Sleep is not just a pleasure, it is a necessity at all stages of life. However, for many older people, nights can become challenging due to insomnia. This problem, which is very common in older people, can affect their quality of life and general well-being. In this article, we explain the causes of insomnia in older adults, the treatments available and how to help those who suffer from it. Because a good rest is also possible at this stage of life.
What can cause insomnia in older people?
As we age, it is normal for our body to undergo changes. Among these changes is the alteration of the sleep cycle, which can cause the elderly person to wake up several times at night or to wake up very early each morning. The fact that older people sleep fewer hours than young people is not because they need less sleep, but rather because they have greater difficulty falling asleep.
Insomnia in older adults has a multifactorial origin, which means that it can be triggered by various factors that, sometimes, combine with each other. Among the main causes of insomnia in older adults are:
- Physiological changes typical of aging: As we have anticipated, the sleep cycle changes over the years, reducing deep sleep phases and increasing nighttime awakenings. Part of this is due to the production of melatonin, a key hormone in regulating sleep, which decreases especially after age 55.
- Chronic and/or neurological diseases: Pathologies such as arthritis, Parkinson’s, heart failure, sleep apnea, chronic fatigue or urinary incontinence are examples of pathologies that can interrupt night’s rest.
- Medication side effects: Some drugs, such as diuretics or antidepressants, can make it difficult to sleep. According to the Spanish Society of Geriatrics and Gerontology (SEGG), the prevalence of insomnia in the elderly is higher in those who have health problems and require medication.
- Psychological alterations: As we know, the person’s emotional state influences rest. Depression and grief are common at this stage and directly affect sleep. In fact, according to the SEGG, up to 50% of chronic insomnia can be related to psychiatric illnesses, such as anxiety, bipolar disorder, schizophrenia, major depression, etc.
- Poor sleep hygiene: Sleep hygiene is very important during old age. Changes in schedules, noise, extreme temperatures or an uncomfortable bed can be even more annoying with age.
Knowing how to identify these causes is key to achieving correct management of insomnia in older adults. If not, insomnia can negatively affect the physical and mental health (irritability, lack of concentration, memory loss, anxiety) of the person who suffers from it, as well as their social environment. But the consequences of insomnia in older people do not end there. The SEGG explains that people with sleep disorders tend to more frequently develop hypertension, depression, cardio and cerebrovascular disease.
But it also happens in the opposite direction, since people with these types of diseases more frequently develop sleep problems. Hence, insomnia in older adults is associated with greater morbidity and mortality.
How to treat insomnia in older people
Treatment of insomnia in older adults varies depending on its causes and severity, but generally includes:
Sleep Hygiene
It is important to create healthy routines before bed, such as:
- Avoid using screens before going to bed, as well as large dinners and stimulating drinks.
- Maintain a regular sleep schedule, which means always going to bed and getting up at the same time. It is also important to avoid naps during the day so as not to disrupt your sleep schedule and to sleep exclusively at night. If you need a nap, it should not exceed 20-30 minutes.
- Create a comfortable environment: a good mattress, a comfortable temperature, clean bedding that is soft to the touch, etc. They help us fall asleep.
Moderate exercise
Gentle activities such as walking improve sleep quality. The ideal is to do it for at least one hour a day, with sunlight, preferably in the afternoon and always at least three hours before going to sleep.
Relaxation exercises
If after 20 minutes in bed we cannot fall asleep, we can resort to relaxation, meditation or breathing exercises. And if the causes of insomnia in older adults are related to emotional problems, psychological therapy can help identify and modify the thoughts and habits that affect sleep.
Pharmacological treatments
Sleep and wakefulness are regulated by neurotransmitters, which are activated or inhibited pharmacologically to achieve sleep. However, in the pharmacological approach to
insomnia it is necessary to evaluate the relationship between the risk and benefit of hypnotics and their effects on wakefulness and concomitant pathologies.
- In specific cases and under strict medical supervision, especially if the elderly person cannot sleep due to a chronic or cognitive illness, sleep-inducing medications or supplements such as melatonin can be used.
- It is essential to avoid self-medication, since some medications used to combat insomnia can cause dependence or adverse effects (cognitive impairment, delirium, falls and fractures).
The combination of these approaches is usually the most effective strategy for treating insomnia in older people.
Tips for caring for an older person with insomnia
If you are caring for an elderly person who suffers from insomnia, these recommendations may be useful:
- Establish a daily routine: Help him regulate his biological clock with fixed times for eating, sleeping and doing activities.
- Create a relaxing environment: A dark, quiet bedroom with an appropriate temperature promotes sleep.
- Encourage physical and social activity: Encourage him to participate in walks or workshops, as they can reduce stress and improve rest.
- Avoid stimulants: Avoid offering coffee, tea, chocolate or alcohol in the hours before sleep.
- Make sure devices such as glasses or headphones have been removed and are next to their bed.
- Seek professional support: If, despite following these tips, the elderly person you care for cannot alleviate the insomnia, the best thing to do is to go to the doctor to prescribe the most appropriate treatment.
Insomnia in older people does not have to be a losing battle. With an appropriate approach, personalized treatments and an environment that promotes well-being, it is possible to significantly improve the quality of life of the elderly. At NAMI, we offer personalized attention to each resident, addressing their different pathologies, as well as insomnia in a comprehensive manner. To do this, we have a transdisciplinary medical team made up of psychology, physiotherapy, occupational therapy and speech therapy.
