older Singaporeans reported that those who had trouble sleeping were more likely to have existing conditions and be less physically active.

Health conditions that may cause sleep problems include:

Parkinson’s disease. This is a neurodegenerative disorder where how often it occurs, or incidence, increases with age. Up to 40 percent of people with Parkinson’s disease have obstructive sleep apnea, according to the Parkinson’s Foundation.

Alzheimer’s disease. Alzheimer’s may cause daytime drowsiness and difficulty staying asleep at night.

Chronic pain like arthritis pain.

Cardiovascular disease. A study showed that 39 percent of people with cardiovascular disease regularly slept fewer than 6.5 hours, resulting in an increased death risk.

Neurological conditions. Examples include multiple sclerosis and traumatic brain injury.

Gastrointestinal conditions. Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are examples of gastrointestinal conditions.

Lung or respiratory conditions. Examples of these conditions include chronic obstructive pulmonary disease (COPD) and asthma. These conditions may increase the risk for obstructive sleep apnea.

Poor bladder control.

Many older adults are on medications that can disrupt sleep. These include:

diuretics for high blood pressure or glaucoma

inhaled anticholinergics for COPD

antihypertensive drugs for high blood pressure

oral corticosteroids (prednisone) for rheumatoid arthritis and lupus

antidepressants and anti-anxiety medications (anxiolytics)

antihistamines for allergies

levodopa for Parkinson’s disease

donepezil (Aricept) for Alzheimer’s disease

Caffeine, alcohol, and smoking may also contribute to sleep problems.

The stimulant caffeine may reduce sleep time by causing a delay in the body’s circadian rhythm, according to research.

Alcohol may increase the risk for sleep apnea by 25 percent.

Research shows that nicotine disrupts the circadian rhythm, causing more daytime sleepiness and less sleep time, including less REM sleep.

The sleep problems older adults most commonly experience include:

Obstructive sleep apnea, or brief interruptions in breathing during sleep that occur if the upper airway repeatedly becomes blocked. It affects an estimated 20 to 60 percent of people over 65 years old.

Restless leg syndrome (RLS), or the overwhelming need to move your legs during sleep, may start at any age, but it more severely affects middle-aged and older adults who may experience it more frequently and for longer periods.

REM behavior disorder (RBD), or the vivid acting out of dreams during sleep, may occur when the brain chemical that paralyzes your muscles during REM sleep does not function properly. A study found that up to 7.7 percent of 456 participants over 60 years old without Parkinson’s disease had probable RBD.

Circadian rhythm sleep disorders disrupt the daily sleep-wake cycle of the body’s internal clock. As you age, your internal clocks become less efficient, resulting in falling asleep and waking up earlier.

Other sleep disorders that can affect anyone of any age include:

Insomnia is difficulty falling asleep, staying asleep, or restless sleep. According to some studies, 50 to 70 percent of people over 65 years old have symptoms of insomnia.

Periodic limb movement disorder, or involuntary movement of the limbs during sleep, does not have a known cause, but it may originate in the central nervous system.

To make a diagnosis, your doctor will ask about your symptoms and conduct a physical examination to look for any underlying conditions. They may also ask you to complete a sleep diary for 1 to 2 weeks to learn more about your sleep patterns.

The diagnosis of insomnia requires three main components:

persistent sleep difficulty

adequate sleep opportunity

associated daytime dysfunction

If your doctor suspects a primary sleep disorder, particularly obstructive sleep apnea, they will recommend either an in-lab sleep study called a polysomnography (PSG) or an at-home sleep test (HST).

A polysomnogram sleep study is usually done at night in a sleep lab. You should be able to sleep as you normally would at home.

If your doctor orders an in-lab sleep study, a technician will place sensors on you to monitor your:

body movement

breathing

snoring or other noises

heart rate

brain activity

You may also have a finger device to measure the oxygen in your blood.

The technician will watch you through a video camera in the room. You can talk with them if you need any help. During your sleep, the devices will continuously record your information on a graph. Your doctor will use this to diagnose if you have a sleep disorder.

For older adults, it’s recommended to first use nonpharmaceutical treatments like cognitive behavioral therapy (CBT) for sudden and chronic insomnia. This is because older adults may already be taking multiple medications.

