Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia Update 04/2024

Insomnia is a frequent sleep condition defined by an inability to fall or stay asleep even when the chance exists. Excessive daytime drowsiness and other cognitive impairments are closely related to sleep deprivation in those who suffer from 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.

Adults with insomnia affect 10-30% of the population, based on current figures. Insomnia is more common in those over the age of 60 for a number of different reasons. Sleep disorders such as insomnia and restless legs syndrome can be caused by medical and psychological diseases that are more prevalent in the elderly. It is also possible that as we get older, our internal circadian clocks and sleep-wake cycles will shift, affecting the amount of time and quality of sleep that we get. Specific elderly medical disorders can produce sleep disturbances due to the use of certain drugs to treat them.

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Sleep and Aging

As we grow older, the quality of our sleep often degrades. In general, people tend to sleep less and have a greater number of awakenings after they have fallen asleep at first. The time it takes to fall asleep, known as sleep latency, may also lengthen. According to some research, the average person loses an additional 27 minutes of sleep per night after reaching middle age.

There is a direct link between these changes in sleep quality and duration and the body’s internal clocks. Circadian signals are less efficiently processed by the body in older persons because of the earlier bed and wake-up hours.

As we grow older, our sleep patterns also alter. Four stages of sleep are typical in a normal night’s rest. There are three stages of NREM sleep: “light” and “heavy” (also known as “slow-wave”), and then “rapid eye movement” (or “REM”) before the cycle repeats. It has been found that senior persons had a smaller percentage of both slow-wave NREM and REM sleep than younger people, according to polysomnographic research. Because of this, individuals are more sensitive to nighttime awakenings, which has an effect on how rested and awake they are in the mornings.

Recognizing and Diagnosing Insomnia in Seniors

There’s a strong correlation between insomnia and growing 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):

• The inability to get or stay asleep.
• The tendency to wake up sooner than planned on a regular basis.
• Resentment toward setting a fair bedtime.
• Inability to sleep on one’s own without assistance.

Daytime impairments must be included in the definition of insomnia. Excessive daytime sleepiness, weariness, malaise, irritability, and difficulty concentrating and paying attention are all possible symptoms. Risk of accidents and difficulties in social and familial circumstances are greater for those who suffer from insomnia.

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

Identifying the underlying reasons for insomnia in older persons is essential to a good diagnosis. To differentiate primary insomnia from secondary insomnia, it is important to understand the difference between the two conditions. It doesn’t matter if the insomnia is primary or secondary; the symptoms are the same for both. Because of this, treating secondary insomnia often involves addressing the underlying disease that is interfering with sleep.

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. Bedrooms should be dark and quiet, with temperatures no higher than 75 degrees Fahrenheit ideal (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. During the warmest months of the year, an air conditioner may be useful. 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:

• Stimulus control: In order to get a decent night’s sleep, patients should only go to bed when they are exhausted, which is why this method was developed. 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. As an added precaution, they should abstain from taking daytime naps and make an effort to wake up at the same time every day.
• Sleep restriction: Insomnia patients are sometimes advised to keep a sleep diary in which they note how long it takes them to fall asleep each night, how many times they wake up during the night, and other relevant information. According to sleep diary entries, a doctor may advise a patient to limit how long they spend in bed each night until they increase their sleep efficiency. Each night’s sleep efficiency is calculated by dividing the amount of time spent sleeping by the amount of time spent awake in bed. By sleeping for at least 90% of the time spent in bed, a person is ready to begin waking up early.
• Cognitive-behavioral therapy: Seniors who suffer from insomnia may benefit from cognitive behavioral therapy, which aims to identify and change any erroneous or negative attitudes or ideas they may have about sleeping.
• Bright light therapy: In the evening, timed exposure to bright lights could assist seniors who normally go to bed and wake up early stay awake longer and fall asleep later.

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 adults are more vulnerable to falling due to the hypnotic effects of some medications, such as benzodiazepines (BZDs) and nonbenzodiazepines (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.

