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Sleep disorders in older adults

Insomnia - older adults

 

Sleep disorders in older adults involve any disrupted sleep pattern. This can include problems falling or staying asleep, too much sleep, or abnormal behaviors with sleep.

Causes

 

Sleep problems are common in older adults. The amount of sleep needed stays constant throughout the adult years. Doctors recommend that adults get 7 to 8 hours of sleep each night. In older adults, sleep is less deep and choppier than sleep in younger people.

A healthy 70-year-old may wake up several times during the night without it being due to disease.

Sleep disturbances in older adults may be due to any of the following:

  • Alzheimer disease
  • Alcohol
  • Changes in the body's natural internal clock, causing some people to fall asleep earlier in the evening
  • Long-term (chronic) disease, such as heart failure
  • Certain medicines, herbs, supplements, and recreational drugs
  • Depression (depression is a common cause of sleep problems in people of all ages)
  • Brain and nervous system conditions
  • Not being very active
  • Pain caused by diseases such as arthritis
  • Stimulants such as caffeine and nicotine
  • Frequent urination at night

 

Symptoms

 

Symptoms that may occur include:

  • Difficulty falling asleep
  • Difficulty telling the difference between night and day
  • Early morning awakening
  • Waking up often during the night

 

Exams and Tests

 

The health care provider will take a history and perform a physical exam to look for medical causes and determine which type of sleep disorder is causing the problem.

 

Treatment

 

Relieving chronic pain and controlling medical conditions such as frequent urination may improve sleep in some people. Treating depression can also improve sleep.

Sleeping in a quiet room that isn't too hot or too cold and having a relaxing bedtime routine may help improve symptoms. Other ways to promote sleep include these healthy lifestyle tips:

  • Avoid large meals shortly before bedtime.
  • Avoid stimulants such as caffeine after mid-afternoon.
  • Get regular exercise early in the day.
  • Go to bed and wake up at the same time every day.
  • DO NOT take naps.
  • Use the bed only for sleep or sexual activity.

If you can't fall asleep after 20 minutes, get out of bed and do a quiet activity such as reading or listening to music.

Avoid using sleeping pills to help you sleep, if possible. They can lead to dependence and can make sleep problems worse over time if you don't use them the right way. Your provider should assess your risks of daytime sleepiness, mental (cognitive) side effects, and falls before you begin taking sleep medicines.

  • If you think you need sleeping pills, talk with your provider about which pills are safe for you when taken properly. Certain sleeping pills should not be taken on a long-term basis.
  • DO NOT drink alcohol at any time when you are using sleeping pills. Alcohol can make the side effects of all sleeping pills worse.

WARNING: The FDA has asked manufacturers of certain sleep medicines to put stronger warning labels on their products so that consumers are more aware of the potential risks. Possible risks while taking such medicines include severe allergic reactions and dangerous sleep-related behaviors, including sleep-driving. Ask your provider about these risks.

 

Outlook (Prognosis)

 

For most people, sleep improves with treatment. However, others may continue to have sleep disruptions.

 

Possible Complications

 

Possible complications are:

  • Alcohol use
  • Drug abuse

 

When to Contact a Medical Professional

 

Call for an appointment with your provider if a lack of sleep or too much sleep is interfering with daily living.

 

Prevention

 

Getting regular exercise and avoiding as many causes of sleep disruption as possible and adequate exposure to natural light may help control sleep problems.

 

 

Open References

References

NIH Senior Health. Sleep and aging. Updated December 2012. nihseniorhealth.gov/sleepandaging/aboutsleep/01.html . Accessed October 14, 2016.

Shochat T, Ancoli-Israel S. Insomnia in older adults. In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . 6th ed. Philadelphia, PA: Elsevier; 2017:chap 153.

Sterniczuk R, Rusak B. Sleep in relation to aging, frailty, and cognition. In: Fillit HM, Rockwood K, Young J, eds. Brocklehurst's Textbook of Geriatric Medicine and Gerontology . 8th ed. Philadelphia, PA: Elsevier; 2017:chap 108.

