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Elderly Insomnia: Causes & Treatment

Last Updated: April 30, 2015

Everyone experiences an occasional restless night. But for those who toss and turn regularly, the inability to sleep 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, feel refreshed and maintain 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 Basics

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. 

Insomnia Symptoms & 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.

Night

Day

  • Taking more than 30-45 minutes to fall asleep*
  • Having trouble staying asleep*
  • Waking up early, unable to fall back asleep*
  • Depression
  • Night falls
  • Feeling drowsy, tired or exhausted*
  • Complaining of being up all night
  • Depression
  • Accidents due to sleep deprivation
  • Irritability
  • Impaired memory
  • Difficulty concentrating

Causes of Insomnia

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):

  • Stress and Anxiety: Work-related pressures, death of a loved one, or other significant life changes that cause worry and distraction may affect sleep.
  • 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 depression.)
  • Pain. Arthritis, osteoporosis or other conditions causing physical pain or discomfort.
  • Frequent Urination: Waking up to go to the bathroom throughout the night.
  • Movement and Sleep Disorders: Restless leg syndrome, periodic limb movement disorder, snoring, sleep apnea, and others are linked to insomnia.
  • Neurodegenerative Disorders: Dementia, Parkinson's, Alzheimer's, Lou Gehrig's disease and other similar disorders can cause insomnia.

Insomnia Diagnosis

Diagnosing and determining the causes of insomnia may involve the following tests:

  • 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 habits.
  • 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.

Insomnia Treatment & 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 environment:

Create (or begin):

Avoid:

  • A regular sleep/wake schedule
  • Exercise early in the day or no later than 4 hours before bed
  • A sleep environment that is dark, quiet, safe and comfortable
  • 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 before bedtime
  • 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, or television.

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.

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 the FDA.

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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