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Insomnia in the elderly

What is it?

  • Insomnia (in-SOM-nee-ah) is a condition where you have trouble getting to sleep or staying asleep. Insomnia is also the feeling that you are not getting enough sleep. Older people are more likely to have problems with sleep than younger people. Insomnia can be temporary (happens for days or weeks) or chronic (lasts for months or years). Insomnia can be treated.
  • Most adults need about seven to eight hours of sleep each night. As people get older, their need for sleep stays about the same. Normal sleep happens in several stages. There are times in the night when you sleep lightly and do not dream. There are also periods of deep, dreamless sleep. Throughout the night you have several periods of dreaming called REM (Rapid Eye Movement) sleep. The amount of time you spend in each stage of sleep changes as you get older. These changes in sleep patterns do not mean that sleep problems are "normal" for older people. Talk to your caregiver if you think you may have insomnia.

Causes:

There may be one or more causes of insomnia. The most common causes are health problems, medicines or food, mental health conditions, nighttime habits, or surroundings. The following are some causes of insomnia:

  • Health problems:
  • Asthma, or other breathing problems such as emphysema (em-fi-SEE-mah), COPD, asthma, or other lung problems.
  • Dementia (de-MEN-shah) or Alzheimer's (ALTZ-hi-merz) disease.
  • Diseases that cause pain, such as arthritis.
  • "Heartburn" or GastroEsophageal (gas-troh-ee-sof-ah-JEE-al) Reflux Disease (GERD).
  • Heart disease.
  • Kidney disease.
  • Diabetes.
  • Thyroid disease.
  • Prostate problems that can cause you to wake up many times at night to go to the bathroom (urinate).
  • Parkinson's disease.
  • Sleep apnea (AP-nee-ah) (not breathing normally while you sleep) or Restless Leg Syndrome (SIN-drohm) (RLS).
  • Medicines or Food:
  • Caffeine (found in coffee, tea, cola, drinks, chocolate, and some cold medicines).
  • Alcohol may cause you to wake up more times in the night. Some people use alcohol to fall asleep but alcohol may make it difficult to stay asleep through the night.
  • Diuretics (water pills) taken at night.
  • Some cold and allergy medicines, diet pills, or "energy" pills. Many herbs, supplements, and "natural remedies."
  • Nicotine (NIK-oh-teen) (cigarettes or chewing tobacco).
  • Some antidepressant (an-teye-dee-PRES-ant) medicines (medicine used to treat deep sadness).
  • Mental Health Conditions:
  • Anxiety (ang-ZI-i-tee) (feeling worried or anxious), depression, or stress.
  • Nighttime Habits or Surroundings:
  • Eating too much (especially greasy or heavy foods) before bedtime.
  • Feeling too hungry at bedtime.
  • Not getting enough or any exercise during the day.
  • Exercising too close to bedtime (within three hours of going to bed).
  • Noise or extreme temperatures (too hot or too cold).
  • Irregular sleeping times (going to sleep or waking up at different times every day). For example, some people work night shift jobs or are caring for someone who is sick.

Signs and Symptoms:

You may have one or more of the following signs and symptoms of insomnia:

  • Having a hard time staying asleep. You may also have problems with waking up too early.
  • Having a hard time falling asleep (taking 30 to 45 minutes or longer to fall asleep).
  • Waking up many times each night.
  • Feeling tired, irritable (cranky), and having a hard time concentrating (focusing on one thing) during the day.

Medical Care:

Your caregiver will ask you many questions and do a physical checkup. If your caregiver does not feel you have a health problem that is causing the insomnia, you may be given sleeping medicine. This medicine should be used for a short time as it can be addicting. The purpose of sleep medicine is to help you sleep and return you to better sleep habits. Some sleeping medicine has side effects, such as confusion. Do not take sleeping pills given to you by friends. You should also not take over-the-counter sleeping pills or medicine that cause insomnia, like some cold medicines.

Wellness Recommendations

  • Set a bedtime routine for yourself. Sticking to this routine will help good sleep habits develop with time.
  • Go to bed and get up at the same time every day. Try not to go to bed until you feel sleepy.
  • Read or watch television before bedtime. This may help you feel sleepy and allow you to fall asleep naturally.
  • Make sure that your bedroom is quiet, peaceful, and comfortable.
  • Make sure your mattress is comfortable.
  • Try to make your bedroom as soundproof as possible so that noises do not wake you. Use earplugs or eye shades if necessary.
  • If you have a bedroom clock, make sure it does not tick or hum because this can awaken you.
  • Exercise regularly so that you will be naturally tired at bedtime. Do not exercise three hours before bedtime.
  • Many people find that they "worry" about things when they are in bed. Try to deal with your worries before going to bed for the night. Try to turn off your mind. Focus on peaceful and relaxing thoughts. Play soft music or relaxation tapes. Ask your caregiver for help with relaxation training or stress management.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

