Sleep Problems in The Elderly

Do you have trouble staying asleep or falling asleep? When we age, we start to notice the differences in our appearance. We see the amount of white hair is increasing, more wrinkles and pigmentation. Our inside is changing as well, including our sleep patterns.

You may wake up earlier because you sleep earlier. You may wake up during the night and have a less deep sleep. Trouble staying asleep and other sleep problems in the elderly are considered common. However, it is not normal if you wake up tired every day and experience disrupted sleep every night.

These can be the symptoms of a sleeping disorder. Insomnia in the elderly isn’t a usual problem. Sleep disorders in the elderly involve any disrupted sleep pattern. This can include trouble staying asleep or falling asleep. Also excessive sleepiness during the day. Abnormal behaviours while sleeping can also occur. Some need far more than 10 hours of sleep.

Sleep also refreshes your immune system that prevent you from having diseases. However, many people think that the older you are, the less sleep you need. It has been proven that the amount of sleep you need stays the same throughout adulthood. An average adult needs 7-9 hours of sleep to stay healthy. Some even need 10 hours of sleep or more. That truly depends on the person! However, the elderly simply have trouble staying asleep and falling asleep.

Why do the elderly have trouble staying asleep? What makes it difficult for the elderly to reach the required sleeping hours? What causes excessive sleepiness in the elderly? Why do elderly have insomnia? What are other sleeping problems in the elderly? What types of sleeping disorder occurs in the elderly?

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Sleep is essential for everyone. For your physical health and emotional well-being. For adults in the elderly stage of life, a good night of sleep is critical. It will improve their memory and focus. Your body repairs damaged cells during your sleep.

Insomnia in the elderly

There are two categories of insomnia in the elderly. Sleep onset insomnia and sleep maintenance insomnia. Sleep onset insomnia is when you have difficulties falling asleep. Sleep maintenance insomnia is when you can’t remain asleep throughout the night. If you have trouble staying asleep, this may be something worth looking into.

The duration of insomnia can also be categorized in 3 ways. Transient insomnia, acute insomnia and chronic insomnia. Transient insomnia can last a few days to a week while severe insomnia may last several weeks. Constant may appear nightly for months and if left untreated for years. This can have significant effects on health, safety, and the quality of life.

Symptoms of insomnia in the elderly are:



• Excessive sleepiness

   •     Depression

   •     Accidents due to sleep deprivation

   •     Irritability

   •     Impaired memory

   •     Difficulty concentrating

• Takes more than 30-45 minutes falling asleep

   •     Trouble staying asleep

   •     Waking up early, unable to sleep again

   •     Night falls

Do you have trouble staying asleep or falling asleep? Do you fit into the categories above? You can also always opt for an insomnia test. Some of which you can do online. You should always pay your general practitioner a visit if you think you suffer from insomnia. However, you could also read this late at night. We have found a simple online insomnia test which you could do. Maybe this can give you some peace of mind!


Here is the link to the insomnia test!

Sleep cycle changes in elderly

 A normal sleep cycle has some stages during each sleep period. You can divide your sleep into non-REM (non-rapid-eye-movement) sleep and REM (rapid-eye-movement) sleep. When you fall asleep, your body enters into non-REM sleep.

Non-REM sleep is split into four stages. It begins with light sleep, progressing to deeper sleep. The deepest non-REM sleep usually occurs early at night. At this stage, usually people do not have trouble staying asleep. The issue, though, comes a bit later.

After the four stages of non-REM sleep, you will enter the fifth phase of sleep. This stage is called REM-sleep. It occurs in about 90 minutes cycles. Your breathing becomes irregular, and your eyes move rapidly in this stage. Also, you won’t be able to use your limb muscles. It’s common that dreams occur in this phase as well. The duration of REM sleep tends to increase each time throughout the night. One sleep cycle lasts about 90-110 minutes and is repeated 4 to 5 times during the night of healthy sleep.

Research has shown that in the elderly, people spend more time sleeping in the lighter stages. The deepest stages 3 and 4 are very short as you age. Also, the time spent in the REM sleep ireduces, but the frequency stays the same. This is why the elderly often have trouble staying asleep.

The reason you sleep lighter is because your body produces lower levels of growth hormone. When you produce fewer growth hormones, you also produce less melatonin. You will often experience more fragmented sleep and trouble staying asleep. The changes can influence your health, and the disruption may lead insomnia in the elderly. This is where you have trouble staying asleep.

Circadian rhythm changes the elderly

The tendency to sleep and wake up earlier than usual is one of the sleep problems in the elderly. The cause is your circadian rhythm. Also known as you internal clock. Your circadian rhythm controls your energy levels and tells you when to sleep and wake up. In the elderly, your sleep rhythm shifts forward. This makes you want to go to bed earlier. You still get your 7-9 hours of sleep, because you also wake up earlier. Known as advanced sleep phase syndrome.

Older people may find this annoying to wake up at 5 AM instead of 7 AM. However, there may be consequences if they don’t listen to their body and sleep earlier. Sleep problems such as sleep deprivation and excessive sleepiness in the elderly may occur. You can also consider taking naps during the day to compromise the sleep lost. Don’t take the naps close to bedtime, this can cause more trouble staying asleep. Resulting in delayed sleep and less duration of night-time sleep.


