What causes insomnia in older adults and how to address the common sleep disorder

April 28, 2021

If you or your older loved one are tossing and turning throughout the night, you’re not alone — especially if you watch the news for more than a few minutes. Published research has long found that aging is associated with numerous changes, including changes in sleep timing, duration, and quality. 

But persistent difficulty falling or staying asleep or constantly feeling like it’s interfering with daily activities could indicate insomnia, the most common sleep disorder in older adults. And the downstream effect is significant. Studies have shown that older adults with insomnia are not only more fatigued, irritable and unable to focus during the day but also at a greater risk for depression, memory problems and falls. Poor sleep also increases the risk of cardiovascular and metabolic diseases.

Here, what causes the sleep disorder and the best treatments for insomnia in older adults.

What causes insomnia in older adults?

In addition to pre-existing sleep disorders like sleep apnea, other causes of insomnia in older adults include:

  • A slower-paced retirement lifestyle (e.g., lack of exercise, too much time in the recliner)

  • Pre-existing mental illness such as depression or anxiety.

  • Medication side effects (e.g., urination more than twice per night).

  • Taking the incorrect dose of medication or taking it at the wrong time. Alpha-blockers, beta-blockers, corticosteroids, SSRI antidepressants and ACE inhibitors are the top five medications that may cause insomnia, according to AARP. 

  • Poor sleep habits and sleep environment (e.g., screen time before bed, too much napping).

  • Chronic stress or trauma.

  • Other pre-existing sleep disorders such as restless leg syndrome.

  • Lack of sunlight.

  • Caffeine, nicotine, or alcohol before bed.

  • Too hot or cold room temperature. (As we get older, we get colder).

Best treatments for insomnia in older adults

Even if you or your love one is dealing with one or several of these causes of insomnia, it is possible to improve sleep and breathing as you age, notes Dr. Steven Olmos, a dental surgeon and founder of TMJ & Sleep Therapy Centres International who has spent the last 30 years devoted to the diagnosis and treatment of sleep disorders. 

Older adults who want to improve their sleep are generally offered two options by their doctor: medication or evidence-based psychological treatments (EBTs). According to a 2020 review of all available treatments for the elderly with insomnia, no one specific intervention was found to be “most effective.” Everyone is a bit different, so it may take some trial and error to find what works best for you or your older loved one.

The first step to improving sleep is to create a calm nighttime routine and focus on “stimulus control,” or techniques that are designed to strengthen the brain's association between the bed and sleep, says Christine Walsh, an assistant professor of neurology at the University of California, San Francisco who holds a doctorate in neuroscience and studies sleep in older adults and those who have neurodegenerative diseases. A few options: 

Prepare your body and environment for sleep

Walsh recommends avoiding entertainment or news that might be stressful or energizing. Other moves to keep in mind:   

  • Maintain a regular bedtime and rise time everyday (including weekends).

  • Take naps early in the afternoon to avoid nighttime sleep interference. 

  • Avoid exercising 90 minutes before bed, as the endorphins can create a level of activity in the brain that makes it harder to fall asleep.  

  • Align your spine to reduce pain-related awakenings.

  • Limit fluid intake before bedtime to avoid frequent trips to the restroom.

  • Don't let pets sleep in the room with you.

  • Limit interruptions due to noise and technology.

  • Keep the room as dark as possible while maintaining safety.

  • Maintain a comfortable room temperature.

  • Avoid caffeine, nicotine and alcohol close to bedtime. “A lot of people think drinking alcohol can make them sleepy, but it can worsen sleep apnea,” Walsh notes. “This is because as alcohol is metabolized, it gives a ‘sugar rush’ that can increase sleep disruption during the night.”

Consider talk therapy  

If insomnia stems from stress, anxiety or the loss of a loved one, talking with a therapist can be helpful. 

A silver lining to come out of the pandemic has been the rise of telemedicine. You can quickly find a teletherapist offering online and video counseling on Psychology Today’s website. If you or your senior loved one is vaccinated and comfortable with in-person visits, you can also search for a therapist near you by entering in your city or zip code.

There is increasing evidence that cognitive behavioral therapy (CBT) — a type of talk therapy that helps you become aware of inaccurate or negative thoughts — may improve sleep for those with older adults with insomnia.  

Other therapies that might prove useful include: 

Talk with your doctor about medications

Medications can be both a cause and a treatment for insomnia sufferers, especially among older adults who are more likely to have co-existing health conditions. It’s important to work closely with your or your loved one’s doctor if you decide you’d like to go the pharmacology route. Here’s why:  

  • Over-the-counter sleep aids can worsen some conditions like dementia with side effects such as drowsiness, confusion, constipation and dry mouth. 

  • Prescription sleep medication, such as benzodiazepines or the so-called “z-drugs” and other hypnotic drugs are not recommended for seniors, as their side effects are often severe and increase the risk of falls, fractures, oversedation and confusion.

Medication adherence can be hardest on caregivers, but Walsh says the benefits of maintaining a consistent schedule for your senior loved one will not only help their sleep but your own, as well. 

Get screened for sleep disorders

If you or your older loved one have problems sleeping for more than one night a week for several weeks in a row, you may an underlying sleep disorder such as:

  • Sleep apnea.

  • Periodic limb movements.

  • Restless Leg Syndrome (RLS).

  • REM Sleep Behavior Disorder.

A primary care provider might ask that an older adult or their caregiver keep a sleep diary over several weeks or suggest a sleep study. Many sleep centers are now dispensing home sleep apnea test units through mail delivery or via curbside pickup and return. The raw data is then reviewed and interpreted by a physician who is either board-certified in sleep medicine or overseen by a board-certified sleep medicine physician before a diagnosis is made, as per guidelines from the AASM.  

By continuing to work with your or your loved one’s doctor, you’ll be able to pinpoint the root of sleep troubles and stay abreast of new treatment discoveries that could ultimately lead to a restorative night’s sleep.

Tips and stories from parents and caregivers who’ve been there.

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