5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia

What should you do if an older person complains of not sleeping well at night?

Experts do believe that “normal aging” brings on some changes to sleep. (See this post for more on how sleep changes with aging.) Basically, older adults tend to get sleepy earlier in the evening, and tend to sleep less deeply than when they were younger.

So it’s probably not realistic to expect that as you get older, you’ll sleep as long or as soundly as when you were younger.

That said, although aging by itself does change sleep, it’s also quite common for older adults to develop health problems that can cause sleep disturbances. So when your older relatives say they aren’t sleeping well, you’ll want to help them check for these. Figuring out what’s going on is always the first step in being able to improve things.

And remember, getting enough good quality sleep helps maintain brain health, physical health, and mood.

In this article, I’ll cover the top causes of sleep problems in older adults. I’ll also tell you about what approaches have been proven to work, to help treat insomnia and sleep problems in older adults.

5 Common Causes of Sleep Problems in Older Adults

1. Sleep problems due to an underlying medical problem. Although older adults do often suffer from what’s called “primary” sleep disorders, many sleep problems they experience are “secondary” sleep problems, meaning they are secondary to an underlying medical condition whose main symptoms are not sleep related.

Common health conditions that can disrupt sleep in older adults include:

Heart and lung conditions which affect breathing, such as heart failure and chronic obstructive pulmonary disease

Gastroesophageal reflux disease, which causes heartburn symptoms and can be affected by big meals late at night

Painful conditions, including osteoarthritis

Urinary problems that cause urination at night; this can be caused by an enlarged prostate or an overactive bladder

Mood problems such as depression and anxiety

Neurodegenerative disorders such as Alzheimer’s and Parkinson’s

Medication side-effects

If an older person is having difficulty sleeping, it’s important to make sure that one of these common conditions isn’t contributing to the problem. Treating an underlying problem — such as untreated pain at night — can often improve sleep. It can also help to talk to a pharmacist about all prescription and over-the-counter drugs, to make sure that these aren’t contributing to insomnia.

2. Snoring, Sleep Apnea, and other forms of Sleep-Related Breathing Disorders. Sleep-related breathing disorders (“SRBD”; it’s also sometimes called sleep-disordered breathing) is an umbrella term covering a spectrum of problems related to how people breathe while asleep.

Sleep apnea is a common condition which is important to diagnose since it’s been associated with many other health problems (especially in middle-aged adults). In sleep apnea, a person has frequent pauses in their breathing during sleep. The most common form is obstructive sleep apnea (OSA), in which the breathing pauses are due to obstructions in the breathing passages. OSA is often associated with snoring. A less common form is central sleep apnea, in which the breathing pauses are related to changes in the brain.

How common it is: The likelihood of having sleep-disordered breathing disorders goes up with age. It’s also more common in men, and in people who are overweight. In one study o827 healthy older adults aged 68, 53% were found to have signs of SRBD, with 37% meeting criteria for significant sleep apnea. Interestingly, most participants did not complain of excess sleepiness.

Why it’s a problem: Studies have found that untreated OSA is associated with poor health outcomes including increased mortality, stroke, coronary artery disease, and heart failure. However,  studies also suggest that these associations are strongest in people aged 40-70, and weaker in older adults. For older adults with symptomatic OSA, treatment can reduce daytime sleepiness and improve quality of life.

Whether or not you pursue an official diagnosis for SRBD, avoiding alcohol (and probably other sedatives) is likely to help.

3. Restless leg syndrome (RLS). This condition causes sensations of itching, crawling, or restlessness as a person is trying to fall asleep. The symptoms are unpleasant but not usually painful, and improve with movement. The exact biological underpinnings of this problem remain poorly understood, but it seems to be related to dopamine and iron levels in the brain. Most cases are not not thought to be related to neurodegeneration.

How common it is: Studies suggest that 5-15% of the general population meet criteria for RLS, but only 2.5% of people are thought to have clinically severe symptoms. Poor health, older age, low iron levels, and being female are some risk factors. It also tends to run in families.

Why it’s a problem: RLS has been associated with depression, anxiety, and sleep-onset insomnia. It can also get worse with certain types of medication.

4. Periodic Limb Movements of Sleep (PLMS). This condition is not easily treatable, but I’m listing it since I’ve discovered it’s much more common than I realized. PLMS causes intermittent movements while asleep, usually in the lower limbs. It can affect the toes, ankles, knees, or hips. The movements may or may not wake the person up; they can be annoying to a bed partner.

