Insomnia in The Older People: Cause, Approach, And Treatment

Changes in sleep habits, such as feeling drowsy earlier, getting up earlier, or sleeping less deeply, are natural occurrences as we age.

But, it is not a natural aspect of aging to experience insomnia symptoms like difficulty falling asleep, staying asleep, or waking up feeling exhausted. Even as you age, a good night’s sleep is essential to your mental and physical health.

Getting adequate sleep each night will make you more awake and improve your memory. If you get enough sleep, your immune system will strengthen and be better able to battle off illness.

Depression, difficulties focusing and remembering, and excessive daytime sleepiness are examples of inadequate sleep. It is an increased risk of overnight falls, all linked to poor sleep quality in older adults. Also, the risk of heart disease, diabetes, obesity, and breast cancer in women is all elevated in those who don’t get enough shut-eye.

Knowing what’s causing your insomnia is the first step in addressing it. The following advice can assist you in recognizing and resolving sleep issues that occur with older age. It allows you to finally sleep easily and enjoy a higher quality of life during the day.

Sleep And Aging

Sleep And Aging

As people become older, their sleeping habits naturally evolve. The internal clock of an older person appears to advance. It causes older adults to feel fatigued earlier in the evening and to wake extremely early in the morning.

This may make it more challenging for older adults to fall asleep at night, as they may be tempted to take more daytime naps.

Having a habitually poor sleep routine is possible. The National Sleep Foundation reports that adults of all ages require roughly the same amount of sleep to feel refreshed. So, sleeping for seven or more hours per night is advised.

There are four distinct sleep phases, from REM (rapid eye movement) sleep through deep sleep. Adults start spending less time in REM sleep and deep sleep around the middle years. The upshot of this is that as you become older, the quality of your sleep will worsen.

In addition, research has shown that older people have less restorative sleep and sleep for shorter durations of time. This transformation may come about as a natural consequence of becoming older. But it may also be the consequence of other medical issues, poor lifestyle choices, or drug side effects.

Even the structure of our sleep shifts as we become older. There are four distinct phases of sleep:

  • Two periods of “light” NREM sleep
  • One of the “heavy” or “slow-wave” NREM sleep
  • One period of REM sleep

Researchers have found that the percentage of slow-wave NREM sleep and REM sleep in older adults is lower than in the young. This makes individuals more prone to nighttime awakenings. It also diminishes their morning energy and alertness.

Common Causes of Insomnia Among The Older Adults

TheĀ  common causes of Insomnia which is prevalent among older adults are as follows:

1. Lack of Quality Sleep And a Poor Place to Sleep

Lack of Quality Sleep And a Poor Place to Sleep

Failing to get enough sleep, drinking alcohol before bed, and falling asleep with the television on are some examples of insomnia. It is essential to establish a bedtime ritual that is calming and to sleep in an environment that is relaxing.

2. Physical Discomfort or The Need For Medical Attention

Physical Discomfort or The Need For Medical Attention

Some medical issues might make it difficult to get a good night’s rest. It includes the need to get up frequently to urinate, pain, arthritis, asthma, diabetes, osteoporosis, heartburn at night, dementia, etc. If you’re experiencing health problems, consult your doctor.

3. Menopause And its Aftereffects

Menopause And its Aftereffects

Night sweats and hot flashes are two symptoms of menopause. It can keep women from getting a good night’s rest. Sleep issues can persist long after menopause has passed. Changing how you spend your days, particularly regarding eating and exercising, can assist.

4. Medications


Persons over 65 take more prescriptions than other people. The combined effects of all those medications can make it difficult to get a good night’s rest. Your doctor may recommend adjustments to your drug regimen to improve your sleep.

5. Not Enough Exercise

Not Enough Exercise

Over time, inactivity might make you either feel drowsy all the time or never feel sleepy at all. Daytime aerobic exercise routines have been shown to improve sleep quality.

6. Stress


When people go through major life transitions like retirement, the death of a loved one, or relocating out of the family home, they often feel overwhelmed. Finding a person you can talk to might work wonders for your mood.

7. Absence of Participation in Social Activities

Absence of Participation in Social Activities

Maintaining an active lifestyle through socializing, caring for family, and working will help you get ready for sleep at night. Try volunteering, connecting with other retirees, or enrolling in a course for adults.

8. Insomnia, or Sleep Issues

Insomnia, or Sleep Issues

The prevalence of RLS and other sleep-disordered breathing disorders, such as snoring and sleep apnea, increases with age.

9. Lack of Sunlight

Exposure to strong light from the sun can assist in normalizing melatonin and the body’s internal clock. If possible, expose yourself to sunshine for at least two hours daily. Keep blinds open or use a light therapy box during the day.


Verifying that an older patient experiences insomnia is the first step in assessing sleep issues. Step two is to identify the primary sleep problem. Finally, it’s beneficial to think about the patient’s sleep pattern in terms of quality, duration, frequency of awakenings, and timing.