Cognitive behavioral therapy can happen over a 6-week period or longer and include:

sleep education

stimulus control

time in bed restrictions

Studies show that CBT largely improved sleep quality for people with insomnia. The studies suggest that it is more effective because it helps target both the quality and quantity of sleep.

You can develop good sleeping habits by:

going to bed and waking up at the same time each day

using the bed only for sleep and sex, not other activities like work

doing quiet activities, like reading, before bed

avoiding bright lights before bed

keeping a soothing and comfortable bedroom environment

limiting liquid before bed

eating 3 to 4 hours before bedtime

exercising regularly but not right before bedtime

taking a warm bath to relax

avoiding naps

If you have trouble falling asleep within 20 minutes, you may want to try getting up and doing something before going back to bed. Forcing sleep may make falling asleep harder.

If these changes aren’t enough, your doctor may recommend medication. Read on to learn more about sleeping pills and other medical treatments.

If you have underlying issues that are interfering with your sleep, your doctor may prescribe medications. Medication shouldn’t replace good sleeping habits, but it may provide some relief in the short term.

Melatonin, a hormone produced by your brain in response to darkness, helps induce sleep faster and restores your sleep-wake cycle. Exposure to light at night can prevent the production of melatonin.

Synthetic melatonin supplements can be bought over the counter. People most commonly use melatonin for insomnia and improving sleep in certain conditions such as jet lag. However, there is limited scientific evidence to support the chronic use of melatonin in most cases.

Your doctor may be able to recommend which medications might work best for you and how long you should take them, depending on what’s causing your insomnia.

Some common types of sleeping medications include:

Benzodiazepines such as temazepam (Restoril) and triazolam (Halcion) reduce anxiety and promote sleep by binding to gamma-aminobutyric acid (GABA) receptors in your brain. However, they are potentially addictive and not recommended for older people due to the possibility of cognitive impairment, falls, and fractures.

Nonbenzodiazepines (Z-drugs), including zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta), slow your brain’s activity to help you sleep by specifically working on your brain’s GABA-A receptors. They may cause morning drowsiness if you’re taking long-acting medication. They are also potentially addictive and not recommended for older people.

Certain antidepressants approved by the Food and Drug Administration (FDA), such as doxepin (Sinequan), may be prescribed in low dosages for chronic insomnia. They may help you stay asleep longer and reduce the number of times you awaken. These drugs mainly work by blocking histamine, which is an alerting neurotransmitter.

It’s generally recommended to only take sleeping pills on a short-term basis, but insomnia treatment is extremely individualized, so your healthcare professional will help create a specific treatment plan for you.

are good for short-term use to reset the sleep cycle

are helpful for a good night’s sleep

can have minimal withdrawal symptoms with proper care

can increase risk of falls

can cause sleep-related activities like sleep-driving

dependence may occur with long-term use

Long-term use of sleeping pills can cause complications, especially in older adults. Other common side effects of benzodiazepines and Z-drugs include:

headaches

dizziness

nausea

fatigue

drowsiness

You should avoid drinking alcohol while taking sleeping pills.

Some medical treatments that are sometimes recommended for older adults are:

continuous positive airway pressure (CPAP) devices to treat obstructive sleep apnea

specific antidepressants to treat insomnia

dopamine agents for restless leg syndrome and periodic limb movement disorder

iron replacement therapy for restless leg symptoms

Sleep remedies include over-the-counter (OTC) antihistamines, such as diphenhydramine (Benadryl), which induce drowsiness. However, the chronic use of antihistamines has been associated with dementia.

Talk with your doctor before taking any OTC medications. They may interact negatively with medications you’re already taking.

In older adults, ongoing sleep disorders can lead to bigger concerns like depression and the risk of falling.

If quality of sleep is the main issue, cognitive behavioral therapies may be more beneficial, especially for insomnia. This means developing good sleeping habits through sleep education, stimulus control, and time-in-bed restrictions. Changes can take up to 6 weeks or more.

If cognitive behavioral therapies don’t work for your insomnia, your doctor may prescribe medication or other treatments, but sleep medication is not a long-term solution. Managing your sleeping habits can be the most effective way to get quality sleep.