Aging & Health A to Z
Care & Treatment
Once the underlying risk factors that have brought on your sleep problems are identified and corrected, your insomnia or other sleep problems might disappear on their own. If they persist, there are many lifestyle and medical approaches that you can follow to start sleeping well again.
Non-Drug Therapies for Insomnia
Good sleep habits and any or all of the following approaches can make all the difference for getting a good night’s sleep, either at home or in long-term care facilities.
Simple improvements in your “sleep hygiene” or habits related to sleep are often very effective.
During the day:
- Stick to a regular schedule of what time you go to bed and when you get up, even on week-ends.
- Exercise every day, but not within three hours of bedtime
- Get plenty of bright light during the day
- Avoid napping
- Stay away from caffeine, alcohol, and tobacco , especially in the afternoon or evening
- Develop a bedtime routine that is the same every night
- Limit time in bed to no more than 7 or 8 hours a night
- If hungry, have a light snack or some warm milk, unless you suffer from reflux(heartburn)
- Do not go to bed unless you are sleepy
- Take a warm bath about 90 minutes before getting into bed
- Keep bedclothes and room temperatures comfortable, and keep the bedroom dark and quiet (use ear plugs or a mask if they help)
- Try using a fan or white noise machine to block external noise
- Use relaxation and stress control techniques before going to bed
- Reserve your bed only for sleep or sex, but not for eating, watching TV or phone conversations
- If you cannot sleep after about 20 minutes, go to another room, keep lights dim, and read or listen to soothing music for about 30 minutes, then try again
A type of talk therapy, called behavioral therapy, can have immediate and lasting benefit in the management of insomnia, especially for older people. Over a period of a few sessions, you and your therapist will identify sleep habits to change and you will learn new behaviors such as:
- Sleep restriction. Time in bed is reduced to your estimated total sleep time (not less than five hours), then gradually increased as you sleep more
- Relaxation techniques. These will involve biofeedback, meditation, muscle relaxation, imagery training, self-hypnosis, especially if you have anxiety about your insomnia
- Stimulus control – Keeping your sleeping area dark, quiet at night; bright light during the day
- Cognitive therapy – learning to have positive thoughts about sleep and bedtime
Exposure to bright light (sunlight or special lamps) is being used more often to help older people with disordered sleep-wake cycles as well as those suffering from depression. It is used upon awakening in the morning and also late in the day to perk up older people who become drowsy too early in the evening. You must consult a trained professional for this approach to be safe and effective.
Consult a professional with training in light therapy and do not try to undertake light therapy on your own. Never stare into a bright light or the sun. This can permanently damage your vision.
Non-Drug Therapies for Sleep Apnea
You may find that certain habit or lifestyle changes alleviate symptoms of sleep apnea. These approaches include
- Losing weight if you are obese
- Exercising the muscles of your upper airway
- Avoiding alcohol, smoking, and sedative drugs
- Sleeping on your side, rather than on your back (use pillows to keep you on your side)
CPAP: Your healthcare professional may recommend a CPAP (continuous positive air pressure) device if you are diagnosed with sleep apnea. This appliance consists of a pump and mask or tubes that gently deliver blown air into your nose and mouth. It is the primary treatment for sleep apnea, and can be very effective.
Oral appliances: You may benefit from a simple, individually fitted device that you place in your mouth before going to sleep. The device holds your tongue and jaw in a position that prevents airway collapse and blockage.
Non-Drug Treatments for Restless Legs Syndrome
Following good sleep hygiene may be beneficial for older adults with restless legs syndrome. Other approaches that have proved effective include:
- Avoiding alcohol, caffeine, and tobacco
- Rubbing legs (or arms if involved)
- Taking hot or cold baths
Once your evaluation is complete and plans for non-drug therapies are in place, your doctor will address your sleep problem by attempting to eliminate other risk factors using medical approaches. These include
- Treatments for painful conditions (e.g., pain medications, physiotherapy)
- Medication adjustments if side effects include insomnia or other sleep problems (antidepressants, dementia medications, beta blockers, other cardiovascular medications are common culprits)
- Control of frequent nighttime urination
- Treatment of depression or anxiety if present (drugs and counseling)
Drug Treatments for Sleep Problems
Older people, in particular, should use caution when using sleep medications. These drugs are linked to:
- daytime drowsiness
- higher risk of falling and breaking a hip
- mental effects like confusion and memory problems
Many sleeping pills are habit-forming. Even if you become dependent on them, their effectiveness may disappear with long-term use.
