Insomnia and Seniors with Sleep Problems
Last Updated: April 2, 2013
Everyone experiences an occasional restless night. But for those
who toss and turn regularly, it can be a source of intense
frustration and may even have serious consequences. Sleep is just
as essential as air, water, or food. We need continuous,
uninterrupted sleep to restore energy and feel refreshed, and for
our health and well-being.
Difficulty falling asleep and/or staying asleep, a disorder
known as insomnia, is more prevalent than people may realize. In
fact, insomnia for seniors is very common, affecting almost 50% of
adults 60 and older, reports the National Institute of Health. This
form of sleep deprivation is often debilitating and can last for
days, months, or even years. Normal sleep patterns are disrupted,
affecting both sleeping and waking hours.
Memory loss, irritability,
depression, and a variety of other symptoms can result.
Sleep requirements and patterns change throughout the life cycle
according to the National Sleep Foundation. Newborns and infants
need about 16 hours of sleep in a 24-hour span. A shift to a later
sleep-wake cycle occurs for adolescents and 9 hours of sleep is
adequate. Adults require 7-9 hours of sleep each night.
Surprisingly seniors need the same 7-9 hours, though they do
experience a shift to an earlier sleep-wake cycle.
Quality sleep is as important as quantity for rejuvenating the
body. While drifting off, our body enters into NREM
(non-rapid-eye-movement) sleep and goes through four stages,
beginning with light sleep, progressing to deeper sleep. During the
fifth stage, known as REM (rapid eye movement) sleep, breathing
becomes irregular and shallow, our eyes move rapidly, limb muscles
become immobile, and dreaming may occur. The entire NREM-REM cycle
lasts about 90-110 minutes, and usually takes place 4-5 times
during normal sleep.
Research shows that seniors tend to sleep lighter and for
shorter spans, spending less time in REM sleep. This change is
attributed to the aging process, but can also result from other
health problems. Whatever the cause, disruptions in the sleep cycle
may lead to insomnia for seniors.
Symptoms and Causes
Dr. Sunit Mistry, a pulmonary, critical care, and sleep medicine
specialist in Los Angeles and a Diplomate of the American Board of
Sleep Medicine, refers to two categories of insomnia. Sleep onset
insomnia, characterized by difficulty with falling sleep, and sleep
maintenance insomnia, which relates to the inability to remain
asleep throughout the night. Chronic insomnia, regarded as more
serious than transient or intermittent insomnia, appears nightly
for a month or more and left untreated, may persist for years.
Recognizing that your loved one has insomnia can be challenging
since sleeplessness occurs overnight. The following checklist may
be useful in helping you identify possible signs and symptoms.
- Taking more than 30-45 minutes to fall asleep*
- Having trouble staying asleep*
- Waking up early, unable to fall back asleep*
- Night falls
- Feeling drowsy, tired or exhausted*
- Complaining of being up all night
- Accidents due to sleep deprivation
- Impaired memory
- Difficulty concentrating
Insomnia may be a primary-but more often secondary-disorder
stemming from some other health condition. It can also be
triggered by medications, and in some cases, caused by sleeping
habits or the sleep environment. Mistry cites the most common
causes (in no particular order):
anxiety. Work-related pressures, death of a loved one, or other
significant life changes that cause worry and distraction may
Poor sleep hygiene. Behaviors, pre-sleep habits, the bed, or
surrounding environment may not be optimal for sleep.
Irregular sleep schedule. Travel, jetlag, or erratic hours can
throw off the body's internal clock, responsible for telling the
body when to sleep and wake.
Consumption of stimulants.Coffee, nicotine, or other stimulants
consumed close to bedtime may induce a "wired" feeling.
Consumption of alcohol. Alcohol has a sedating effect initially
promoting sleep, but later inhibits REM and fragments sleep.
Additional factors may also cause insomnia for seniors:
Phase advance. With age, the brain's internal clock shifts to an
earlier sleep cycle.
Polypharmacy. An increase in the number of medications can
create side effects and a greater chance for drug interactions.