  • Catnip (Nepeta cataria) has been used for many years, but has not been studied in people who have insomnia.
  • Kava-kava (Piper methysticum) has been used for many years, but has not been studied in people who have insomnia.
  • Lavender (Lavandula officinalis) is helpful for insomnia. It works as tea or by smelling the oil (aromatherapy). Warning! Lavender oil should only be smelled and not be taken by mouth.
  • Lemon balm (Melissa officinalis) has been used for many years for insomnia.
  • Passion flower (Passiflora incarnata) has been used for many years, but has not been studied in people who have insomnia.
  • Skullcap (Scutellaria lateriflora) has been used for many years, but has not been studied in people who have insomnia.
  • St. John's wort (Hypericum perforatum) has been used for many years, but has not been studied in people who have insomnia.
  • Valerian (Valeriana officinalis) may be helpful for insomnia and has been studied in people.

Supplements:

  • 5-HTP can also be helpful for insomnia and has been studied in people.
  • DHEA (dehydroepiandrosterone) may help with insomnia and has been studied in people. Even though DHEA is available over-the-counter, it is a hormone that may have dangerous side effects if it is not used correctly. You should only use DHEA with your doctor's permission.
  • Melatonin may be helpful for insomnia and has been studied in people.
  • Vitamin B12 may be helpful for insomnia and has been studied in people.

Complementary Therapies:

  • Aromatherapy with lavender oil has a calming effect which helps sleep.
  • Behavioral therapies, which include biofeedback and other relaxation techniques, are more effective for insomnia than medicine.
  • Light therapy can be effective for insomnia in some patients.

Do's and Don'ts:

  • Do take a hot bath before going to bed.
  • Do not eat a lot late in the evening. A light bedtime snack may help. A glass of warm milk causes sleepiness naturally.
  • Do not turn your bedroom into an office or den.
  • Do not take naps during the day.
  • Avoid stimulants, such as caffeine and tobacco within 6 hours of sleep.
  • Avoid alcohol before bedtime. Alcohol may make you sleep but it can wake you up later in the night.

Other ways of treating your symptoms:

Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

  • You would like medicine to treat insomnia.
  • Your symptoms have not gone away or improved by these self-help measures.
  • You have questions about what you have read in this document.

SEEK CARE IMMEDIATELY IF:

  • You feel like hurting yourself or others.

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care will be used to treat you. You always have the right to refuse treatment.

References:

1. Buchbauer G, Jirovetz L, Jager W et al. Aromatherapy: Evidence for sedative effects of the essential oil of lavender after inhalation. Z Naturforsch [C] 1991; 46:1067-1072.

2. Friess E, Trachsel L, Guldner J et al: DHEA administration increases rapid eye movement sleep and EEG power in the sigma frequency range. Am J Physiol 1995; 268(1 pt 1):E107-E113.

3. Hardy M, Kirk-Smith MD, Stretch DD: Replacement of drug therapy for insomnia by ambient odour. Lancet 1995; 346:701.

4. Hudgel DW, Gordon EA & Meltzer HY: Abnormal serotonergic stimulation of cortisol production in obstructive sleep apnea. Am J Respir Crit Care Med 1995; 152(1):186-192.

5. James SP, Mendelson WB, Sack DA et al: The effect of melatonin on normal sleep. Neuropsychopharmacology 1988; 1(1):41-44.

6. Mayer G, Kroger M & Meier-Ewert K: Effects of vitamin B12 on performance and circadian rhythm in normal subjects. Neuropsychopharmacology 1996; 15(5):456-464.

7. Morin CM, Mimeault V & Gagne A: Nonpharmacological treatment of late-life insomnia. J Psychosom Res 1999; 46(2):103-116.

8. Schulz H, Jobert M & Hubner WD: The quantitative EEG as a screening instrument to identify sedative effects of single doses of plant extracts in comparison with diazepam. Phytomedicine 1998; 5(6):449-458.

9. Solov'eva AD & Fishman EI: The phototherapy of psycho-autonomic disorders. Zh Nevropatol Psikhiatr Im S S Korsakova 1996; 96(3):67-71.

10. Vorbach EU, Gortelmeyer R & Bruning J: Therapie von Insomnien. Wirksamkeit und Vertraeglichkeit eines Baldrianpraeparats. Psychopharmakotherapie 1996; 3:109-115.


Last Updated: 4/4/2014

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