Ever had a sleepless night? Imagine experiencing that every day or every other day – that’s what most senior folks are facing as they grow older. Sleep deprivation is a common issue among the elderly. In fact, up to 50% of the elderly ages 55 and older have sleep issues, according to BMC Geriatrics.
This begs the question, are sleep difficulties part of the natural ageing process or do they point to a more serious distress?
This article helps to create a better understanding of sleep conditions and how it affects our seniors. Particularly, we look into the common sleep problems in the elderly, what causes them, and how to improve sleep.
Sleep problems and ageing
Adults over the age of 65 should be getting 7-8 hours of sleep every night, according to the Sleep Foundation. However, many older adults have a hard time getting as much sleep as they need.
Sleep quality can decline with age. This is largely due to deterioration in certain hormones and cells that are responsible for the body’s internal clock and circadian rhythms. When this happens, the body cannot process signals efficiently. As a result, their sleep-wake schedule becomes less stable.
Common sleep problems in the elderly
Most sleep disorders are preventable or treatable, yet less than one-third of those affected seek professional help. Without proper sleep, we are at risk of detrimental effects on our attention span, memory and health condition.
Let’s take a look at the 5 common sleep disorders that are most prevalent in the older population.
Insomnia is a sleep disorder in which the affected person is constantly faced with difficulty falling or remaining asleep at night. This includes feeling resistant to going to bed. He or she will also experience fatigue, sleepiness and concentration problems during the day.
There are several types of insomnia and they can be categorised as acute or chronic:
- Acute (short-term): Could last from one night to a few weeks for less than 3 months
- Chronic (long-term): Could last at least 3 nights a week for more than 3 months
Insomnia is the most common sleep disorder, affecting 10 to 30 percent of adults in our worldwide population. Women and people above the age of 60 are known to be more susceptible to this disorder for various reasons. It is also often associated with many other medical conditions like depression, diabetes, Alzheimer’s Disease, Parkinson’s Disease and others.
2. Restless legs syndrome (RLS)
Restless legs syndrome, or RLS, is a neurological movement disorder that causes an unpleasant sensation in part(s) of your legs (feet, calves or thighs), such as itching, crawling or tingling. This creates an irresistible urge to move your legs to relieve the discomfort.
The syndrome usually takes effect in the evening or night whether you’re sitting or lying down and lasts for 15 to 40 seconds. People with RLS find it difficult to rest well at night because it kicks them out of deep sleep and they don’t get quality rest.
RLS can affect anyone at any age, where the onset of symptoms is before age 40, but middle-aged and older adults experience it more frequently. Women are more likely to have it than men.
3. Obstructive sleep apnea (OBS)
Obstructive sleep apnea (OBS) is a sleep disorder characterised by momentary interruptions in breathing during sleep. It occurs when the muscles in the soft tissues surrounding your throat are relaxed, blocking the upper airway for about 10 seconds at multiple intervals. This can go on for about an hour.
It’s like snoring but amplified and might point to a serious medical condition. How? The lack of breathing brings down the oxygen levels in your blood and could contribute to or worsen major heart complications like hypertension and heart attacks.
OBS can be observed in individuals with diabetes, women after menopause, and those with Parkinson’s disease.
4. REM sleep behaviour disorder (RBD)
RBD is short for Rapid Eye Movement Sleep Behavior Disorder. It is a type of parasomnia that occurs when a person has vivid dreams causing them to act out in dream-enacting behaviour. They are sudden and violent behaviours like yelling, punching and kicking.
It typically happens during REM sleep, a stage of sleep that occurs at intervals of 90 to 120 minutes after you fall asleep. During this stage, the brain is active, a dream occurs and your eyes move rapidly. In RBD, however, the brain activity is intensified and the nerve pathways controlling our muscles fail to function properly.
RBD primarily affects older men above 50 years old. It can progress over time, and if not treated, threaten the lives of those who have RBD and their bed partners.
