Aging & Health A to Z

Sleep Problems

Causes & Symptoms

Sleep disturbances can be caused by many things: 

• Psychological problems: depression, anxiety, stress
• Lifestyle habits: smoking, caffeine, alcohol, napping and irregular sleeping patterns
• Medical conditions such as congestive heart failure or prostate enlargement
• Painful conditions, such as arthritis, shingles
• Sleep-wake cycle disorders
• Medication side effects
•  Chronic use of sedatives, which can cause light, broken sleep patterns
• Sleep problems such as sleep apnea, restless leg syndrome, periodic limb movement disorder
• Neurological disorders such as Alzheimer’s disease , dementia , delirium , Parkinson’s disease
• Not enough exercise
• Environment problems: Night noise and lights
• Night-time trips to the bathroom. 

Risk Factors

There are some specific risk factors common to older adults that can contribute to sleep problems. 

Insomnia:

• Older age
• Female gender
• Having certain medical or psychological conditions or diseases
• Recent bereavement
• Social isolation
• Certain medications
• Shortness of breath (from heart or lung problems)
• Reflux disease and heartburn
• Chronic pain
• Having to go to the bathroom repeatedly during the night
• Use of alcohol or nicotine
• Have poor sleep habits 

Sleep apnea:

• Obesity
• Have a family history of sleep apnea
• Have a wide neck (large circumference)
• Are male
• Tend to snore loudly
• Have enlarged tonsils or other structural problems in your upper airways
• Have high blood pressure , Heart failure , heart rhythm problems such as atrial fibrillation , or if you have had a stroke
• Use alcohol or sedatives (or both) to put yourself to sleep 

Restless leg syndrome: Some things that are thought to raise your risk of restless leg syndrome or cause the condition include:

• Low iron levels
• Injury or diseases of the spinal cord nerves or nerves in the legs
• Diabetes
• Parkinson’s disease
• Certain drugs (SSRI or tricyclic antidepressants, lithium, caffeine)
• Retention of blood in your legs (venous insufficiency) 

Insomnia in long-term care residents: Older adults in long-term care facilities tend to have conditions or diseases that may be uncomfortable or painful. They often take a variety of medications which may have side effects that disrupt sleep. Depression may also be an issue. 

The environment of a residence typically makes the problem worse. Environmental factors that interfere with sleep include:

• Inadequate daytime light and exercise
• Long periods in bed
• Noise in hallways and rooms at night
• Disruption of sleep to complete nursing care
• Hallway lights that are always turned on 

Symptoms and Warning Signs 

You may have insomnia or another sleep problem that needs attention from a healthcare provider if you have noticed the following warning signs:

• Sleepiness during the day
• Trouble falling asleep at night
• Waking up too early in the morning
• Waking up often at night
• Trouble going back to sleep
• Not feeling rested and refreshed in the morning
• Trouble differentiating between night and day
• Having a hard time concentrating 

Sleep Apnea
Particular signs and symptoms of sleep apnea include:

• Loud snoring, often with choking or pauses in breathing
• Very sleepy during the day
• High blood pressure
• Morning headache
• Personality changes such as increased irritability, confusion, memory problems.
• Urinary incontinence 

Restless Legs Syndrome
The following are often signs of restless legs syndrome:

• An urgent feeling that you must move your legs
• Signs of physical restlessness, such as pacing, rubbing your legs, tossing and turning in bed
• Vague discomfort, usually in both calves
• Symptoms get worse at night when you lie down to sleep
• Discomfort is relieved by walking, stretching, shaking your legs. 

Periodic Limb Movement Syndrome
In this syndrome, your leg makes regular movements in which muscles contract tightly causing your big toe to extend, and ankles and knees to bend. Sometimes your hip may also move. These repetitive slow motion spasms occur over and over and last for between 10 to 30 seconds. You may partially wake up, but will probably not be aware of the movements, although your legs may be tired in the morning. Sometimes other body part can move in addition or instead of the legs. 

Updated: March 2012
Posted: March 2012