Aging & Health A to Z

Sleep Problems

Basic Facts & Information

What are Sleep Problems?

Although you may remember sleeping like a baby when you were younger, a good night’s sleep may feel more and more like a thing of the past as the years go by. You may no longer feel refreshed when you wake up in the morning. Daytime sleepiness and an afternoon nap may have become a normal part of your routine. Experts mostly agree that older people still need as much sleep as younger people.  The idea that we need less sleep as we age is really just a myth. What we do know, though, as that it is more difficult to get into and stay in a deep sleep as we age and our brain rhythms don’t follow the usual patterns as younger people’s brains do when they sleep. 

Even in older age, seven or eight hours of good quality sleep is still as important as a nutritious diet and regular exercise for keeping us healthy. If you are not getting enough sleep and feel tired when you wake up in the morning, you may have a sleep problem. Sleep problems can lead to:

• fatigue and sleepiness during the day
• mood changes such as depression and irritability
• difficulties with work and concentration
• injuries
• increased risk of illness 

Older adults with sleep problems use health care services more often than older people who sleep normally. 

Disrupted sleep is common in older people, and may take many forms. You may have trouble falling or staying asleep, or you may sleep too much. You may be going to sleep earlier and waking earlier.  You may feel that you need to nap during the day, but napping might mean you sleep a bit less at night. You might also experience disturbing movement disorders or abnormal breathing patterns that prevent you from getting the rest you need. Also, researchers have found that older adults spend less time in deep sleep compared to younger people.

The Most Common Types of Sleep Problems

The types of sleep problems most often afflicting older people fall into the following categories:

• Insomnia (difficulty getting enough sleep or poor quality sleep)
• Breathing problems that affect sleep such as sleep apnea
• Movements that affect sleep, such as restless leg syndrome
• Sleep disorders related to living in long-term care facilities
• Sleep problems related to medical or psychiatric conditions
• Sleep-wake cycle (circadian rhythm) sleep disorders 

Insomnia
Insomnia refers to not being able to fall asleep when you think you should, to stay asleep, or to the feeling that you have not slept enough when you wake up in the morning. 

Sleep Apnea
In this condition, you may repeatedly stop breathing for a while (usually at least 10 seconds) while you are asleep. The lack of oxygen turns on an internal alarm system that causes you to partially wake up whenever your breathing stops. Sleep apnea can cause major sleep disruption, and result in severe sleepiness during the day. It can also bring on heart problems and high blood pressure. 

Sleep apnea occurs as one of the following two types or a combination of both:

• Obstructive sleep apnea (OSA).  This type of apnea caused by a collapse and blockage of the airway while you are sleeping. Often people with this type of breathing problem when they sleep snore loudly as the airway starts to close and then appear to snort or choke while sleeping.
• Central sleep apnea (CSA). This type of apnea can cause your breathing effort to stop as you sleep. 

Restless Legs Syndrome
In restless leg syndrome, you may experience very uncomfortable, abnormal feelings in your legs when you are lying down or even just sitting. Relief comes when you get up and walk around, but the feeling comes back when you lie down, making it very difficult to fall asleep. 

Periodic Limb Movement Disorder
People with this condition move either one or both legs repetitively during sleep.  The legs will move in a specific pattern in which the muscles of the leg, feet, toes tense up in a slow-motion “kicking” movement. You will probably be unaware that you have this disorder, unless your bed partner tells you about it. However, the repeated spasms may make your legs feel quite tired when you wake up the next day.  These movements interfere with your ability to get a good rest while you sleep. You may have both restless legs syndrome and periodic limb movement disorder at the same time. 

Sleep Disorders in Long-Term Care Facilities
Older people who live in long-term care institutions often have trouble sleeping. The special circumstances of life in chronic care facilities may contribute to this problem. If you or someone in your care is a resident of a long-term care home, make sure to let healthcare professionals know that when a sleep problem is present. 

Sleep Disorders Telated to Medical or Psychiatric Conditions
Many older people suffer from physical conditions or disabilities that make it hard to find a comfortable sleeping position. Psychiatric conditions common in older people, such as depression and anxiety, also interfere with sleep. 

Sleep-wake Cycle Sleep Disorders
Older people are more likely to suffer from a disturbance that disrupts the normal timing for waking and sleeping. A common sleep rhythm disturbance is the tendency to wake up earlier in the morning and fall asleep earlier at night in older people. Also, older people have more trouble with adjusting to travel through many time zones. 

How Common are Sleep Problems?

Sleep problems, especially insomnia, are extremely common among adults, but occur even more often in older people. About 30% of all adults over age 65 suffer from insomnia. For most people, the problem does not occur every night, but comes back after a few nights of better sleep. Older women have more frequent sleep disturbances, in some cases associated with menopause. Older black Americans, particularly women, have an even higher risk for sleep problems. Also, older people often have medical conditions that cause pain or discomfort that interfere with sleep.

Most adults (86%) report feeling sleepy at least three times each week, and that sleepiness interferes with their daily activities. Among adults who nap during the day, 62% report that they have symptoms of insomnia. 

Updated: March 2012
Posted: March 2012