Insomnia in Older Adults

What is insomnia?

Insomnia is trouble falling asleep or staying asleep that results in feeling tired during the day. It can be either a long-term or a short-term problem.

Insomnia affects 1 in 3 adults every year in the US. It occurs more often in older adults, half of whom have some trouble going to sleep, staying asleep, or both. Other sleep problems such as restless legs syndrome, periodic limb movements, and sleep apnea are also more common among older adults.

As you get older, you may find that you spend more time in bed but the same or less time asleep. Older people tend to go to sleep earlier in the evening and wake up earlier in the morning. You are also more likely to take daytime naps as you grow older. Older men generally take longer to fall asleep and they wake up more often than older women. Both sexes awaken briefly more often during the night, with an increase in the lightest and least restful sleep and a decrease in the deepest and most refreshing sleep.

Problems with sleep may be the result of poor sleeping habits, but they can be a sign of other physical or mental problems.

How does insomnia occur?

Causes include:

• stress such as being in the hospital or having a sick relative
• depression, anxiety, or other emotional problems
• use of caffeine or other stimulants
• use of alcohol, other depressants, or sedatives, which can relax you but lead to shallow, fragmented sleep, especially if used long term
• pain, shortness of breath, and other discomfort caused by an illness such as arthritis or heart failure
• poor sleep habits, including going to bed at different times at night, noisy surroundings, or eating or working in bed before sleeping
• changes in sleep patterns because of different work hours or travel.

Chronic illness or pain can cause insomnia. More than 60% of adults over age 65 have one or more chronic illnesses:

• Diabetes may result in frequent urination that interferes with sleep.
• Urinary incontinence or frequency, caused by drugs, prostate enlargement, or loss of bladder control, can interrupt sleep.
• Chronic lung diseases can cause frequent arousal due to decreased oxygen and the feeling of air hunger.
• Arthritis causes joint pain and stiffness, making it hard to sleep.
• People with Alzheimer's disease have decreased total sleep time and more frequent awakenings.
• If you are very overweight, you are more likely to have sleeping problems.
• Sleep apnea is a disorder where breathing stops many times while you sleep. Most cases are due to partial airway blockage, and obesity is a contributing factor. Loud snoring and a characteristic arousal snort are signs of sleep apnea. If your bedroom partner says that you stop breathing, then snort and wake up or turn over often in your sleep, then talk about sleep apnea with your healthcare provider.
• Periodic movements in sleep is the term used for a condition where there is powerful flexing of the lower leg muscles many times throughout the night.
• Restless leg syndrome is a creepy, crawly, uncomfortable sensation in the leg muscles throughout the night. It can make falling asleep and staying asleep hard.

Certain medicines can also interfere with sleep. You should ask your healthcare provider whether any of your medicines may cause problems with sleep.

What are the symptoms?

Symptoms include:

• trouble falling asleep
• waking often in the night
• waking early in the morning and being unable to return to sleep
• not feeling rested in the morning or feeling tired during the day
• restlessness or anxiety as bedtime approaches.

Insomnia may be situational, meaning it is temporary, or it may be chronic, which means that it is ongoing.

Situational insomnia occurs with a stressful life event. It involves trouble falling asleep or staying asleep and lasts 3 weeks or less. This kind of insomnia generally goes away when the stress or life event is past. Sleeping medicine may be needed for a time to help you through this period.

Chronic insomnia can be caused by irregular sleep-wake patterns resulting from shift work, drug dependency (including chronic use of sleeping pills or alcohol), stress, illness, or psychiatric problems. It lasts longer than 3 weeks and must be treated by addressing the underlying problem. Medicine is used only for the most severe cases and only when it is really needed. Developing good sleep habits is also very important.

How is it diagnosed?

Your healthcare provider will ask you about your:

• sleep patterns
• use of any medicines
• eating habits
• mental and physical condition
• personal medical and psychiatric history and your family's history
• job and travel patterns.

Your provider may ask your spouse, bed partner, or other family member about your sleep habits. You may also have a physical exam and blood tests.

You may be asked to write down the following when you get up each morning:

• how long you were in bed
• how much time you think you actually slept
• how many times and what times you awoke
• what time you woke up in the morning
• your thoughts about the quality of your sleep.

Your healthcare provider may suggest that you spend a night in a sleep center for a continuous recording of your breathing, eye movements, muscle tone, blood oxygen levels, heart rate and rhythm, and brain waves during sleep.

How is it treated?

If a medical problem is causing your insomnia, your provider will treat you for it. If drug or alcohol abuse is the cause of your insomnia, you will need to stop using these substances.

Your provider may recommend relaxation techniques, changes in diet, and a generally healthy lifestyle that includes exercise. Your provider also will probably recommend a regular sleep routine. Counseling may help resolve psychological problems or reduce stress that may cause or contribute to your insomnia. In some situations, a medicine may be prescribed to help you sleep. Do not take any sleep medicine, including nonprescription pills, without your healthcare provider's approval.

How long will the effects last?

Often, insomnia lasts for just a few nights. If you cannot sleep almost every night for 2 weeks, tell your healthcare provider. Insomnia that lasts this long usually continues until the cause is found and corrected.

How can I take care of myself?

• Use the bedroom only for sleep and sex, not for reading or watching TV.
• Keep the room dark and the temperature comfortable.
• Massage or a warm bath before bed may relax you.
• Try a warm glass of milk just before going to bed.
• Soft music may help.
• Consider listening to white noise, such as a fan blowing.
• Keep active during the day. Exercise and get some fresh air.
• Stick to a routine of going to bed and getting up at the same time each day.
• Limit daytime naps to no more than 1 hour each day.
• Avoid caffeine late in the day.
• If you eat late at night, keep it light.
• Avoid drinking a lot of liquid before bedtime.
• If you spend more than 30 minutes in bed and cannot fall asleep, get out of bed, read, or watch TV until you are sleepy.
• Maintain a healthy weight. Being overweight may cause tiredness during the day and may worsen sleep apnea.
• Stop smoking.
• Arrange your medicine schedule with your provider so that you take any drugs that might make you sleepy in the evening and drugs that may interfere with sleep during the day.
• Avoid daily use of sleep medicines. You may become dependent on them or build up your tolerance to them so that they no longer work as well. Most sleeping pills should not be used for more than 2 weeks in a row.
• Do not drink alcohol late in the evening.

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