Ask the Geriatrician: Sleep Problems

Cathy Alessi

Cathy Alessi, MD
Makinodan Director
Geriatric Research, Education and Clinical Center (GRECC)
Chief, Division of Geriatrics
VA Greater Los Angeles Healthcare System

Professor and Associate Director
Multicampus Program in Geriatric Medicine and Gerontology
David Geffen School of Medicine at UCLA

 

 

Sleep problems are very common in older people.  In addition, many older people use prescription or over-the-counter sleeping medications. When used too frequently or inappropriately, these medications may be a risk to your health and safety.

Q:   Does sleep change as people get older?

A:   In surveys, healthy older people report that they sleep less at night, they wake up more often during the night, they are more sleepy during the daytime and they nap more during the day.  Research has also found changes in the structure of sleep in older people. These changes include more time spent in the lighter stages of sleep and less time spent in the deeper stages of sleep. In addition, more time is spent in bed awake. Older people may also have a change in the biological clock that regulates daytime wakefulness and nighttime sleep.  For example, it is very common for an older person to feel sleepy earlier in the evening and wake up earlier in the morning.

Q:   How much sleep do we need, and why is sleep so important?

A:   Sleep is a necessary part of our lives, and most people will spend about one-third of their lives sleeping.  The average person needs about 7 to 8 hours of sleep per night.  However, some people need a lot more and others need a lot less.  The amount of sleep you need is the amount which allows you to feel refreshed and function at your best the following day.

Q:   Are there simple things I can do to improve my sleeping?

A:   Some people have relatively mild problems with sleep that can improve with simple changes in sleep habits, also known as sleep hygiene. During the daytime, get physical exercise (but not right before bedtime) and sunlight exposure (to help the timing of your biological clock).  Cut down on or stop daytime napping, unless this is a necessary rest period. Remember, the more you sleep during the day, the less you will sleep at night.

Avoid alcohol and caffeine, especially late in the day.  Nicotine also disturbs sleep. Wind down and relax prior to bedtime, follow a regular bedtime routine (such as cleaning up and putting on comfortable bedclothes).  Don’t use bedtime as “worry time”. Relaxation techniques may be helpful. If you have trouble falling asleep, try getting out of bed for a while, and don’t return to bed until you feel sleepy again. If you wake up during the night, don’t look at the clock, but rather, try to fall right back to sleep. If you can’t get to sleep, try getting up and doing some peaceful activities until you feel sleepy enough to go back to bed. Spending too much time lying in bed awake can actually lead to more problems with your sleep. Finally, try to set a regular time to get up every morning of the week, including weekends.

Q:   How do I know if I have a serious problem with my sleep?

A:    Insomnia is when you have difficulty getting to sleep or staying asleep, or waking up earlier than you want. This comes along with fatigue or other difficulties during the daytime because of your trouble sleeping at night. Insomnia that lasts for only a few days is often caused by a recent stress or life change (whether good or bad), and generally gets better on its own, as long as you keep good sleep habits during this brief period of trouble sleeping. You may need help from your healthcare provider if you have a long-standing problem with insomnia (also called chronic insomnia). See your provider if you have insomnia that occurs most nights and lasts 3 months or more.

Depression is a common cause of chronic insomnia. In addition, many medical illnesses can increase your chances of chronic insomnia, including stomach problems, heart and lung diseases, conditions that increase nighttime urination, pain from arthritis, Parkinson’s disease, thyroid disease, and many other conditions. People with dementia, such as Alzheimer’s disease, can also have problems sleeping at night.

Many medications can interfere with sleep, such as some blood pressure and asthma medications, and over-the-counter products such as alcohol, decongestants, and caffeine. During menopause, women may have more trouble sleeping. In addition, some serious sleep diseases are more common as people get older. Sleep apnea is a serious condition in which someone's breathing temporarily stops during sleep. Common symptoms include snoring and daytime sleepiness. Restless legs syndrome is a condition where the person has an urge to move their legs while they are awake at night or at rest, which can make it difficult to get to sleep.

Q:   What about sleeping pills?

A:   Sleeping pills should only be used when prescribed by your healthcare provider. If used, these medications are generally recommended to only be taken for the short-term (not longer than 2 to 3 weeks). Sleeping pills should not be taken with alcohol. They should also be avoided if they cause severe sleepiness during the daytime or if you have sleep apnea.

Many over-the-counter sleeping pills (such as diphenhydramine) contain antihistamines, which can make you sleepy. Antihistamines are not recommended for older people because they can interact with other medications and can cause many unwanted side effects, including dry eyes, dry mouth, constipation, trouble with urination, and confusion. 

Melatonin is a hormone in the brain that is available in tablet form and may be helpful for problems with the sleep/wake cycle and jet lag.  Unfortunately, over-the-counter melatonin preparations are not tested or regulated by the government. 

Some older people report sleeping better when they take a mild over-the-counter pain medication such as acetaminophen before bedtime.  However, some over-the-counter preparations of acetaminophen that are marketed as sleeping aids contain an antihistamine. You should be cautious about these preparations because of the possible problems with antihistamines mentioned above.  

The best way to treat chronic insomnia is behavioral treatment, which gives you specific help to learn new habits to improve your sleep. If you have chronic insomnia, talk with your healthcare provider about how to receive behavioral treatment to improve your sleep.

 

Last Updated July 2019