How common it is: Studies estimate that 45% of older adults experience PLMS. Many such older adults are otherwise healthy. However, PLMS is also often associated with other sleep problems, such as restless legs and sleep apnea. Experts believe that it’s fairly rare for people to experience clinically significant sleep disturbances solely due to PLMS.

Is it a problem? PLMS can be an issue mainly because it’s associated with other sleep problems. Most people who experience PLMS don’t notice it much, although some do find it bothersome. Only a few studies have attempted to treat isolated PLMS, and it’s not clear that there is a reliable way to treat this. In its 2012 guideline on treating restless leg syndrome and PLMS, the American Academy of Sleep Medicine concluded that there was “insufficient evidence” to recommend pharmacological treatment.

5. Insomnia. Insomnia means having difficulty falling asleep or staying asleep, despite the opportunity to do so (e.g. being in bed), and experiencing decreased daytime function because of this. I consider this the grand-daddy of all sleep problems, because it affects so many people in middle-age and older age.

How common is it: Very common, and it becomes even more common with aging. One study found that 23-24% of older adults reported symptoms of insomnia.

Why it’s a problem: Insomnia has been associated with anxiety, depression, fatigue, worse quality of life, cognitive decline, and a variety of other worse long-term health outcomes.

What to do if you’re concerned: The main thing to do is assess the problem, by tracking sleep and using a sleep journal. And then seek help. For older adults, it is especially important to not simply rely on prescription or non-prescription (e.g. alcohol, over-the-counter pills) substances to help with sleep. That’s because all such substances worsen brain function and increase the risk of cognitive decline. 

Proven Ways to Treat Insomnia in Older Adults

Insomnia is a very common complaint among family caregivers and older adults. Fortunately, research has shown that it’s possible to treat insomnia effectively, although it does often take a little time and effort.

Why Sedatives Aren’t the Way to Go and Proven Ways to Taper Off Them

Before I go into the recommended treatments, let me say it again: you should only use sedatives as a last resort. That’s because most medications that make people sleepy are bad for brain function, in both the short-term and long-term.

Benzodiazepines such as lorazepam, alprazolam, diazepam, and temazepam (Ativan, Xanax, Valium, and Restoril) are also habit-forming. It can be a lot of work to wean people off these drugs, but research has proven it’s possible.

For instance, in this randomized control study, many older adults who had been on benzodiazepines for sleep (mean duration of use was 19.3 years!) were able to taper off their sleeping pills. 63% were drug-free after 7 weeks. (Yeah!)

Plus, in my own personal experience, it becomes extremely difficult once a person has started to develop a dementia such as Alzheimer’s, because then their behavior and thinking can get a lot worse if they are a little sleep-deprived or anxious. (In the short-term, almost everyone who tapers off of sedatives has to endure a little extra restlessness while the body adapts to being without the drug.) But letting them continue to use their benzodiazepine puts us in a pickle, because it also keeps them from having the best brain function possible, is associated with faster cognitive decline, AND increases fall risk.

I hope you see what I’m getting at. If either you or someone you care for are taking benzodiazepines for sleep or anxiety, and you aren’t dealing with a dementia diagnosis, now is the time to do the work of trying to get off these drugs. (If you are dealing with a dementia diagnosis, you should still ask the doctors for help trying to reduce the use of these drugs, but it will all be harder. It’s still often possible to at least reduce the doses being used.)

The key to successfully stopping sedatives for sleep is to very slowly taper the drug under medical supervision, plus add cognitive-behavioral therapy or other sleep-improving approaches if possible.

Now, let’s review some proven approaches to improving sleep in older adults.

Proven ways to treat insomnia in older adults:

Cognitive-behavioral therapy for insomnia (CBT-I). This means special therapy that helps a person avoid negative thought patterns that promote insomnia, along with regular sleep habits, relaxation techniques, and other behavioral techniques that improve sleep. It has a good track record in research, as described in this NPR story. A new study also confirmed that CBT-I also benefits people who have insomnia combined with other medical or psychiatric conditions.

Mindfulness meditation. A randomized control trial published in April 2015 found that mindfulness meditation was more effective than “sleep hygiene,” to improve the sleep of older adults with a variety of sleep disturbances. Older adults assigned to mindfulness completed a weekly 2-hour, 6-session group-based course.

Local in-person courses to learn mindfulness are often available; search online to find one near you. They may also be available at certain senior centers.

Do you have questions, feedback, or suggestions? We’d love to hear from you!

My Vibesa