Narcolepsy is a chronic sleep disorder in which the brain has difficulty controlling wake-sleep cycles. Someone with narcolepsy will experience “sleep attacks”—where the person may suddenly fall asleep or collapse during the day—due to extreme tiredness or sleepiness.
This can be dangerous if it happens while a person is in the middle of eating or driving because it may lead to injuries, accidents or death.
Narcolepsy can occur at any age in life from as young as seven years old and can progress with age. The good news is that the symptoms generally become stable across adulthood and rarely develop after age 55.
Causes of sleep problems in the elderly
Before we dive into the ways to improve sleep, it’s beneficial to understand what is causing the sleep problems in the first place. There are numerous causes for sleep problems, but these are the notable ones in the elderly:
When a person ages, it is natural that they go through physical changes in their bodily systems. One instance is when the body produces less of the antidiuretic hormone (which helps retain fluid) in the urinary system. The end result is excessive urination (also called nighttime urination) at night.
Your body also produces less growth hormones like melatonin which helps your body control slow-wave or deep sleep. As your melatonin levels gradually decline, so do your circadian rhythms.
2. Underlying health conditions
Some older adults find it difficult to sleep when they experience pain or discomfort at night due to a medical condition like arthritis, gastroesophageal reflux disease, or osteoporosis. Speak to your doctor if the problem persists as it could be a warning sign.
Other health conditions that are not seen with the naked eye are mental health issues. Studies have revealed that sleep disorders are associated with mental conditions like dementia, Alzheimer’s Disease, depression, and anxiety disorders. Racing, anxious thoughts and tendencies that come at night can rob you of your sleep.
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3. Medication and other substances
Did you know that many prescription or over-the-counter drugs all come with side effects that can impair sleep? Furthermore, older adults 65 and older are also more likely to be taking more than four prescription medications daily.
Here are some types of medication commonly used by the elderly that are known to cause sleep problems:
- Statins (used for cholesterol)
- Alpha- and Beta-blockers (used for hypertension)
- Corticosteroids (used to reduce inflammation)
- Cholinesterase inhibitors (used for dementia or Alzheimer’s Disease)
- SSRI antidepressants (used to treat various mental health conditions)
Other substances that can affect sleep include vitamins, alcohol, nicotine, and caffeine when consumed in large amounts.
4. Shift in sleep schedule
Older people tend to shift their sleep schedules forward in time as the circadian rhythms become less and less efficient. Hence, they wake up earlier in the day and go to bed earlier at night. If they take extended nap times later in the day, it will make it harder for them to fall asleep at night or they might have disrupted sleep.
All these disruptions in a person’s sleep schedule would therefore lead to poor sleep quality.
5. Distractions or discomfort in the room
Using your mobile phone, television or computer late at night can interfere with your sleep. Not only do these digital distractions keep you up for hours on end, but the blue lights and loud sounds coming from your device may also keep your brain stimulated and your body awake.
Besides that, if your mattress is uncomfortable or your bedroom is untidy, it can influence your sleep quality and you wake up with aches and pains.
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How to improve sleep in the elderly
Good quality and restorative sleep is essential for our overall health and well-being. On top of that, it can have a significant impact on our daily activities and social interactions, which in turn, influence our family life and relationships.
So, what can be done to protect your beauty sleep in your golden age? These ten tips can help you reprioritise healthy sleep and clock in some much needed ZZZs.
1. Develop a disciplined routine
Go to bed and wake up at the same time. Resist the urge to make any sudden changes in your sleep schedule like sleeping in too long, for instance. This may be easier said than done, but it will be worthwhile to practise every night. In fact, studies reveal that sleep quality is more important than sleep quantity in improving your quality of life and daytime functioning.
If you find it hard to wake yourself up, get the help of technology by using timers or reminders on your phone.
2. Reduce the lighting or sounds at night
Dim the lights down and block out the noise before bed. The quiet darkness signals your body to increase its melatonin levels to facilitate sleep. This way, your body knows it’s time to transition into bedtime.
