The Complete Guide to Insomnia for Aging Adults + How to Get More Sleep

Seniors need just as much sleep as younger adults, according to numbers from the National Sleep Foundation. However, the prevalence of sleep disorders like insomnia among older adults is a growing concern for the medical community. In fact, some studies have found that around 50% of seniors report difficulty falling and staying asleep.

This comprehensive guide outlines the causes and symptoms of insomnia, as well as common treatments. Jump to a specific topic using the links below or keep reading to learn more about insomnia in seniors and adults.

Table of Contents

The Causes of Insomnia in Older Adults

As people age, changes to normal sleep patterns may occur. Seniors may produce less melatonin, the hormone that regulates sleep cycles and circadian rhythms. This often results in lighter, more fragmented sleep during the night.

While the normal aging process can cause symptoms of insomnia, there are other factors that may result in an inability to fall asleep naturally.

insomnia causes

Physical Conditions

Many common health conditions are correlated with insomnia. Examples of conditions linked to insomnia include:

Chronic pain: Pain can make falling asleep difficult. Common conditions like arthritis, fibromyalgia and obesity can result in chronic pain, making nightly movements and adjustments painful.

Diabetes: Uncontrolled blood sugar levels caused by diabetes may lead to sleep problems. Symptoms of irregular blood sugar include night sweats, frequent urination and hypoglycemia. For those who have nerve damage as a result of diabetes, nighttime movement may cause leg pain.

Heart disease: Heart conditions can lead to a number of symptoms that may make sleep difficult. Some heart problems can lead to a buildup of fluid in the lungs, which may cause shortness of breath or sleep apnea. For those living with coronary artery disease, the natural pattern of circadian rhythms during the night may lead to chest pain, irregular heartbeat and, in extreme cases, heart attack.

Asthma: The natural circadian rhythms can cause small movements in the muscles around the airways, potentially making breathing difficult. This constriction can cause nocturnal asthma attacks and shortness of breath that may wake the sleeper up immediately.

Alzheimer’s Disease and Dementia: Memory loss conditions can disrupt normal brain function and sleep regulation. For those who experience nightly wandering, disorientation and agitation, falling asleep can be difficult as a result.

Medications

Some medications list insomnia and sleeplessness as side effects. The main types of medications that may cause insomnia include:

  • Alpha-blockers: Alpha-blockers have been linked to decreased REM sleep and increased daytime sleepiness. These effects can cause nighttime sleeplessness.
  • Beta-blockers: This type of medication has been linked to sleep disturbances and nightmares. They are also known to reduce the production of melatonin.
  • Corticosteroids: Corticosteroids can mimic the effects of the adrenal glands, which regulate stress and relaxation.
  • SSRI antidepressants: While it’s not clear exactly how these medications cause insomnia, research has linked SSRI antidepressants with agitation, sleeplessness and mild tremors in some individuals.
  • ACE inhibitors: These medications have been correlated with frequent coughing that can keep people awake at night. ACE inhibitors can also cause an increase in the production of potassium, which sometimes leads to diarrhea, cramps and pain in the joints, bones and muscles. This pain can make it difficult to fall asleep.
  • ARBs: Like ACE inhibitors, ARBs cause a buildup of potassium which can trigger pain.
  • Cholinesterase inhibitors: These medications inhibit the enzyme that breaks down acetylcholine, the neurotransmitter related to alertness and memory. Interference with this breakdown can affect involuntary body processes, including sleep regulation.
  • H1 antagonists: H1 antagonists block a neurotransmitter called acetylcholine, which can cause anxiety and insomnia.
  • Specific supplements: Supplements glucosamine and chondroitin have been found to cause nausea, diarrhea, headaches and insomnia in some studies.
  • Statins: A common side effect of statin drugs that can make it difficult to sleep is muscle pain. Fat-soluble statins like Lipitor, Mevacor, Vytorin and Zocor often cause insomnia and nightmares. This is because they penetrate cell membranes and move across the blood-brain barrier, which protects the brain from chemicals traveling through the blood.

Be sure to consult a doctor before taking or changing any medication. 