Having the patient keep a sleep log can be quite helpful. In addition, every detail of the patient’s daily routine, from bedtime to waking time to mealtime to alcohol use to physical activity to medicine use (both prescribed and over-the-counter), should be recorded here.

While taking a patient’s overall clinical and medication history, doctors should check for any symptoms or medications that cause sleep disruptions. In addition, all patients complaining of sleep disturbances should have their medical history evaluated for potential complicating factors such as drugs, alcohol, and substance misuse.

Until otherwise demonstrated, a medicine that causes insomnia at the same time it’s being used is likely to be to blame.

A thorough psychological and neurological examination should be conducted. It includes an array of laboratory tests (including thyroid function, a serum chemistry panel, and cardiovascular studies if required), etc. An analysis of the sleeping environment should round out the initial evaluation. It may be necessary to have a sleep specialist check the patient.

Treatments For Older Adults With Insomnia

Education about the importance of sleep and better habits before attempting to treat chronic insomnia in older people is a common first step. During this appointment, the doctor will discuss with the patient what elements should be included in a bedroom to promote restful sleep.

For example, a bedroom should be cool (below 75 degrees Fahrenheit), dark, and quiet.

It’s not appropriate to work or play video games in bed; it’s meant for sleep exclusively. However, an air conditioner could be very useful during the warmer months. In addition, doctors will stress the need to stay active. They will also encourage you to eat a healthy diet while discouraging using stimulants such as caffeine and smoking.

Older adults with insomnia may get relief from non-pharmaceutical methods as well. Among these are:

1. Management of Stimulus

Management of Stimulus

The theory behind this method is that patients are more likely to get a decent night’s sleep if they only go to sleep when they are truly exhausted.

Anyone who has been lying in bed for twenty minutes and still hasn’t been able to fall asleep must get out of bed. They should engage in another activity until they feel tired again. They should also make it a point to get up at the same time every morning and not nap during the day.

2. Restriction of Sleep

Restriction of sleep

Patients who struggle with insomnia are often given the recommendation to maintain a sleep diary. This is done to keep track of the hours in which they are awake and asleep. Also, note the amount of time it takes them to drift off to sleep on a nightly basis.

Once a doctor has reviewed a patient’s sleep diary, they may recommend cutting back on time spent in bed each night until the patient’s sleep efficiency improves. 

The term “sleep efficiency” refers to the proportion of time that is spent asleep in comparison to the time that is spent awake in bed. People can start going to bed earlier once they have reached a 90% sleep efficiency rate.

3. Cognitive Behavioral Therapy

Cognitive Behavioral Therapy

Older adults with insomnia can benefit from cognitive behavioral therapy. This is because it helps them identify erroneous thoughts and attitudes about sleep and replace them with more accurate ones.

Timed exposure to intense lights in the evening can aid older adults who typically go to bed and wake up quite early. Do stay up for longer and eventually fall asleep later.

When these non-drug approaches have failed, a doctor may prescribe sleep aids. A lot of thought and effort must go into selecting the best insomnia medicine for older individuals. The risk of falling increases in older people using pharmaceuticals with hypnotic effects. It includes pharmaceuticals such as benzodiazepines (BZDs) and non-benzodiazepines (Z-drugs).

Because of the significant risk of tolerance, dependency, and withdrawal with these medications, doctors need to consider their patients’ medications when prescribing them.

Other sleep aids have fewer side effects. But doctors should still use caution when prescribing them. By modulating the body’s endogenous hormones, some drugs can induce sleepiness.

Among these is ramelteon, an agonist for melatonin receptors. Melatonin is a pineal gland hormone that produces sleepiness in the evening. Another is suvorexant, which blocks the effects of orexins (neuropeptides responsible for arousal and alertness). Antihistamines available without a doctor’s prescription are another option.

You should consult a qualified doctor first whether you’re considering trying for insomnia, pharmaceutical, or otherwise.

The Takeaway

Persistent sleep issues in older adults have been linked to greater health risks, such as depression and accidental falls.

People living with insomnia may benefit more from CBT if they address the underlying causes of poor sleep quality.

As such, it’s important to train one’s body and mind to fall asleep quickly. Try to stay asleep through the night with the help of sleep education, stimuli control, and time-in-bed limitations. But, the process of making adjustments may take up to six weeks.

While a doctor may prescribe sleep medicine if cognitive behavioral therapy fails to alleviate insomnia, this is only a temporary measure. The best method to ensure you get sufficient quality sleep is to take control of your sleeping routine.

Sarah Wagner

I'm Sarah Wagner, and I founded Sweet Island Dreams in 2022. It's a blog dedicated to helping people mental vacation virtually anytime they want. By providing information about the best sleep of your life, I help people drift away to paradise without ever having to leave their bed!