It is not unusual to hear an elderly person say, “it’s just part of getting older,” when asked about Insomnia. To that end, studies show that over 50% of people 65 years and older report trouble falling and staying asleep.
“Too often, the sleep complaints of our senior citizen patients are ignored or undertreated. This needs to change.” Dr. Tomkinson
Sleep problems are often chalked up to a natural part of aging. Though your sleep changes as you grow older, age itself does not create sleep problems. As you age, you fall asleep earlier in the night and sleep less deeply. You also tend to nap throughout the day, though excessive napping can add to sleep loss. With these sleep pattern changes, elderly patients will not have the same type of sleep that they experienced when they were young. But age itself does not cause Insomnia. However, many conditions that are seen more frequently in geriatric patients can cause or exacerbate sleep dysregulation.
Common Causes for Sleeplessness in the Elderly
From environmental factors to sleep pattern changes to other medical diagnoses, many things can contribute to sleeplessness in the elderly. Here is a list of some of those things.
➤ Typical sleep pattern changes are associated with aging. As we already discussed, aging doesn’t cause insomnia, but your sleep patterns change as you age.
➤ Prescribed medications can cause sleep dysregulation as a side effect. Some well-known drug types that have these side effects are antidepressants, benzodiazepines, blood pressure medication, corticosteroids, diuretics, and anticholinergics to treat COPD.
➤ Mental illnesses are known to cause sleep dysregulation and are often caused by sleep problems. It is a “chicken and the egg” situation; doctors don’t always know which came first. However, doctors know that both disorders must be treated, or they will worsen each other. Depression, Bipolar Disorder, and Anxiety disorders are a few mental illnesses known to affect sleep.
➤ Other sleep disorders can exacerbate sleep dysregulation. Conditions such as sleep apnea and Restless Leg Syndrome can worsen sleeplessness. Sleep apnea is caused when a patient’s airway is obstructed, causing them not to breathe, sometimes hundreds of times a night. Restless Leg Syndrome causes patients’ legs to burn, have pain, or feel like they have something crawling on their calves. The only way they can alleviate this feeling is to move their legs.
➤ Poor sleep hygiene can cause sleep dysregulation. Examples of bad sleep hygiene are napping too much during the day, bad eating habits, not getting enough exercise, and watching computer and television screens before bed.
➤ Drinking too much caffeine or alcohol or drinking them too close to bedtime will cause sleep problems. Caffeine remains in the system for at least five hours and should not be consumed past 2 pm. In addition, despite popular belief to the contrary, alcohol does not help you to sleep. Though it may help you fall asleep quicker, it has a rebound effect that keeps you from sleeping deeply and disrupts the REM cycle.
➤ Patients diagnosed with other medical conditions may also have chronic sleep dysregulation. We will look more deeply into what some of these conditions and diagnoses are in the next section.
➤ Smoking can also cause sleep issues, especially if you sleep right before going to bed. There are several reasons for this. First, cigarettes contain nicotine which is a stimulant. Second, another reason is smoking affects your sleep is that it dramatically increases your chances of developing sleep apnea.
➤ Stress, particularly chronic stress, affects your sleep in many ways. For example, it significantly increases your risk of depression and anxiety. Stress also causes your body and mind to be unable to relax. Stress also causes sleep disruptions and disruption of your REM sleep cycle.
“Sleep is the single most effective thing we can do to reset our brain and body health each day — Mother Nature’s best effort yet at contra-death.”
― Matthew Walker
Health Diagnosis that Affect Sleep in Elderly Adults
Here is a list of some of the medical diagnoses that can cause sleep dysregulation. This is by no means a complete list. Many other medical conditions cause sleep problems.
“The comorbidity of sleep disorders and other diseases is well proven. Yet too often a patient isn’t even asked how they are sleeping.” Dr. Tomkinson
➤ Anxiety Disorders
➤ Asthma
➤ Arthritis
➤ Bi-polar
➤ COPD
➤ Congestive Heart Failure
➤ Chronic Pain Syndrome
➤ Dementia
➤ Depression
➤ Fibromyalgia
➤ GERD
➤ Heartburn
➤ Menopause
➤ Restless Leg Syndrome
➤ Multiple Sclerosis
➤ Chrohn’s Disease
➤ Colitis
➤ Narcolepsy
➤ Sleep Apnea
➤ Thyroid Diseases
Sleeping Pills and The Elderly
A full one-third of elderly patients in the U.S. today say that they take some form of sleep aid to fall and stay asleep. More than 50% of these patients have been on these sleep aids for longer than a year. However, sleep aids are not recommended for use for more than two weeks at a time. This includes prescription medications, but it also is over-the-counter medications and natural sleep remedies.
You may have watched the ads on television for sleeping medication. First, there is a person on the screen fitfully tossing and turning in their sleep. Then they take a little magic pill, and, POOF, they are sleeping peacefully with a contented smile on their face in the next shot. Who wouldn’t want that? There are no more long hours of staring at the ceiling, no more dark bags under your eyes, no more dragging through the morning propped up only by your fifth cup of coffee. No, all your sleep problems are solved by one tiny pill. It sounds too good to be true.
As the famous saying goes, “if it sounds too good to be true, then it probably is.” Unfortunately, sleeping medications and other remedies are short-term solutions at best.
Prescribed sleeping medications are strongly discouraged for patients over 65 years old. Studies show that there are significant and dangerous side effects for the elderly.
Sedative drugs have a more intense effect on seniors than younger patients, and they stay in their system longer. Studies have proven that sleeping medications cause memory problems to worsen, or they can cause memory issues to start. They also can cause or worsen confusion in elderly patients.
