Sleep disorders are fairly common in older adults. As you get older, sleep patterns and habits change. As a result, you may:
- have trouble falling asleep
- sleep fewer hours
- wake up frequently in the night or early morning
- get less quality sleep
This can lead to health concerns like increased risk for falling and daytime fatigue.
Many older people report trouble maintaining a good night’s rest, not so much falling asleep. Most studies conclude that behavioral therapies are preferable to medications, which can have unwanted side effects like nausea.
Talk to your doctor if you or someone you know has trouble sleeping. You may see benefits from lifestyle changes or medication, depending on the cause.
Primary sleep disorders
A primary sleep disorder means there isn’t another medical or psychiatric cause.
Primary sleep disorders can be:
- insomnia, or difficulty falling asleep, staying asleep, or restless sleep
- sleep apnea, or brief interruptions in breathing during sleep
- restless leg syndrome (RLS), or the overwhelming need to move your legs during sleep
- periodic limb movement disorder, or involuntary movement of the limbs during sleep
- circadian rhythm sleep disorders, or a disrupted sleep-wake cycle
- REM behavior disorder, or the vivid acting out of dreams during sleep
Insomnia is both a symptom and disorder. Conditions like depression, anxiety, and dementia can increase risk for sleep disorders, especially insomnia, according to a study in Nurse Practitioner.
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.
These conditions include:
- Parkinson’s disease
- Alzheimer’s disease
- chronic pain like arthritis pain
- cardiovascular disease
- neurological conditions
- gastrointestinal conditions
- lung or respiratory conditions
- poor bladder control
Many older adults are on medications that can disrupt sleep. These include:
- diuretics for high blood pressure or glaucoma
- anticholinergics for those with chronic obstructive pulmonary disease (COPD)
- antihypertensive drugs for high blood pressure
- corticosteroids (prednisone) for rheumatoid arthritis
- H2 blockers (Zantac, Tagamet) for gastroesophageal reflux disease (GERD) or peptic ulcers
- levodopa for Parkinson’s disease
- adrenergic drugs for life-threatening conditions like asthma attacks or cardiac arrest
Caffeine, alcohol, and smoking may also contribute to sleep problems.
To make a diagnosis, your doctor will ask about your symptoms and conduct a physical examination. This is to look for any underlying conditions. Your doctor may also ask you to complete a sleep diary for one to two weeks to learn more about your sleeping patterns.
If your doctor suspects a primary sleep disorder, they will send you for a polysomnogram, or a sleep study.
A sleep study is usually done at night in a sleep lab. You should be able to sleep as you normally would at home. A technician will place sensors on you to monitor your:
- body movement
- 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 to 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 use nonpharmaceutical treatments like behavioral therapy first. This is because older adults tend to already be taking multiple medications.
Therapy can happen over six weeks or longer and include sleep education, stimulus control, and time in bed restrictions.
A randomized controlled trial showed that cognitive behavioral therapy (CBT) largely improved sleep quality for people with insomnia. The study suggests that CBT is more effective because it helps target the quality of sleep rather than the transition into sleeping.
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
- 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.
A study about managing sleep disorders in older adults also suggests:
- limiting liquid before bed
- avoiding caffeine and alcohol
- eating three to four hours before bedtime
- exercising regularly, but not right before bedtime
- taking a warm bath to relax
If these changes aren’t enough, then your doctor may recommend medication. Read on to learn more about sleeping pills and other medical treatments.
If you have underlying diseases that are interfering with your sleep, your doctor may prescribe medications. Medication shouldn’t replace good sleeping habits.
Melatonin, a synthetic hormone, helps induce sleep faster and restores your sleep-wake cycle. The Mayo Clinic recommends 0.1 to 5 milligrams two hours before bedtime for several months if you have insomnia. But melatonin doesn’t improve the quality of sleep.
Sleeping pills and side effects
Sleeping medications may help ease the symptoms of your sleep disorder, especially as a supplement to good sleep habits. Your doctor may be able to recommend what drugs will work best for you and how long you should take them, depending on the cause of your insomnia.
It’s recommended to only take sleeping pills on a short-term basis. This means less than two to three weeks for benzodiazepine drugs like Triazolam and only six to eight weeks for nonbenzodiazepine drugs (Z-drugs) like zolpidem, or Ambien.
- are good for short-term use to reset 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:
You should avoid drinking alcohol while taking sleeping pills.
Other medical treatments
Other medical treatments include:
- continuous positive airway pressure (CPAP) device to treat sleep apnea
- 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, which induce drowsiness. But tolerance to antihistamines can build up in three days.
Talk to 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 risk of falling. If quality of sleep is the main issue, behavioral therapies may be more beneficial. This means developing good sleeping habits through sleep education, stimulus control, and time in bed restrictions. Changes can take up to six weeks or more.
If behavior therapies don’t work, then your doctor may prescribe medication or other treatments. But sleep medication isn’t a long-term solution. You’ll find that the best way to get quality sleep is to take control of your sleeping habits.