Medication Type Common Drugs Used to Treat
Alpha-blockers
  • Alfuzosin (Uroxatral)
  • Doxazosin (Cardura)
  • Prazosin (Minipress)
  • Silodosin (Rapaflo)
  • Terazosin (Hytrin)
  • Tamsulosin (Flomax)
  • High blood pressure
  • Benign prostatic hyperplasia (BPH)
  • Raynaud’s disease
  • Male urinary difficulty
Beta-blockers
  • Atenolol (Tenormin)
  • Carvedilol (Coreg)
  • Metoprolol (Lopressor, Toprol)
  • Propranolol (Inderal)
  • Sotalol (Betapace)
  • Timolol (Timoptic)
  • High blood pressure
  • Arrhythmia
  • Angina
  • Migraines
  • Tremors
  • Glaucoma
Corticosteroids
  • Cortisone
  • Methylprednisolone (Medrol)
  • Prednisone
  • Triamcinolone
  • Inflammation
  • Rheumatoid arthritis
  • Lupus
  • Sjögren’s syndrome
  • Gout
  • Allergic reactions
SSRI antidepressants
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac, Sarafem)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil, Pexeva)
  • Sertraline (Zoloft)
  • Moderate to severe depression
ACE inhibitors
  • Benazepril (Lotensin)
  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Fosinopril (Monopril)
  • Lisinopril (Prinivil, Zestril)
  • Moexipril (Univasc)
  • Perindopril (Aceon)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)
  • High blood pressure
  • Congestive heart failure
ARBs
  • Candesartan (Atacand)
  • Irbesartan (Avapro)
  • Losartan (Cozaar)
  • Telmisartan (Micardis)
  • Valsartan (Diovan)
  • Coronary artery disease
  • Heart failure
Cholinesterase inhibitors
  • Donepezil (Aricept)
  • Galantamine (Razadyne)
  • Rivastigmine (Exelon)
  • Alzheimer’s Disease
  • Dementia
H1 antagonists
  • Azelastine (Astelin)
  • Cetirizine (Zyrtec)
  • Desloratadine (Clarinex)
  • Fexofenadine (Allegra)
  • Levocetirizine (Xyzal)
  • Loratadine (Claritin)
  • Allergic reactions
  • Seasonal allergies
Supplements
  • Glucosamine
  • Chondroitin
  • Joint pain
  • Joint function
  • Inflammation
  • Arthritis
Statins
  • Atorvastatin (Lipitor)
  • Lovastatin (Mevacor)
  • Rosuvastatin (Crestor)
  • Simvastatin (Zocor)
  • High cholesterol

A doctor or pharmacist may have recommendations for alternative medications. If a prescription causes insomnia or other symptoms that make it challenging to fall and stay asleep, consult a professional before stopping or changing the medication. 

Stress and Mental Health

Mental health plays a significant role in sleeping ability. In addition, stress caused by life events and mental health conditions like anxiety have been closely linked to the development of insomnia.

Research shows that insomnia is more frequent in those with psychiatric conditions such as major depression disorder, bipolar disorder and cyclothymic disorder, as well as most anxiety disorders and substance abuse disorders. These conditions, especially depression, are common in older adults and seniors, meaning they are also more likely to experience symptoms of insomnia.

Lifestyle

In addition to medical conditions and medications, lifestyle factors and environment can affect sleep regulation.

  • Sunlight: Getting enough sunshine can help regulate sleep cycles. Exposure to bright sunlight early in the day helps regulate circadian rhythms and melatonin production. Dark rooms and excessive time spent indoors can negatively affect one’s ability to sleep well at night.
  • Social time: Interacting with others, from family members to senior community residents, can help keep the brain active and engaged during normal daytime hours. In turn, this can help seniors fall asleep more easily at the end of the day.
  • Exercise: Regular exercise and physical activity promotes healthier sleep. While research hasn’t pinpointed exactly why exercise is good for sleep, moderate aerobic exercise has been correlated with increased deep sleep.
    Unhealthy habits: Focusing on healthy lifestyle habits can make a difference in sleep quality. Irregular sleeping hours, excessive screen time and consuming alcohol or sugar before bedtime can all hinder healthy sleep.
  • Significant stress: Managing stress is an important part of healthy sleep. Major life events like the loss of a loved one or a sudden move can affect sleep habits and can cause insomnia if not handled appropriately.