Perhaps you need a little more help with making your environment “sleep-ready”. These three practical things could be worth the investment:
- Ambient lights: Replace your white overhead lights with warm, ambient lights that will lull you to sleep.
- Earplugs: Whether you’re living in a noisy urban area or have a snoring partner, earplugs can help block out sounds for restful sleep.
- Blackout blinds: Replace your curtains with dark blinds if you are sensitive to bright lights.
In addition, it’s a good idea to unplug from your devices at least half an hour before bedtime.
3. Adjust the room temperature
If your room environment is too hot or too cold, it can affect the quality of your sleep as well. The best temperature for sleep is said to be between 15 to 19 degrees, but this is up to your personal preference. Find out what suits you best. Another tip is to wear light sleepwear and avoid heavy blankets or multiple layers.
4. Remove any hazards in the room
Clear the way of any loose cords or small objects on the ground. This is an important step for anyone and especially for the elderly. Decluttering not only keeps your space safe and relaxed but also prevents the risk of falling—another common, but often overlooked, problem in the elderly.
5. Unwind with some relaxing activity
Find activities that help you wind down physically and mentally like taking a nice warm bath, reading a good book, or meditating/praying before you sleep. Not only can this help to slow down the activity in your brain, but it can set the tone for the rest of your night.
If you find that your thoughts are racing, write them down in a journal to bring some clarity to the mind. Once your mind is clear, you’ll be able to sleep soundly through the night.
6. Alleviate stress with natural remedies
There are tons of natural remedies that you can buy or make that can bring many health benefits to your body. Essential oils, chamomile tea and herbal treatment are a few examples that contain active ingredients that allow you to calm down and relieve some symptoms.
However, take caution that some ingredients are not meant to be mixed with medication. Consult your doctor to be very sure.
7. Try cognitive-behavioural therapy for insomnia (CBT-i)
If what’s keeping you from sleep is persistent thoughts or behaviours, consider going for therapy. Cognitive-behavioural therapy for insomnia (CBT-I) is a combination of cognitive therapy with behavioural treatments and relaxation therapy.
It could be helpful to combat or control negative patterns in your negative thoughts or sleep-related behaviours. Additionally, it is said to be an effective alternative to sleeping drugs because it gets to the root of your problem, rather than simply relieving your symptoms.
7. Consider sleeping aids
Sleeping aids can improve sleep duration and sleep quality. You can purchase sleeping aids over the counter. Some prescribed agents available in Malaysia according to MIMS Psychiatry are:
- Non-benzodiazepine hypnotics
Having said that, some sources consider this to be the last resort as these substances may not be good for your brain, in both the short-term and the long-term. We recommend considering your options and getting the advice of a few doctors to make an informed decision.
9. Exercise regularly
Exercise reaps many benefits for older adults, including improving the quality of your sleep. Regular exercise can lower the risk of diseases, improve bodily function and allow your body to release chemicals that can promote good sleep.
If you have mobility issues, try activities that are easy to do like dancing, swimming or aerobics.
10. Watch what you eat or drink
There are some diet changes you can make to ease your sleep:
- Limiting your caffeine, sugar alcohol and nicotine intake
- Avoid eating large meals
- Eat your last meal of the day at least four hours before bedtime
- Avoid spicy foods
- Minimise your liquid intake
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- Billiard, M. (2010). Narcolepsy in the elderly. In S. R. Pandi-Perumal, J. M. Monti & A. A. Monjan (Eds.), Sleep Disorders in the Elderly (pp. 227–23). Cambridge University Press. DOI: https://doi.org/10.1017/CBO9780511770661.023
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- Neel, A. B. (n.d.). 10 Types of Meds That Can Cause Insomnia. Retrieved from https://www.aarp.org/health/drugs-supplements/info-04-2013/medications-that-can-cause-insomnia.html
- Suni, E. (2021). Stages of Sleep. Sleep Foundation. Retrieved from https://www.sleepfoundation.org/stages-of-sleep
- WebMD. (2022, January 15). Parasomnias. Retrieved from