Studies have proven that sleeping pills also double the risk of falling and fracturing bones, particularly hip bones. Falls are the number one reason for hospitalization of patients over 65. Seniors are also twice as likely to have a car accident when taking sleeping medication.
Another risk of sleeping aids is that they can react with other medications the patient is taking. These include medications for depression and anxiety, medication for heart and respiratory diseases, and medications for autoimmune diseases. Even many of the over-the-counter drugs and natural supplements react with prescribed medication. Therefore, you must discuss any of these prescribed or non-prescription sleep medications you consider taking with your doctor and pharmacist. Be sure that they look for interactions with your other medicines. Talk to your doctor about sleep therapies that are not medications. First, try these interventions. If you are still having trouble with sleep dysregulation, your doctor can prescribe low-dose medicines for a short time to help reset your sleep cycles.
Sleep Therapies and Good Sleep Hygiene
“Sleep hygiene awareness is sadly lacking in the U.S. Instead, patients either suffer from disturbed sleep or turn to unproven and sometimes dangerous OTC and natural remedies.” Dr. Tomkinson
There are many different therapies that you can try to establish good sleep hygiene habits.
Many studies have proved Cognitive Behavioral Therapy (also known as CBT) to be an effective way to treat patients with sleep dysregulation issues. CBT can include relaxation techniques, sleep limitations, controlling stimuli, and cognitive therapy.
Meditation is proven to help regulate sleep and manage stress and anxiety. You can find guided sleep meditation podcasts and youtube channels that are helpful.
Exercise is a good form of therapy to help straighten out your sleep cycle. Taking a walk or doing something more structured like a swim aerobics class is helpful. Water therapies and exercise are exceptional for elderly patients because they take pressure off their joints.
Establishing good sleep hygiene is another way to treat sleep disturbances. Good sleep hygiene is essentially creating good habits around your sleep. These habits need to be consistent, even on weekends and holidays. Here is a list of good sleep hygiene habits to begin to practice,
➤ Go to bed and wake up at the same time every day,
➤ Get at least twenty minutes of exercise a day. However, do not exercise close to bedtime.
➤ Do not eat a heavy meal before bed because it can cause indigestion and heartburn.
➤ Do not go to bed hungry. If you are hungry, eat something light like fruit salad or a healthy sandwich.
➤ Do not watch television or use computers and other electronics for at least an hour before bed. The blue light is proven to cause sleep disruptions.
➤ Do not drink caffeine for at least five hours before sleep.
➤ Do not drink alcohol before bed.
➤ Create a peaceful and calming environment in your bedroom with comfortable bedding. People are proven to sleep better in a cool and dark environment.
➤ Use calming essential oils, such as lavender, in a diffuser to encourage relaxation.
➤ Do something relaxing like reading or meditating for thirty minutes before bedtime.
Conclusion
Elderly patients suffer from many sleep disturbances. These sleep disturbances are better served by therapy and good sleep hygiene because medications and natural sleep aids can be dangerous.
“Our senior citizens deserve to have a good night’s sleep. So we need to focus on sleep awareness for our senior patients.” Dr. Tomkinson
The information in this article is not meant for diagnostic purposes, and we are not doctors. Please consult your doctor before making any decisions concerning your healthcare.
References
Darrell Hulisz, R. P. (2009, June 18). Assisting Seniors With Insomnia: A Comprehensive Approach. U.S. Pharmacist – The Leading Journal in Pharmacy. https://www.uspharmacist.com/article/assisting-seniors-with-insomnia-a-comprehensive-approach.
Foundation, A. B. I. M. (2018, November 1). Sleeping Pills for Insomnia and Anxiety in Older People: Choosing Wisely. Choosing Wisely | Promoting conversations between providers and patients. https://www.choosingwisely.org/patient-resources/treating-insomnia-and-anxiety-in-older-people/.
Gavin, K. (2017, October 11). 8 Tips to Help Older People Fall – and Stay – Asleep. Tips to Help Older Adults Fall and Stay Asleep Without Medication | Michigan Medicine. https://healthblog.uofmhealth.org/wellness-prevention/8-tips-to-help-older-people-fall-and-stay-asleep.
Gavin, K. (2017, September 27). Sleep Aids Aren’t Safe for Older Adults, but 1 in 3 Still Take Them. University of Michigan. https://labblog.uofmhealth.org/rounds/sleep-aids-arent-safe-for-older-adults-but-1-3-still-take-them.
Glen L Xiong, M. D. (2021, May 26). Geriatric Sleep Disorder Medication: Sedative/Hypnotics, Antidepressants, Melatonin Agonists, Orexin Receptor Antagonists. https://emedicine.medscape.com/article/292498-medication.
Goodreads. (n.d.). Sleep Quotes (1536 quotes). Goodreads. https://www.goodreads.com/quotes/tag/sleep?page=5.
Insomnia in Elderly Adults: Causes & Prevention. A Place for Mom. (n.d.). https://www.aplaceformom.com/caregiver-resources/articles/insomnia-and-sleep-aids.
Insomnia in the Elderly: Cause, Approach, and Treatment. The American Journal of Medicine. (n.d.). https://www.amjmed.com/article/S0002-93430501056-9/fulltext.
Kernisan, L., says, B., says, S. L., says, L. L., Didyk, N., says, R. G. M. D., says, G., says, C. R., says, H. J., says, D., Says, B. R., says, C., says, E., says, M., says, F. G., says, A. G., says, J. A., says, G. R., says, M., … says, D. (2020, August 28). 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia. Better Health While Aging. https://betterhealthwhileaging.net/top-5-causes-sleep-problems-in-aging-and-proven-insomnia-treatments/.