Symptoms of Insomnia

While insomnia can manifest in many ways, there are three telltale signs of the sleep disorder. Struggling to fall asleep, stay asleep and feeling unrested after sleep are all warning signs of insomnia.

insomnia signs

According to the National Sleep Foundation, those living with insomnia may experience one or more of these symptoms:

  • Difficulty falling asleep at night
  • Difficulty maintaining sleep (waking up during the night)
  • Difficulty sleeping long enough (waking up too early)
  • Sleep that does not feel restful
  • General fatigue and low energy
  • Daytime sleepiness
  • Excessive napping
  • Difficulty concentrating
  • Agitation and irritability
  • Impulsivity and aggression
  • Difficulty in personal relationships

Any of these symptoms could be caused by acute or chronic insomnia and should be discussed with a medical professional.

Types of Insomnia

While there are many kinds of insomnia (listed below), most forms fall into two main categories:

  1. Primary insomnia: This type of insomnia occurs when sleep problems are not a result of another health condition.
  2. Secondary (comorbid) insomnia: This type of insomnia occurs when sleep problems are caused by another medical condition, such as arthritis, heart disease or mood disorders. Secondary insomnia can also be caused by pain, medication, life changes and substance abuse.

Acute Insomnia

This is a type of secondary insomnia that usually occurs as a result of a stressful life event or sudden change in medication. Acute insomnia can last from a single night to several weeks, but can usually be resolved with medical treatment.

Chronic Insomnia

Chronic insomnia can be primary or secondary and is characterized by long-term sleep problems. Insomnia is classified as chronic if sleep difficulty lasts more than three nights per week for three months or more.

identifying your insomnia

Onset Insomnia

The Journal of Sleep Medicine describes onset insomnia as difficulty initiating sleep. This type of insomnia is typically secondary to another health condition or medication. Onset insomnia can also be caused by behavioral habits like drinking caffeine before bedtime, lack of exercise and a bedroom environment not conducive to healthy sleep.

Maintenance Insomnia

Sleep-maintenance insomnia makes it difficult to stay asleep at night. Similar to onset insomnia, this form of sleep difficulty is usually secondary to another condition or sleep disorder like sleep apnea and Restless Leg Syndrome.

How to Fall Asleep

With many seniors experiencing symptoms of insomnia and other sleep disturbances, learning how to effectively manage sleep disorders is important to other areas of health.

While insomnia can negatively affect an individual’s quality of life, there are ways to manage and treat the sleep condition that can make sleep a more restful experience.

insomnia tips

Medication for Sleep

More than 30% of seniors aged 65 and older take some type of medication for sleep, from prescription pills to supplements like melatonin.

There are hundreds of medications and supplements that can help treat sleep disorders. Here are some of the more common medical treatments for insomnia:

  • Antidepressants: Some antidepressant medications like trazodone (Desyrel) can help treat sleeplessness and anxiety.
    • Antidepressants have a range of side effects from weight gain to blurred vision. Always consult with a medical professional before and while taking antidepressants.
  • Benzodiazepines: These medications, like temazepam (Restoril) and triazolam (Halcion) are older forms of sleep treatments and can effectively treat sleepwalking and night terrors.
    • Consult a doctor before taking a benzodiazepine medication, as some may cause dependence and daytime sleepiness.
  • Doxepin (Silenor): This drug is approved for sleep-maintenance insomnia and can help individuals stay asleep by blocking histamine receptors.
    • This medication should only be taken if seven to eight hours can be dedicated to sleep, as it can cause drowsiness.
  • Eszopiclone (Lunesta): Lunesta is an effective treatment for onset insomnia.
    • The FDA recommends starting with a dosage of one milligram to avoid next-day grogginess or impairment.
  • Ramelteon (Rozerem): Prescribed to those who have trouble falling asleep, Rozerem works by targeting the sleep-wake cycle. It can be used long term and has no evidence of dependence or abuse.
    • Side effects include dizziness, fatigue and in some cases, worsening sleeping problems.
  • Zolpidem (Ambien, Edluar, Intermezzo): This type of medication is prescribed for onset insomnia and can help ease the process of falling asleep.
    • The FDA warns that because Ambien has long-lasting effects on the body, users should avoid driving or operating machinery.
  • Over-the-counter treatments: Sleep aids like Advil PM, ZzzQuil, Unisom and melatonin can all be used to help regulate sleep, though they are not official insomnia medications.
    • Most over-the-counter sleep aids contain antihistamines, which should not be taken in conjunction with other drugs containing antihistamines like cold or allergy medication.