It is strongly advised to avoid using these medications at all, but if you and your care provider determine it is appropriate to use them, aim to use the smallest effective dose and only for a short time.
If you have tried non-drug therapies and still cannot sleep, your doctor may recommend a sleeping pill specifically for your pattern of sleeplessness. For example, if you have trouble falling asleep, a short-acting agent may be all you need. If staying asleep is your greatest challenge, a more long-acting product may be best.
Avoid taking sleeping pills more than four times in a week to avoid daytime grogginess. Remember that sleeping pills do not cure insomnia, but are only a temporary relief and have serious risks associated with them. You may have even more trouble sleeping after stopping sleeping pills, especially if you have become addicted to them.
Do not drink alcohol if you are taking sleeping pills because side effects of the pills may increase significantly.
Insomnia: Short-acting sleeping pills that help you fall asleep may be effective but should only be used for a 2-4 days at a stretch, and not more than four times in a week. Some people have unusual reactions to these products, and many cases of sleep-walking, sleep-eating, and even driving while asleep have been reported. In older people, especially, the risk of a fall is significant. Always start with the lowest effective dose prescribed by your healthcare professional. And always only consider medications if all other approaches have not helped and you are truly suffering.
Benzodiazepines are “sedative-hypnotic” drugs that include Ativan and Restoril.
There are also three newer, "non-benzodiazepine" drugs-zolpidem(Ambien), zaleplon (Sonata), and eszopiclone (Lunesta)-that are also prescribed for insomnia. They are sometimes called "the Z drugs."
These drugs are longer-lasting medicines that may be more appropriate if you have trouble staying asleep, but also have very dangerous risks associated with their use. Benzodiazepines are habit-forming if used regularly, and lose their sedative effect eventually. Recent studies have indicated that benzodiazepines and the Z drugs more than double the risk of falls and hip fractures leading to hospitalization and death among older adults. In addition, benzodiazepines have been linked to higher risks of cognitive (thinking and memory) problems, delirium, and motor vehicle accidents. They should be used with caution, if at all for this condition, and only after alternatives have been tried and failed.
Restless legs syndrome and periodic limb movement disorder: Some older adults with these conditions experience some relief from a class of drugs known as “dopamine agonists.”
Iron deficiency is sometimes linked to restless legs syndrome. An iron supplement may therefore reduce your symptoms if a blood test shows your iron levels are low. If you do have low iron, you may need other tests to sort out why. An anti-epileptic drug called gabapentin, or – for stubborn cases – benzodiazepines may also be helpful for this disorder. As discussed above, benzodiazepines can be very addictive and can impair your memory, concentration, and put you at risk for falls and accidents, so their use has to be with extreme caution.
Your healthcare professional must weigh the benefits of a sleep medication against the increased risk for daytime drowsiness, falls, and mental impairment before recommending any drug treatment.
Non-prescription (over-the-counter) Drugs
Insomnia: Common non-prescription drugs used by older people include antihistamines and melatonin.
You should not use antihistamines (especially if they contain diphenhydramine) to help you sleep. The side effects of this medication include constipation, delirium, drowsiness the next day, and difficulty urinating. You may easily develop a tolerance for this type of product also, which reduces its effectiveness.
Melatonin and valerian are complementary or alternative remedies that have not been approved by the US Food and Drug Administration (FDA) and lack scientific evidence for benefit. Let your healthcare professional know if you are taking these products, since they may produce unwelcome side effects. Many people find herbal teas, such as chamomile, or a glass of milk help them relax at bedtime. For most people, these are safe approaches to try, but drinking fluids at bedtime may increase the number of times you must get up during the night to go to the bathroom.
Check with your healthcare professional before trying a non-prescription (over-the-counter) sleep remedy. Even non-prescription products may interact with other medications or alcohol, or become habit-forming.
Updated: February 2013
Posted: March 2012