With caution, other insomnia drugs can be administered despite their lower dangers. Natural hormones in the body may be a factor in the sleep-inducing effects of several prescription drugs. Sleep-inducing medications include suvorexant, which blocks orexin, the neuropeptide that generates sensations of alertness and arousal. Ramelteon, which acts as a melatonin-receptor antagonist, is another option. Antihistamines available 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 elderly people are more likely to suffer from various sleep disorders, such as insomnia. This complicates treatment options for older adults with insomnia and other sleep disorders. Elderly people are more likely than younger people to experience the following types of sleep disorders

Circadian Rhythm Sleep Disorders

Having a circadian rhythm sleep issue occurs when a person’s internal clock does not match their external 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. Between 7 and 9 p.m., people with this disorder are often exhausted, and they’ll naturally wake up between 3 and 5 a.m. Sleep-wake cycles cause them to wake up even if they go to bed later than normal. Patients over the age of 65 may benefit from light therapy in the evening. Keeping a regular sleep schedule can also help.

Parkinson’s disease and Alzheimer’s disease are two examples of neurological and neurodegenerative disorders that are associated with abnormal sleep-wake cycles. People with this illness have disrupted sleeping habits that do not follow a 24-hour day/night cycle.

Doctors should think twice before prescribing melatonin tablets to their elderly patients in order to address their patients’ circadian rhythm sleep disturbances. It is unclear whether or not melatonin supplements are safe or effective over the long term because they are not subject to FDA regulation.

Sleep-Related Breathing Disorders

Obstructive sleep apnea and central sleep apnea are more common in the elderly population. Dementia patients in nursing homes are at high risk for developing these illnesses. Obesity, alcoholism, and smoking are all risk factors that can accumulate over time.

Seniors who suffer from sleep-related breathing problems typically snore loudly, which can induce nightly awakenings and excessive daytime tiredness for the rest of the day. Other medical diseases, such as congestive heart failure, myocardial infarction, and stroke, can be predicted by these disorders.

Sleep apnea in the elderly is often treated using continuous positive air pressure (CPAP) therapy, in which a breathing mask is worn while the patient receives pressurized air. People with sleep apnea who use a CPAP machine report reduced snoring and fewer episodes of sleep apnea.

Periodic Limb Movements and Restless Legs Syndrome

Periodic limb movements, which occur more than 15 times per hour of sleep, are repetitive, involuntary movements of the arms and legs. RLS, a neurologic condition, is characterized by an excessive desire for movement of the legs while the body is at rest. As a result of both of these circumstances, sleep disturbances and exhaustion can follow the next day. According to research, the prevalence of these illnesses nearly doubles with increasing age.

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, it can be more difficult to implement an intervention.

REM Sleep Behavior Disorder

During REM sleep, people tend to have the most vivid dreams. Rarely do individuals physically act out their dreams, except for those with REM sleep behavior disorder (RBD). As a result, the sleeper and their spouse are at a greater danger of physical damage.

An extremely high incidence of RBD in elderly males has been documented in the literature. Degenerative neurologic disorders including Parkinson’s disease and Lewy body dementia are linked to this ailment.

Because BZDs are commonly used for RBD, elderly patients may find it challenging to address this condition. 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?

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The average senior requires seven to nine hours of sleep each night to feel relaxed and alert the following day. Insomnia and other sleep problems can seriously disrupt your sleep schedule. Try one of the following to ensure that you get enough sleep and feel awake the next day:

• Set tight bedtimes and wake-up schedules for your children, and enforce them even while you’re away from home.
• Avoid taking a nap right before going to bed. If you feel the desire for a quick nap, try to keep it to the early hours of the day.
• Create a nightly ritual that aids you in winding down. You can help yourself relax by reading or listening to soothing music.
• In your bedroom, avoid using electronic gadgets like televisions, cell phones, and computers. To help you sleep, these gadgets generate blue light.
• Maintain a temperature that is neither too hot nor too cold, and keep the light level low in your bedroom.
• 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.
• Don’t use alcohol to help you sleep. Alcohol has a sedative effect, but it can also 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. Make an appointment with your doctor to discuss diagnosing and treating the issue.