It’s important to speak to a doctor or pharmacist before taking any medication for sleep. Some medications come with serious side effects that can be dangerous for seniors. For example, a study found that people taking sleep medications like Ambien or Lunesta fell asleep only eight to 20 minutes faster than people taking a placebo.

Common side effects of typical sleep medications include:

  • Drowsiness
  • Headache
  • Muscle pain and stiffness
  • Constipation
  • Trouble concentrating
  • Dizziness

For those taking prescription sleep medication, risks include: 

  • Eventual tolerance to medication
  • Drug dependence
  • Symptoms of withdrawal
  • Interaction with other medications

In addition to these risks, taking sleeping medication may mask an underlying condition causing insomnia – physical or mental disorders that cause insomnia can’t be treated with sleeping pills. 

Cognitive Behavioral Therapy for Insomnia

Often referred to as CBT-I, cognitive behavioral therapy for insomnia can be an effective alternative to medication.

CBT-I involves regular visits to a certified therapist who assesses sleep patterns and helps adjust behaviors to achieve better sleep. Specifically, CBT-I works to change sleep hygiene and habits, as well as mitigate anxieties around sleep that may cause disturbances in normal sleep patterns.

insomnia data

CBT-I techniques include:

  • Stimulus control therapy: This technique removes factors that condition the mind to resist sleep. For example, the therapist may recommend leaving the bedroom if sleep does not come within 20 minutes.
  • Sleep restriction: Reducing the amount of time spent in bed can lead to increased feelings of sleepiness, which can help insomniacs fall asleep the next night.
  • Sleep hygiene: Lifestyle habits like drinking caffeine and alcohol, smoking and limited exercise can negatively affect sleep. The therapist will recommend lifestyle changes to make it easier to fall asleep.
  • Remaining passively awake: Also known as paradoxical intention, this technique involves trying to avoid sleep. Worrying about being unable to fall asleep can prevent sleep, so focusing on avoiding sleep can act as reverse psychology and trick the brain into sleeping.

While sleeping pills treat symptoms of insomnia, cognitive behavioral therapy targets the underlying cause. CBT-I may be a good option for seniors living with long-term sleep concerns or other health conditions, as well as those taking certain medications that may interact with sleeping pills.

Natural Solutions to Insomnia

While medical treatment is often the most effective way to manage insomnia, there are natural treatments and lifestyle changes that can be implemented in addition to medication or therapy.

Incorporate these things into a daily routine to improve sleep quality:

  • Exercise: A study found that people who get 60 minutes of exercise five days per week have more normal REM sleep than those who don’t exercise.
  • Natural light: Exposure to sunlight during daytime hours can actually help improve sleep quality at night. This exposure helps the body determine when to produce melatonin, the hormone that causes sleepiness.
  • Yoga or meditation: A 2013 study found that 40% of people report feeling tired as a result of stress. Because stress plays a significant role in sleep disorders like insomnia, it’s important to manage stress proactively. Yoga has been found to lower stress hormones in the blood.
  • Nutrition: Certain foods – like fruit, cottage cheese, almonds and whole grains – can promote sleep. For example, almonds contain melatonin, the sleep hormone. In addition, chamomile is thought to function like a Benzodiazepine, a drug that induces sleep.

There are many ways to combat symptoms of insomnia and encourage a healthier sleep pattern. Check out the infographic below for more ways to manage insomnia and improve quality of life.

Senior Insomnia Infographic

Whether it’s the sounds of the city, stress or another health condition that’s preventing sleep, it’s important to be proactive about insomnia. Promote better sleep by making healthy lifestyle changes, consulting a doctor and keeping your living environment clean and comfortable. 

Sources

Healthline: 1, 2, 3, 4 | The National Sleep Foundation: 1, 2, 3, 4, 5, 6, 7 | NCBI: 1, 2 | Amerisleep: 1, 2 | WebMD: 1, 2 | National Institute on Aging | Sleep Advisor | Verywell Health | Sleep Education | NHS | Alaska Sleep | Always Well Within | HelpGuide | AARP | Medscape | John Hopkins University | Insomnia