 
  • Insomnia

    Insomnia

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    Insomnia - Animation

    Do you have trouble falling asleep at night? Or, do you go to sleep, only to wake up a few hours later and stay awake for hours at night? Well, let’s today talk about insomnia. Your sleep-wake cycle is a delicate pattern run by something called circadian rhythms. These rhythms are physical, mental, and behavioral changes in your brain that roughly follow a 24-hour cycle. Your daily and nightly habits, many you learned as a child, may affect your circadian rhythms and how well you sleep at night. Poor sleep or lifestyle habits that may cause insomnia include going to bed at different times each night, daytime napping, and a poor sleeping environment such as too much noise or light. Spending too much in time in bed while you’re awake can change your sleep patterns too. Likewise, working evenings or night shifts and not getting enough exercise can affect your sleep. People who use alcohol or recreational drugs may have trouble sleeping. Heavy smoking and drinking too much caffeine can also cause insomnia. And, even using some types of sleep medications a lot can cause you to lose sleep. Medical problems can cause insomnia too. People with anxiety disorders, bipolar disorder, thyroid disease, depression, and chronic pain problems may have trouble going to sleep or staying asleep. So, what do you do about insomnia? Well, it’s important to remember that not everyone needs 8 hours of sleep every night. Some people do just fine on 6 hours of sleep, while others need much more. If you need more sleep, your doctor will probably ask about any medications you’re taking, your drug or alcohol use, and your medical history. Spend some time thinking about your lifestyle and sleep habits. It’s best to avoid caffeine and alcohol at night. If you don’t exercise, starting regular exercise might help you sleep better. If you’re depressed or anxious, talk to your doctor to see if relaxation techniques can help, if medication might be helpful, or if seeing a mental health provider is best. If you’re suffering from bouts of insomnia, take heart. Most people can return to more normal sleep patterns when they make simple changes in their lifestyle or habits.

  • Sleep disorders

    Sleep disorders

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    •  

    Sleep disorders - Animation

    You tuck yourself under the covers, turn out the light, and look forward to eight hours of blissful slumber. But, after turning for hours you're still exhausted, and no closer to sleep than when you first got into bed. Let's talk toady about sleep disorders. Sleep disorders fall into four basic categories. The scenario I described, in which you toss and turn because you can't fall asleep, is called insomnia. Another type of insomnia is when you wake up in the middle of the night and can't get back to sleep. Sometimes people get insomnia for a night or two because they're stressed out over a big meeting at work, or they're excited about an upcoming trip. Others can't sleep night after night, and that's called chronic insomnia. People with the second category of sleep disorders have a hard time staying awake during the day, even if they slept well the night before. This is called hypersomnia. Sometimes doctors can't find a cause for hypersomnia. But in many cases, a health condition like fibromyalgia, a thyroid problem, a disease like mononucleosis, obesity, or obstructive sleep apnea, can make you sleepy. If you notice a co-worker is nodding off in the middle of meetings, he might have narcolepsy, a sleep disorder that causes people to sleep uncontrollably at inappropriate times during the day. Narcolepsy isn't only embarrassing, it can be dangerous if you nod off behind the wheel of a car. A sleep rhythm problem means that you can't stick to a normal sleep schedule. Maybe you work the night shift at your job, or you're always traveling to different time zones and are constantly battling jet lag. Well, whatever the cause, the lack of a normal sleep pattern is called a sleep rhythm disorder. And finally, there are the types of sleep disorders that wake you up with a jolt in the middle of the night, and, these are called parasomnias, and they can severely interrupt your sleep. You may walk in your sleep, or act out your dreams. Children often have night terrors, in which they wake up from a deep sleep in a terrified state. The good news is that you don't have to live on fewer hours of sleep, because there are decent treatments for sleep disorders. If you're struggling to sleep throughout the night, and dragging through the day as a result, talk to your doctor, who can refer you to a sleep specialist for an evaluation.

  • Sleep patterns in the young and aged

    Sleep patterns in the young and aged - illustration

    Sleep patterns change with age, anxiety levels and many other factors. Normally, younger people have more concentrated periods of deep sleep compared to older people.