Depression. Depression is more common in the elderly, and
insomnia is often a symptom. (Conversely, insomnia may also cause
osteoporosis, or other conditions causing physical pain or
Frequent urination. Waking up to go to the bathroom throughout
Movement and sleep disorders. Restless leg syndrome, periodic
limb movement disorder, snoring, sleep apnea, and others are linked
Neurodegenerative disorders. Dementia,
Alzheimer's, Lou Gehrig's disease, among others.
Physical Exam. Mistry stresses the importance of talking with
your loved one's doctor and providing a medical history, list of
current medications, and description of your loved one's sleeping
Sleep Diary. A sleep diary, in which sleep and waking times,
disturbances, habits, and feelings are recorded for 1-2 weeks, is
also a helpful tool in determining factors affecting sleep
patterns. Request a copy from the physician, help your loved one
fill it out, and bring it to the exam.
Sleep Study.If more information is needed, a polysomnogram, or
sleep study, may be conducted and usually involves an overnight
stay. The time taken to fall asleep and enter REM are measured; the
stages of sleep are observed; and twitching, seizures, breathing
patterns, oxygen saturation, heart rate fluctuations, and other
conditions are monitored by a sleep specialist.
Treatment and Prevention
If it is determined that another condition or medication(s) is
causing insomnia, addressing these issues first is important.
As a preventative as well as a treatment measure, Mistry
recommends focusing on proper sleep hygiene and provides some
suggestions to promote healthy sleeping and improve habits, or the
Create (or begin):
- A regular sleep/wake schedule
- Exercise early in the day or no later than 4 hours before
- A sleep environment that is dark, quiet, safe and
- Activities that encourage relaxation before bed, such as a warm
bath or shower, or calming music.
- Caffeine, other stimulants and alcohol no later than 3 hours
- Heavy meals, spicy food, and excessive amounts of liquid before
bedtime (a light snack or warm milk is okay)
- Naps (or limit them)
- Activities in bed that may cause anxiety such as work, reading,
Are sleeping pills safe?
According to Mistry, the growing trend in medicine for "quick
fixes" has led to an overuse of sleeping pills for the treatment of
insomnia. Some are relatively safe, but it is always best to
consult a physician before using them as each have their own set of
precautions, side effects, and other considerations. "Older people
tend not to metabolize medicine as quickly and as a result,
medications may either stay in their system longer, and/or
potentially interact with other drugs. The risks associated with
sleeping pills for those suffering from liver or kidney disease may
also be higher. Dependence on sleeping aids can be physical, but
may also become psychological," Mistry cautions.
Prescription Sleeping Aids
Ambien®, Sonata®, and Lunesta®
represent the newest class of sleeping pills on the market,
referred to as nonbenzodiazepine hypnotic medications. They quiet
the nervous system to induce sleep, generally have reduced risks of
side effects the next day, and are intended for short-term or
intermittent use. Rozerem®, currently the latest
nonbenzodiazepine hypnotic, works in a slightly different way from
the others (similar to melatonin; see below) and is the only one
approved for long term use by the FDA.
Benzodiazepine hypnotic medications such as
Restoril®, Prosom®, Dalmane®, and
Halcion® are an older class of sleeping pills. They have
a higher likelihood of causing next day drowsiness and headaches
than newer medications, and may be habit-forming.
Sedating antidepressants such as Desyrel®,
Aventyl®, and Elavil®, can also relieve
insomnia in lower doses. If insomnia is secondary to depression or
anxiety, both conditions may be improved by these medications.
Non-prescription Sleeping Aids
Common over-the-counter options, such as Nytol®,
Sominex®, and Tylenol® PM are readily
available at most pharmacies, and may relieve short-term sleep
issues. Many contain antihistamines, which induce drowsiness;
however, prolonged use can decrease effectiveness.
Certain supplements have also been used to treat insomnia, the
most known of these is the hormone melatonin, believed to help
control the body's internal clock. The long-term effects of
melatonin and most other supplements, such as valerian, chamomile,
and kava are unknown at this time, and they are not regulated by
We all deserve a good night's sleep. Our health depends on it.
So if insomnia is affecting your loved one, be sure to encourage
him or her to seek medical help. In order to properly treat
insomnia one must first understand the root causes, so a thorough
examination by a qualified physician is the first step toward
finding the solution.
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