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

Having a sluggish night’s sleep may be a sign that your body is producing less growth hormone (an especially refreshing part of the sleep cycle). When this happens, your body produces less melatonin, which results in a less restful night’s sleep. That’s why, as we become older, so many of us start to think of ourselves as “light sleepers. You could also:

• Aiming for a more restful night’s sleep and an early morning start
• To acquire the amount of sleep you need, you’ll either have to spend more time in bed at night or take a nap during 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 usual for people of any age to have occasional sleep issues. The following signs and symptoms may indicate a sleep disturbance if you have them on a regular basis:

• Even when you’re exhausted, it’s difficult to fall asleep.
• When awake, I have difficulty returning to sleep.
• After a night’s sleep, I don’t feel rested.
• Become irritated or drowsy during the workday.
• Sitting idle, watching TV, or even driving can cause you to fall asleep.
• The ability to focus during the day is a problem.
• Sleeping medications or alcohol should not be used to help you sleep.
• You’re unable to keep your emotions in check.

Tip 2: Identify underlying causes for your insomnia

Often, the fundamental reasons for sleep deprivation are quite curable. The more you know about a problem, the more equipped you are to deal with it.

• Are you feeling overwhelmed?
• Is your mood bleak? Do you feel hopeless and depressed?
• Are you plagued by constant worry or anxiety?
• If so, please share your story with us.
• What drugs might be interfering with your sleep?
• 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

Negative sleeping habits and a bad sleep environment. A few of these include erratic sleep schedules, the drinking of alcohol prior to bedtime, and falling asleep with the television on. Establish sleep-promoting rituals and ensure your sleeping environment is favorable to restful sleep.

Injuries or other health issues. People who suffer from illnesses such as insomnia, frequent urination, arthritis, asthma, diabetes, and osteoporosis may find it difficult to sleep. Contact your doctor 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, insomnia can persist. Changing your day-to-day behaviors, particularly your food and exercise routine, can help you achieve this.

Medications. There is a correlation between the number of medications older individuals take and their ability to get a good night’s sleep. Whether you’re having trouble sleeping, ask your doctor if there’s anything he or she can do to help.

A lack of physical activity. Sedentary lifestyles might cause you to feel constantly tired. Good sleep can be achieved with regular aerobic exercise during the day.

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 with a friend or loved one can do wonders for your spirits.

There is a lack of interaction with others. It is important to maintain a healthy level of activity in order to prepare your body for a good night’s rest. It’s never too late to get involved in your community or learn something new.

Sleep apneas. There is a greater prevalence of Restless Legs Syndrome (RLS) and other sleep-disordered breathing disorders among older persons.

Sunlight is scarce in this area. Your sleep-wake cycles and melatonin production are aided by exposure to bright sunlight. Try to spend at least two hours a day in the sunshine. Use a light treatment box or open the blinds during the day.

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

Increase your melatonin levels naturally. The hormone melatonin, which makes you sleepy, can be suppressed by artificial lighting at night. In areas where it is safe to do so, use low-wattage light bulbs and turn off the TV and computer one hour before bedtime.

When you’re trying to sleep, avoid using a backlit device (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.

Your bed should be comfortable and your bedroom should be quiet and dark. We become more sensitive to light and heat as we age, which can also interfere with our ability to sleep. You can try using an earplug or a sleep mask to help you get some shut-eye.

Do not use your bedroom for anything other than sleeping and having sex. Your brain will link the bedroom with sleep and sex if you don’t work, watch TV, or use your computer in bed.

Remove the clocks from the bedrooms from view. Anxiously counting down the minutes is a definite way to suffer from insomnia.

Keep a regular bedtime routine for better sleep

Maintain a regular bedtime 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.

You should get some shut-eye earlier in the day. Regardless of how much sooner you want to go to bed now than you used to, you should still be able to stick to your regular sleep schedule.

Create routines that help you relax before you go to sleep. It’s possible to wind down before going to bed by bathing, listening to music, or engaging in a relaxation technique such as progressive muscle relaxation (PMR), mindfulness meditation (MBSR), or deep breathing.

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 for insomnia.

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

How to nap

Taking a sleep can give you the energy you need to get through the rest of the day if you aren’t feeling particularly awake. Try it out and see if it works for you.

