Sleep Problems

Care & Treatment

Once the underlying risk factors that have brought on your sleep problems are identified and corrected, the insomnia or other sleep problems might improve. But if they continue, there are many lifestyle and medical approaches that you can follow to start sleeping well again. 

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.

Non-Drug Therapies for Insomnia

Sleep Hygiene

Simple improvements in your “sleep hygiene” (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 weekends.
  • Exercise every day, but not within three hours of bedtime.
  • Get plenty of bright light during the day.
  • Avoid napping. 
  • If you are taking a medication that may cause sleepiness (for example, sedating antidepressants), try to take it at bedtime if possible.
At Bedtime
  • 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.
  • Avoid screens such as TV or cell phones for two hours before bedtime.
  • 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.
  • Use your bed only for sleeping or having sex. Do not eat, watch TV, or have phone conversations in bed.
  • If you cannot sleep after about 30 minutes, go to another room, keep lights dim, and read or listen to soothing music until you feel sleepy. Then get back into bed.

Cognitive-Behavioral Therapy

In addition to good sleep hygiene, behavioral therapy (a type of talk therapy) can have immediate and lasting benefit in the management of insomnia, especially for older people. Cognitive behavioral therapy has been shown to be the most effective form of insomnia therapy. Therapy typically also involves developing sleep hygiene habits. Over 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. The estimated total sleep time is obtained from keeping a sleep diary.
  • Relaxation techniques. These will involve biofeedback, meditation, muscle relaxation, imagery training, and self-hypnosis, especially if you have anxiety about your insomnia.
  • Stimulus control. Keeping your sleeping area dark and quiet at night but getting bright light during the day.
  • Cognitive intervention. Correcting maladaptive and incorrect beliefs about sleep.

Even brief courses of cognitive-behavioral therapy (for example, two in-person sessions plus two phone calls) are effective in older adults with chronic insomnia.

Light Therapy

Exposure to bright light (sunlight or special lamps) is being used more often to help older people with circadian rhythm disturbances as well as those suffering from depression. When used for the treatment of circadian rhythm disturbances, the timing of light therapy is important, since using light at the wrong time of day may worsen the underlying sleep disturbance., You mustconsult a trained professional for this approach to be safe and effective. 

Consult a healthcare 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

Lifestyle Changes

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). This may be effective for some individuals.

CPAP

If you are diagnosed with sleep apnea, your healthcare provider may recommend a CPAP (continuous positive air pressure) device. This appliance consists of a pump and mask or tubes that gently deliver blown air into your nose and mouth. There are variations in the mask, so find one that is comfortable for you. It is the primary treatment for sleep apnea, and can be very effective in reducing sleepiness and improving quality of life. Patients with mild to moderate dementia who have sleep apnea tolerate CPAP devices well, and there is some evidence of a beneficial effect on cognition.

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. These devices are typically not as effective as CPAP, however.

Surgeries

Various surgeries are available for the treatment of obstructive sleep apnea. They typically involve making changes to the upper airway to reduce the amount of obstruction and allow more air to pass into the lungs. A sleep specialist may refer you to a surgeon if traditional forms of therapy have proven to be ineffective.

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.
  • Using pressure blankets or compression stockings.

Medical Management

Once your evaluation is complete and plans for non-drug therapies are in place, your healthcare provider will address your sleep problem by attempting to eliminate other risk factors using medical approaches. These include: 

  • Treatments for painful conditions.
  • Adjusting medications if their side effects include insomnia or other sleep problems. Antidepressants, dementia medications, beta blockers, and other cardiovascular medications are common causes of such problems.
  • Controlling frequent nighttime urination.
  • Treatment of depression or anxiety (such as through the use of medication and counseling). 

Prescription and Over-the-Counter Treatments for Sleep Problems

Prescription Medication

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 

Some sleeping pills are habit-forming. Additionally, their effectiveness to improve sleep may disappear with long-term use.   

It is strongly advised to avoid using these medications at all. However, if you and your healthcare provider decide that it is appropriate to use them, try to use the smallest effective dose and only for a short time. 

If you have tried non-drug therapies and still cannot sleep, your healthcare provider may recommend a sleeping pill specifically for your pattern of sleeplessness. For example, if you have trouble falling asleep, a short-acting medication 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 feeling groggy during the daytime. Remember that sleeping pills do not cure insomnia, but provide only 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. This may cause the side effects of the pills to increase significantly. 

There are a large number of over-the-counter and prescription sleep aids. Most of them have only small benefits on sleep, but have the potential for causing serious side effects in older adults such as falls and bone fractures, confusion, and disordered thinking. As a result, they should be avoided unless they are a last resort, even for short-term use.  The best solution for sleep problems usually comes from changes in diet, nighttime behaviors, and cognitive strategies to promote restful sleep.  Ask your healthcare provider for help in managing your sleep problems.  Three main types of sleep aids are particularly problematic:

  • Benzodiazepines, such as lorazepam and temazepam. In older adults, these drugs can increase risks for confusion and disordered thinking, falls and bone fractures, and motor vehicle crashes. 
  • Benzodiazepine receptor agonists, such as zolpidem, zaleplon, and eszopiclone. Like benzodiazepines, these drugs can increase the risk for confusion and disordered thinking, falls and bone fractures, and motor vehicle crashes.  
  • Diphenhydramine and over-the-counter sleep aids that contain antihistamines. These medications can cause confusion, difficulty urinating, dry mouth, constipation, and other side effects. You may also easily develop a tolerance for this type of product, which reduces its effectiveness. 

The best solution for sleep problems usually comes from changes in diet, nighttime behaviors, and cognitive strategies to promote restful sleep.  Ask your healthcare professional for help in managing your sleep problems.  

Before recommending any drug treatment, your healthcare provider must consider the benefits of a sleep medication against the increased risk for daytime drowsiness, falls, and mental impairment.
 
Non-Prescription (Over-the-Counter) Medication

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 antihistamines 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 help with sleep. While melatonin is not recommended for management of insomnia by the American Academy of Sleep Medicine, it may improve sleep quality and duration in certain individuals. Let your healthcare provider know if you are taking these products, since they may interact with prescription medications. Many people find that a glass of milk or herbal teas, such as chamomile, help them relax at bedtime. For most people, these are safe approaches to try, but drinking fluids at bedtime may increase the number of bathroom trips at night which may affect sleep. 

Check with your healthcare provider before trying a non-prescription (over-the-counter) sleep remedy. Even non-prescription products may become habit-forming or interact with other medications or alcohol.

 

 

Last Updated August 2020