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. You are not alone. About 30% of all adults over age 65 suffer from loss of sleep or insomnia. For most people, the problem does not occur every night, but comes back after a few nights of better sleep. Older women, especially those of African American background, have frequent sleep disturbances, in some cases associated with menopause. 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.
There are many misconceptions about older adults and sleep:
- We need less sleep as we age.
- Sleeping during the day is a common problem among older adults.
- Snoring is a common but harmless problem among older adults.
- A drink of alcohol before bedtime can help sleep.
There are also important facts to know about older adults and sleep:
- It is more difficult to get into and stay in a deep sleep as we age.
- The brain rhythms in older adults don’t follow the usual patterns as younger people’s brains do when they sleep.
- Seven or eight hours of good quality sleep is important for keeping us healthy.
- If you are not getting enough sleep (or sleeping too much) and feel tired when you wake up in the morning, you may have a sleep problem.
There are many different sleep problems older adults can experience:
- Trouble falling or staying asleep.
- Sleeping too much. You may be going to sleep earlier and waking earlier.
- The need to nap during the day, which may lead to you sleeping less at night.
- Disturbing movement disorders or abnormal breathing patterns that prevent you from getting the rest you need.
Sleep problems can lead to:
- Fatigue and sleepiness during the day.
- Mood changes such as depression and irritability.
- Difficulties with work and concentration.
- Falls and injuries, including fractures.
- Increased risk of illness.
- Using healthcare services more often than older people without sleep issues.
- Poor quality of life for patients and caregivers. Studies show that for 70% of caregivers, disrupted sleep played a major role in the decision to institutionalize the adult in their care.
The Most Common Types of Sleep Problems
The types of sleep problems that most often affect older people fall into the following categories:
Insomnia is defined as the inability to fall or stay asleep despite the desire to sleep. It is associated with daytime problems such as tiredness or fatigue, poor concentration, daytime sleepiness, or concerns about sleep.
Sleep Apnea & Breathing Problems
In this condition, someone may repeatedly stop breathing for a while (usually at least 10 seconds) while asleep. The lack of oxygen turns on an internal alarm system that causes you to partially wake up whenever your breathing stops. Untreated sleep apnea is associated with an increased risk for high blood pressure, heart disease, and sudden death.
Sleep apnea occurs as one of the following two types or a combination of both:
Obstructive Sleep Apnea (OSA)
This disorder is caused by a collapse and blockage of the airway while a person is sleeping. Often people with this disorder snore loudly when sleeping as the airway starts to close. They then appear to snort or choke while sleeping. They may not be aware of waking up frequently during the night. A bed partner may report loud snoring, intervals when the person stops breathing while sleeping, and choking sounds during sleep. Other symptoms may include napping during the day, early morning headaches, problems with memory, or elevated blood pressures.
Central sleep apnea (CSA)
This type of apnea can cause breathing effort to stop as a person sleeps. It typically occurs along with other disorders such as stroke, heart failure, or atrial fibrillation.
Movements that Affect Sleep
Restless Leg Syndrome
In restless leg syndrome, a person may experience very uncomfortable, abnormal feelings in their legs when lying down or just sitting. Symptoms typically occur with greater intensity in the evening time, or with prolonged periods of not moving such as during car rides or long plane trips. Relief comes with getting up and walking around or stretching legs, but the feeling may come back when lying down, making it very difficult to fall asleep. It is commonly associated with iron deficiency, chronic kidney disease, Parkinson’s Disease, diabetes, spinal cord injuries, use of certain drugs (such as SSRIs or tricyclic antidepressants, lithium, and caffeine), and venous insufficiency (problems with the return of blood from the legs back to the heart).
Periodic Leg Movement Syndrome
In this condition, a person may 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, and toes tense up in a slow-motion “kicking” movement, lasting 10-30 seconds. It is common for this to occur, and most people are unaware that they have this disorder unless their bed partner tells them about it. In rare cases, the repeated spasms may be associated with disrupted sleep or daytime feelings of tiredness in the legs. When this occurs, a diagnosis of periodic limb movement disorder is made. An individual may have both restless legs syndrome and periodic limb movement disorder at the same time.
Circadian Rhythm Disorders
This set of disorders occurs when there is a misalignment between a person’s internal body clock and the external (societal) 24-hour clock. When this occurs, a person may fall asleep and wake up too early. This is known as advanced phase sleep wake disorder. An older adult may not be able to fall asleep at the desired bedtime because they are not tired at the desired time for sleep. This is known as delayed phase sleep wake disorder. Both disorders can occur in older adults.
REM Sleep Behavior Disorder
People with this condition act out their dreams in the middle of the night. Behaviors are typically associated with dreams that are violent, and therefore someone with this condition may be brought to a clinic or healthcare provider after having punched or kicked their bed partner. This disorder is commonly associated with neurodegenerative disorders such as Lewy Body dementia or Parkinson’s Disease.
Sleep Disorders Related to Living 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 such as night-time noise and lights may contribute to this problem. People residing in long-term care homes or their caregivers should alert the healthcare team if experience sleep problems are experienced.
Sleep Problems Related to Medical or Psychiatric Conditions
Many older adults have medical conditions (such as acid reflux, breathing issues due to heart or lung conditions, pain due to arthritis, back pain, or sensory discomfort due to neuropathy) or other disabilities that make it hard to find a comfortable sleeping position. Psychiatric conditions common in older people, such as depression and anxiety, can also interfere with sleep.
Sleep Problems Caused by Medications
- Some medications (such as those commonly prescribed for dementia and heart conditions) can cause sleep disturbances.
- Diuretics or water pills prescribed for high blood pressure or heart or kidney diseases can result in frequent bathroom trips at night to urinate, which can affect sleep.
- Using sedative medications can result in light, broken sleep patterns.
Last Updated August 2020