Tips for a good nap:

• It’s best to keep things to a minimum. Short naps can have a positive effect on alertness and some memory processes. Restorative naps should be limited to 15 to 45 minutes for most people. Taking a long snooze may leave you feeling tired and unable to focus.
• Take a nap early in the day. Be sure to take a nap in the afternoon if possible. Napping late in the day can interfere with your sleep at night.
• Be at ease. Try to get some shut-eye in a quiet, dark, and secluded area.

Tip 4: Use diet and exercise to improve sleep

Diet and exercise are two of the most significant daytime factors that influence the quality of sleep at night. It’s critical to manage what you eat in the hours leading up tonight in addition to following a sleep-friendly diet during the day.

Diet tips to improve sleep

After a certain point in the day, cutting back on your caffeine intake is a good idea. Consuming caffeine at the end of the day can lead to sleep deprivation.

Before you go to sleep, stay away from alcoholic beverages. While it may appear that alcohol induces sleep, the truth is that it will keep you awake.

Reduce your hunger before going to bed. Cereal, yogurt, or warm milk are good options for a low-sugar snack.

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.

Prior to going to bed, stay away from heavy or spicy meals. It is possible to have indigestion or discomfort after consuming large or spicy meals. Eat a light dinner at least three hours before going to bed.

Before going to bed, try to limit your liquid intake. 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. However, before beginning any new exercise regimen, talk to your doctor.

Try:

Exercising in water via swimming. If you’re looking for a low-impact strategy to get in shape, swimming laps is a terrific option. Many communities and YMCA pools provide swimming and water-based exercise classes specifically for older persons.

Dancing. Go dancing or sign up for a dance lesson if you enjoy moving to music. Taking dance courses might also help you grow your social circle.

Play bocce, pétanque, or lawn bowling. Playing with a ball is a great way to get some exercise without exerting too much effort. If you walk a lot and at a fast speed, you’ll get more cardio benefits.

Golfing. As an example of a low-intensity workout, golf is a popular choice. Walking and spending time with pals on the course can both boost your mood.

Running or cycling are the two most common methods of transportation. Late in life, if you’re in good form, you can still go for a run or ride a bike. A stationary bike or treadmill can be used for both.

Tip 5: Reduce mental stress

Sleep can be disrupted by the accumulation of stress and anxiety during the day. Let go of worries and anxieties before you sleep so you can get a good night’s sleep.

• 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.
• Listen to peaceful music to relax.
• Relax by reading a good book.
• Consider getting a massage from someone you know.
• 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

As you get older, you’re more likely to wake up during the night. This is natural. The following suggestions, however, may assist you in returning to sleep:

Don’t worry about it. The more you worry about not being able to sleep, the more likely it is that your body will stay awake. Try to keep your thoughts out of your head and instead focus on the sensations and feelings in your body.

Relaxation, not sleep, should be your goal. Get out of bed and practice a relaxation method like deep breathing or meditation. Relaxation, while not a replacement for sleep, can nonetheless help your body regenerate.

Engage in a low-key activity that won’t set off any alarms. Spending more than 20 minutes awake is a sign that you need to get out of bed and engage in something relaxing, like reading a book. However, avoid using displays and reduce the brightness.

Worrying is a waste of time. 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

Keep a sleep journal and bring it to your doctor if you can’t get a good night’s sleep on your own. Record when you drink, smoke, or take medication. Also keep track of your lifestyle changes, recent stressors, and prescriptions. If your insomnia is affecting your emotions and health, your doctor may recommend you to a sleep specialist or a cognitive-behavioral therapist for additional treatment.

Therapy vs. sleeping pills for insomnia in seniors

While sleeping tablets and other sleep aids can be helpful in the short term, such as after a medical procedure, they won’t be able to cure your chronic insomnia. In fact, they have the potential to exacerbate the symptoms of insomnia in the long run.

As a kind of psychotherapy, cognitive-behavioral therapy (CBT) addresses the negative thoughts, anxieties, and behaviors that keep you awake at night. Clinical behavioral therapy (CBT) is more beneficial than prescription sleep medicine in treating chronic insomnia, according to a study from Harvard Medical School. CBT can be done alone, in a group, or even online.

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