July 22, 2021

What Causes Insomnia in the Elderly? How to Treat Them?

Written by: Amanda Cheong, M.D.

There’s nothing like laying your head down, and drifting into a restful and restorative sleep at the end of a long day. You deserve that. You close your eyes and look forward to feeling refreshed the next time you open them in the morning. But sleep does not come this easy in elderly individuals.

 

Studies have shown that as much as 60% of older adults with insomnia have a hard time sleeping. 70% of the elderly have a hard time staying asleep throughout the evening. Around 50% of elderly adults experience symptoms of insomnia.[1] But what are those really?

 

What is insomnia?

 

Generally speaking, insomnia can be seen as dissatisfaction with the amount of sleep or sleep quality someone is getting at night. There are specific criteria for diagnosing insomnia which vary depending on the reference material.[1] But there are some experiences and symptoms that are common in those who have insomnia.

 

Those with insomnia usually lay in bed, unable to go to sleep even if they want to. When they do go to sleep, they may be woken up in the middle of the night and unable to get back to sleep. Or, they may simply not feel refreshed when they wake up from sleep. Typically, more than one symptom is present in an elderly individual complaining of insomnia.[2

 

But the question really is what causes these symptoms and what can we do to fix it

 

Causes and consequences of lack of sleep in elderly individuals

 

One of the chief causes of insomnia in the elderly is multimorbidity. This refers to having multiple, chronic medical conditions. Some of these medical conditions may have insomnia as a symptom.[3] Some may have a symptom that promotes insomnia, such as urinating several times over the course of the night.[4]

 

Medications can also have side effects that lead to poor sleep quality.[5] Some of the drugs that cause insomnia in the elderly include antihypertensive medications, antidepressants, corticosteroids, medications with caffeine, and even some over the counter nasal decongestants (Yes, the kind you get for a runny nose. They can cause insomnia). [2]

 

Especially troublesome in the elderly is that the amount of time spent sleeping normally goes down as people age. Termed age-related sleeping changes, they may account for some of the symptoms of insomnia in seniors.[6]

 

There are medications available for insomnia in the elderly. [1,2] However, the physiology of older adults is a bit more delicate than that of the younger folk. Older adults absorb more of the active medication in a tablet. They excrete less of it compared to younger individuals. They also often have more medical conditions and take more medications that can interact with each other.[7]

 

It is best to consult a medical professional who would be more experienced in juggling the different conditions, medications, and their side effects along with the added insomnia in the elderly. But insomnia in the elderly treatment guidelines will always start with nonpharmacologic methods or methods that don’t require medication to treat insomnia.[1,2] Let’s go through those.

 

Natural sleep remedies for the elderly

 

There isn’t a one-size-fits-all technique or even something that I would call the “best treatment” for insomnia in older adults. However, there are several tried and tested methods that have been studied and show results.[1,2

 

These aren’t magic solutions that promise a blissful night’s sleep the first time you try them. Like a good diet and regular exercise, these methods require a certain amount of diligence and patience. These techniques also build on each other, and more than one technique can be used together. 

 

Let’s start with sleep hygiene. 

 

Sleep hygiene isn’t about keeping your sleeping space clean. It’s about creating an environment and a bedtime routine that promotes better sleep. [1,2]

 

Your bedroom and, specifically, your bed constitute this sleeping environment. You want your body to be able to sense that it’s time to sleep soon when you enter your bedroom or when you lay down in bed. The body can sense when you’re in a place where you need to stay awake or need to sleep--- but you must teach it. You need to create strong associations between your bed and sleep.

 

That is, sleep and only sleep.

 

For this to work for older adults, their bed must be a place that is exclusively for sleep. Not reading books or not texting for the tech-savvy seniors out there. Just sleep. It is also best to leave the things that you usually associate with staying awake outside the door. Most elderly individuals don’t have work or meetings on their computers. But some might still own laptops or watch televisions before they go to bed. These can still be cues to stay awake and interfere with the sleep associations we want in our bedroom.[1,2]

 

These associations are also strengthened when one has a winding down routine. This routine ideally starts at the same time each night, and that the time an elderly individual sleeps also stays the same. They may take a warm bath with some scents that help them relax. They may brew a cup of caffeine-free tea (my favorite would be lavender or chamomile). This winding down, ideally, doesn’t involve any gadgets that could emit blue light that stimulates wakefulness.[1,2]

 

As we’ve mentioned, the body can sense when you need to be asleep and when you need to wake. As such, we can train our body on what time they need to sleep if we do it at the same time every day. Elderly individuals will, then, get sleepy when the body senses that it’s almost bedtime. Waking up at the same time daily, even if you slept late and even on the weekends, will also help keep this learned body clock consistent.[1,2]

 

Sometimes the best advice is not to think about falling asleep too much. We get so caught up in the idea of “failing” to fall asleep that it is the thought that keeps us awake at night. Meditation and relaxation techniques can help with this-- to keep our thoughts quiet in the evening. It’s the same logic as counting sheep to go to sleep.[2]

 

Each person is a little different. There are techniques that work for some but not others. These sleep routines can be personalized for every elderly to find the best way to relax. At the end of the day, all we want for our loved ones are sweet and restful dreams.

References:

  1. Patel D, Steinberg J, Patel P. Insomnia in the Elderly: A Review. J Clin Sleep Med. 2018;14(6):1017-1024. Published 2018 Jun 15. doi:10.5664/jcsm.7172
  2. Krystal AD, Prather AA, Ashbrook LH. The assessment and management of insomnia: an update. World Psychiatry. 2019;18(3):337-352. doi:10.1002/wps.20674
  3. He L, Biddle SJH, Lee JT, et al. The prevalence of multimorbidity and its association with physical activity and sleep duration in middle aged and elderly adults: a longitudinal analysis from China. Int J Behav Nutr Phys Act. 2021;18(1):77. Published 2021 Jun 10. doi:10.1186/s12966-021-01150-7
  4. Chartier-Kastler E, Leger D, Montauban V, Comet D, Haab F. Etude observationnelle nationale (Association française d'urologie) de l'impact de la nycturie sur le sommeil des patients porteurs d'une hyperplasie bénigne de la prostate [Impact of nocturia on sleep efficiency in patients with benign prostatic hypertrophy]. Prog Urol. 2009;19(5):333-340. doi:10.1016/j.purol.2008.10.013
  5. Campanini MZ, González AD, de Andrade SM, et al. The association of continuous-use medications and sleep parameters in a sample of working adults [published online ahead of print, 2021 Mar 13]. Sleep Breath. 2021;10.1007/s11325-021-02343-x. doi:10.1007/s11325-021-02343-x
  6. Miner B, Kryger MH. Sleep in the Aging Population. Sleep Med Clin. 2017;12(1):31-38. doi:10.1016/j.jsmc.2016.10.008
  7. Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev. 2009;41(2):67-76. doi:10.1080/03602530902722679
Article written by Amanda Cheong, M.D.
Dr. Amanda Cheong spent her formative medical years within the walls of the Philippine General Hospital, a high-volume tertiary institution built to serve the underserved. After graduating with a degree in medicine, she went on to write, edit, and compile healthcare stories from the start of the COVID-19 pandemic for an online anthology. Currently, she is involved in medical research as well as volunteer telemedicine consults. She enjoys writing fiction on the side when she’s not tending to her plants and three pet turtles.

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