Sleep disorders in the elderly

  • Definition
    • Sleep disorders in the elderly 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 the elderly. In general, 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.

      Sleep patterns in the young and aged

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

      Some causes or contributors to sleep disturbances in older adults include:

      • 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 (depression is a common cause of sleep problems in people of all ages)
      • Neurological 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:

      • 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 is not too hot or too cold and having a relaxing bedtime routine may help improve symptoms. Other ways to promote sleep include the following 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 cannot 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 correctly. Your health care provider should assess your risks of daytime sleepiness, mental (cognitive) side effects, and falls before you begin taking sleep medications.

      • If you think you need sleeping pills, talk with your doctor 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 doctor 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 health care 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.

  • References
    • Ancoli-Israel S, Shochat T. Insomnia in older adults.  In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 135.

      Juergens TM, Barczi SR. Sleep. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 4th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 22.

      National Heart, Lung, and Blood Institute. How Much Sleep is Enough? Available at: Updated February 22, 2012. Accessed October 22, 2014.