Tip Sheets

Ideas for reporting on sleep problems among older adults

By Liz Seegert 

English writer Thomas Dekker once said, “Sleep is that golden chain that ties health and our bodies together.” Nearly 400 years after his death, we’re still learning just how right he was.

We all need a good night’s sleep, every night. However, at least half of all older adults complain of chronic poor or insufficient sleep. Despite popular misconceptions, older adults need as much sleep as do younger people — about 7 to 9 hours, on average each night. Older adults may suffer from certain health conditions, have pain, or side effects from medication which can make a good night’s sleep difficult, if not impossible. Poor sleep is linked to numerous health issues, from hypertension to depression, and to potentially increased risk of Alzheimer’s disease.

Compared with younger adults, older adults sleep less, despite spending more time in bed, spend more time awake during the night. The sleep of older adults can more fragmented because they have greater difficulty falling asleep and are more easily awakened. They wake up earlier in the morning, nap more, and take longer to fall asleep, according to this Psychiatric Times article. The article describes a meta-analysis of more than 3,500 participants showing that after age 60, sleep efficiency (defined as the ratio of total sleep time to nocturnal time in bed, normally ≥85 percent) decreases with age.

The National Institute on Aging says poor sleep may be caused by:

  • Alzheimer disease,

  • Alcohol,

  • Changes in the body's natural internal clock, causing some people to fall asleep earlier in the evening,

  • Chronic disease, such as heart failure,

  • Certain medicines, herbs, supplements, and recreational drugs,

  • Depression,

  • Neurological conditions,

  • Lack of physical activity,

  • Pain caused by diseases such as arthritis,

  • Stimulants such as caffeine and nicotine and

  • Frequent urination at night.

Insufficient sleep is associated with significant morbidity and increased mortality. It can increase symptoms of depression or anxiety and decrease the quality of life. Poor quality sleep also can lead to:

  • Increased risk of falls or accidents,

  • Increased irritability,

  • Memory problems,

  • Slower response times,

  • Excessive daytime sleepiness and

  • Worsening of certain chronic conditions such as hypertension and diabetes.

Insomnia, defined as difficulty initiating and maintaining sleep, can also be caused by conditions like sleep apnea, which is more common in older adults. As many as 20 to 25 percent of older adults may have sleep apnea, compared with only 10 percent of middle-aged adults, according to this Philly.com article.

The National Sleep Foundation explains that sleep occurs in multiple stages, including dreamless periods of light and deep sleep, and occasional periods of active dreaming (REM sleep). The sleep cycle is repeated several times during the night. Although total sleep time tends to remain constant, older people spend more time in the lighter stages of sleep than in a deep sleep.

Circadian rhythms, such as core body temperature, hormone secretion and the sleep-wake cycle, swing back and forth at roughly 24-hour intervals. As people age, their circadian rhythms become desynchronized and lose strength. Additionally, secretion of melatonin, known to play an important role in the sleep-wake cycle, decreases with age and may contribute to poor sleep efficiency, as this article in the journal Gerontology explains.

Studies on the sleep habits of older Americans show an increase in the time it takes to fall asleep (sleep latency), an overall decline in REM sleep, and an increase in sleep fragmentation (waking up during the night) with age. These studies also confirm that prevalence of sleep disorders tends to increase with age.

According to the American Academy of Family Physicians (AAFP), older adults tend to go to sleep earlier in the evening and awaken earlier in the morning. Many older adults complain they are wide awake by 4:30 or 5 a.m. That means they must go to bed earlier to compensate otherwise sleep deprivation and excessive daytime sleepiness may result.

Many people with Alzheimer’s disease wake up more frequently and stay up longer than those without the condition. Researchers are still not sure why so many with the disease have sleep disturbances but think it may have to do with other changes going on in the brain. Some people with Alzheimer’s wander in the middle of the night, yell or exhibit other behaviors that can interrupt their caregivers’ sleep, according to the Alzheimer’s Association.

Treatment options

Sleep disorders are not an inevitable part of aging. Many older adults have good sleep quality until the end of their lives, as this article points out. There are many pharmacologic and non-pharmacologic approaches to treating sleep problems.

Once diagnosed, sleep apnea usually is treated using continuous positive airway pressure (CPAP), which ensures an open airway through the use of a small machine that maintains constant air pressure during the breathing cycle. Although CPAP decreases the risk of stroke, cardiovascular disease, and mortality in older patients, compliance can be a problem due to discomfort or machine noise.

The National Institute on Aging recommends that older adults get regular exercise, manage chronic pain and control medical conditions such as frequent urination for a better night’s rest. Treating depression may also improve sleep. 

The bedroom should be quiet, dark and at a comfortable temperature and should only be used for sleeping or sexual activity. Experts advise not eating large meals late in the evening and avoiding stimulants such as caffeine after mid-afternoon. Regular exercise can help (but not too late in the day), as can going to bed and waking at the same time every day, even on weekends.

Sleeping pills should be avoided if possible, as they can lead to dependence. Alcohol can worsen any side effects. Older adults should always speak with their health provider before taking any sleep medication, even those sold over the counter. They may interact with other drugs and lead to serious problems like dizziness, balance problems, falls or hallucinations.

More than nine million U.S. adults took prescription sleeping pills at least once during the prior month between 2005 and 2010, CBS reported. Many tended to be older and female according to a CDC study. Some may think that over-the-counter sleeping aids may be safer, but that’s not the case, writes Brandon Peters, M.D., a sleep medicine specialist at Virginia Mason Medical Center in Seattle. Common ingredients in these pills, like Benadryl, can cause confusion and urinary retention, leading to urinary tract infections.

Common prescription medications include:

  • Antidepressants, such as nortriptyline and trazodone,

  • Benzodiazepines, such as lorazepam, oxazepam and temazepam,

  • Sleeping pills such as zolpidem, zaleplon and chloral hydrate,

  • Atypical antipsychotics such as risperidone, onlanzapine and quetiapine, and

  • Older classical antipsychotics such as haloperidol.

The risks of sleep-inducing medications, especially for older people who are cognitively impaired, are considerable, says the Alzheimer’s Association. They can increase fall risk and reduce the person’s ability for self-care. This study from Penn State found that older adults with insomnia may fall more often on prescription sleep medications than those who did not take them. The Alzheimer’s Association advises that any use of sleep medications for older adults with dementia be discontinued once a regular sleep pattern is reestablished.

Further reading

Experts and sources