    Sleep patterns in the young and aged

    illustration

  • Insomnia

    Animation

    •  

    Insomnia - Animation

    Do you have trouble falling asleep at night? Or, do you go to sleep, only to wake up a few hours later and stay awake for hours at night? Well, let’s today talk about insomnia. Your sleep-wake cycle is a delicate pattern run by something called circadian rhythms. These rhythms are physical, mental, and behavioral changes in your brain that roughly follow a 24-hour cycle. Your daily and nightly habits, many you learned as a child, may affect your circadian rhythms and how well you sleep at night. Poor sleep or lifestyle habits that may cause insomnia include going to bed at different times each night, daytime napping, and a poor sleeping environment such as too much noise or light. Spending too much in time in bed while you’re awake can change your sleep patterns too. Likewise, working evenings or night shifts and not getting enough exercise can affect your sleep. People who use alcohol or recreational drugs may have trouble sleeping. Heavy smoking and drinking too much caffeine can also cause insomnia. And, even using some types of sleep medications a lot can cause you to lose sleep. Medical problems can cause insomnia too. People with anxiety disorders, bipolar disorder, thyroid disease, depression, and chronic pain problems may have trouble going to sleep or staying asleep. So, what do you do about insomnia? Well, it’s important to remember that not everyone needs 8 hours of sleep every night. Some people do just fine on 6 hours of sleep, while others need much more. If you need more sleep, your doctor will probably ask about any medications you’re taking, your drug or alcohol use, and your medical history. Spend some time thinking about your lifestyle and sleep habits. It’s best to avoid caffeine and alcohol at night. If you don’t exercise, starting regular exercise might help you sleep better. If you’re depressed or anxious, talk to your doctor to see if relaxation techniques can help, if medication might be helpful, or if seeing a mental health provider is best. If you’re suffering from bouts of insomnia, take heart. Most people can return to more normal sleep patterns when they make simple changes in their lifestyle or habits.

  • Sleep disorders

    Animation

    •  

    Sleep disorders - Animation

    You tuck yourself under the covers, turn out the light, and look forward to eight hours of blissful slumber. But, after turning for hours you're still exhausted, and no closer to sleep than when you first got into bed. Let's talk toady about sleep disorders. Sleep disorders fall into four basic categories. The scenario I described, in which you toss and turn because you can't fall asleep, is called insomnia. Another type of insomnia is when you wake up in the middle of the night and can't get back to sleep. Sometimes people get insomnia for a night or two because they're stressed out over a big meeting at work, or they're excited about an upcoming trip. Others can't sleep night after night, and that's called chronic insomnia. People with the second category of sleep disorders have a hard time staying awake during the day, even if they slept well the night before. This is called hypersomnia. Sometimes doctors can't find a cause for hypersomnia. But in many cases, a health condition like fibromyalgia, a thyroid problem, a disease like mononucleosis, obesity, or obstructive sleep apnea, can make you sleepy. If you notice a co-worker is nodding off in the middle of meetings, he might have narcolepsy, a sleep disorder that causes people to sleep uncontrollably at inappropriate times during the day. Narcolepsy isn't only embarrassing, it can be dangerous if you nod off behind the wheel of a car. A sleep rhythm problem means that you can't stick to a normal sleep schedule. Maybe you work the night shift at your job, or you're always traveling to different time zones and are constantly battling jet lag. Well, whatever the cause, the lack of a normal sleep pattern is called a sleep rhythm disorder. And finally, there are the types of sleep disorders that wake you up with a jolt in the middle of the night, and, these are called parasomnias, and they can severely interrupt your sleep. You may walk in your sleep, or act out your dreams. Children often have night terrors, in which they wake up from a deep sleep in a terrified state. The good news is that you don't have to live on fewer hours of sleep, because there are decent treatments for sleep disorders. If you're struggling to sleep throughout the night, and dragging through the day as a result, talk to your doctor, who can refer you to a sleep specialist for an evaluation.

  • Sleep patterns in the young and aged

    Sleep patterns in the young and aged - illustration

    Sleep patterns change with age, anxiety levels and many other factors. Normally, younger people have more concentrated periods of deep sleep compared to older people.

    Sleep patterns in the young and aged

    illustration

A Closer Look

 

Talking to your MD

 

    Self Care

     

    Tests for Sleep disorders in older adults

     
     

    Review Date: 8/22/2016

    Reviewed By: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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