Types of medication may effect sleep of elderly

Many elderly people are on medications that can affect and disrupt sleep. Many have real trouble staying asleep or falling asleep due to medications. Medications such as antidepressants often have sleep-related side effects. Also, diuretics is often taken for high blood pressure or glaucoma. Using diuretics at night time can cause you to wake up more often to go to the bathroom. Other medication that can disrupt the sleep in the elderly are:

    •       Bronchodilators:

            Prescribed for those with chronic obstructive pulmonary disease (COPD)

    •       Antihypertensive drugs:

            Used to treat high blood pressure

    •       Corticosteroids (prednisone):

            Used to treat conditions like rheumatoid arthritis

    •       H2 blockers (Zantac, Tagamet):

            Used to treat gastroesophageal reflux disease (GERD) or peptic ulcers

    •       Levodopa:

            Medication used to treat Parkinson’s disease

    •       Sympathomimetics:

            Drugs used in extreme situations, such as an asthma attack or extremely low blood pressure

Medical conditions in the elderly

Elderly people may also have an underlying medical condition that causes sleep problems. One could be that they have trouble staying asleep. Neurological conditions such as Parkinson’s disease and Alzheimer’s are examples. Acute and chronic medical conditions can also occur. Examples are arthritiscardiovascular disease, or prostatic hypertrophy. Other examples are gastrointestinal and pulmonary conditions which may cause trouble staying asleep. The discomfort and pain may make it harder to fall asleep and sleep less long. Conditions that affect the bladder can wake you up more often to go to the bathroom. Depression, anxiety and dementia can also cause sleep problems.

Sleep disorders in the elderly

Several primary sleep disorders are connected to aging. Primary sleep disorders can cause difficulties in falling asleep and awakenings at night. The lack of sleep can also cause excessive daytime sleepiness. Sleep disorders are often diagnosed through history, physical tests and polysomnogram. Primary sleep disorders that are connected with people in the elderly are:


Sleep apnea

Sleep apnea causes brief breaks in breathing while sleeping. This results in sleep disruptions and also awakenings throughout the night. This can lead to insomnia and excessive daytime sleepiness. Snoring is a common sign of this disorder.

Weight loose mouthpieces and breathing devices such as CPAP are used to treat sleep apnea. Surgery to widen breathing passage is also possible.

Restless leg syndrome

Restless legs syndrome causes discomfort in the legs and the urge to walk to get rid of the feeling. It is often described the unpleasant, tingling and creepy feeling. The feeling gets worse during the evening and makes it hard to sleep throughout the night. Excessive daytime sleepiness may result from this sleep disruption.

Regular exercise can help greatly. Soaking the legs and feet in a warm bath can be a relief too. At least for some restless legs syndrome patients. Other options include Dopaminergic agents, or benzodiazepines. Opiates are also used to treat restless legs syndrome.

Periodic limb movement disorder

Periodic limb movement disorder can occur alone or accompanied with restless leg syndrome. Periodic limb movement disorder causes muscle contractions. This can make your arms and legs move (kicking legs).

Dopaminergic agents are often used to treat periodic limb movement disorder. This can reduce the number of problems during sleep and increases the time of deep sleep.

REM-behaviour disorder

The REM-behaviour disorder is a rare condition and occurs most commonly in elderly people. Usually, you can’t make many movements while you dream. However, this disease doesn’t prevent the muscle activity. It can cause you to crash into bed, fall or leap from the bed, which can create injuries.

To control this disorder, treat with bedtime doses of the benzodiazepine. One example is clonazepam.

Sleep Old

Sleeping all the time?

Do you have the feeling that you or an elderly person you know can sleep all day?

As mentioned above, the main issue with sleep in the elderly is that they have trouble staying asleep. In turn, this generally means that they have a lighter sleep than younger people.

Actually, they don’t sleep all day. In most cases, it just seems that way. Low quality sleep in the elderly may cause them to dose off frequently. They need to compensate for their lost sleep. There are basically many short naps in between rather than one long period of high quality sleep.

Another reason which leads to the elderly sleeping all the time is medicine. The side effects of the medicine they take to be exact. Some may make them very sleepy and tired.

Treatment for sleep problems in the elderly


    •       Caffeine, other stimulants and alcohol no later than 3 hours before bedtime

    •       Heavy meals, spicy food, and excessive amounts of liquid before bedtime (a light snack or warm milk is all right)

    •       Taking naps close to bedtime

    •       Activities in bed such as work, reading or watching television


    •       A regular sleep/wake schedule

    •       Exercise early in the day or no later than 4 hours before bed

    •       A sleep environment that is dark, quiet, safe and comfortable

    •       Activities that encourage relaxation before bed, such as a warm bath or shower, or calming music.

Sleeping pills

If you have trouble staying asleep, you can also opt for sleeping pills. But please do so with care, especially if you are of age.

Elderly people tend to absorb medicines quickly, and the medications may last longer in the body. This can potentially lead to interaction with other medications. We advise to consult a doctor first before using any sleeping pills. Sleeping pills, which are available in pharmacies, are usually for temporary sleep issues. Dependence on sleeping pills can be the physical necessity, but it can also become an addiction.

They may remove the trouble staying asleep, but may also come at a cost.

Sleeping pills side effects

We think it is important to note that sleeping pills side effects can occur. This is fully dependent on which sleeping pills you take, how regular, as well as the dosage. We strongly advise to visit your general practitioner before taking any further action with sleeping pills. They will also be able to tell you all about sleeping pills side effects!

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