Insomnia in Older Adults: Causes and Safe Home Help

What normal ageing sleep looks like

• Falling asleep takes a little longer, and sleep is lighter.
• Waking once or twice a night, usually for the toilet, is common; going back to sleep within about 20 minutes is normal.
• Waking earlier in the morning and feeling sleepy in the evening are common.
• Total sleep need is about 7 to 8 hours for most older adults, but varies; some feel well on slightly less.
• Daytime short naps are normal.

It becomes a problem when sleep trouble happens at least three nights a week for a month or more, or causes distress, daytime exhaustion, accidents or mood change. See know everything about the key to good health: sleep.

Common causes

• Body clock and light: little daylight, long periods indoors, irregular timings, watching television late.
• Pain: arthritis, back pain, neuropathy; see how to get rid of chronic pain for sound sleep and arthritis home care guide.
• Night-time urination: an enlarged prostate, bladder problems, diabetes, heart failure, evening fluids, caffeine; see prostate problems and urinary symptoms and night-time toilet trips and falls.
• Breathing problems: COPD, asthma, heart failure with breathlessness lying flat, sleep apnoea; see sleep apnoea in older adults.
• Restless legs and cramps; see restless legs and night cramps.
• Mood and worry: depression often shows as early waking; anxiety as difficulty falling asleep; see depression in older adults and anxiety in older adults.
• Dementia and Parkinson's disease: reversed sleep-wake patterns, night wandering, vivid dreams; see learn about sleeping disorders in dementia and dementia sundowning.
• Medicines: some affect sleep (for example certain water tablets taken late, steroids, some blood pressure, asthma and antidepressant medicines). Never change timing or stop medicines yourself; ask the doctor to review; see polypharmacy and deprescribing.
• Caffeine, nicotine, alcohol: tea, coffee, cola, chewing tobacco and evening drinks fragment sleep.
• Heavy dinners, hunger, acid reflux.
• Bedroom problems: noise, heat, mosquitoes, an uncomfortable mattress or pillow, light, a full-time television.
• Long daytime naps, inactivity and boredom.
• Bereavement, loneliness and stress.

Home steps that work

Fix the rhythm - Go to bed and wake at about the same time every day, including weekends. - Get morning daylight: a walk outdoors or sitting by a bright window for 30 minutes helps set the body clock. - Keep days active: gentle exercise such as walking or chair exercises, finished a few hours before bed; see walking programme for older adults. - Limit naps to 20 to 30 minutes, early afternoon. - Use bed for sleep and rest only; avoid lying awake for hours.

A calming evening - A quiet routine in the hour before bed: a wash, soft light, prayer, gentle music, reading, slow stretches or breathing; see 7 essential elements of a good sleep-time routine and how does meditating before bed every night benefit you. - Dim lights and turn off screens, including phones and television, for at least 30 to 60 minutes before bed; if the person likes the television on, use a timer and low volume. - A light dinner a few hours before bed; a small snack if hungry. - Cut down tea, coffee and cola after midday; avoid alcohol and tobacco. - Reduce fluids in the last two hours before bed, but not below the doctor's advice for heart or kidney disease; see hydration for older adults. - Empty the bladder before bed. - Write down worries earlier in the evening so they are not left for the pillow.

A comfortable bedroom - Cool, dark and quiet: a fan or cooling in summer, light blankets in winter, curtains that block street light, a mosquito net rather than strong coils or sprays. - Mattress and pillows: supportive and comfortable, with pillows to ease back, neck or breathlessness; see mattress hardness for back pain and pillows for side sleepers and shoulder pain. - Safety at night: a night light on the path to the toilet, a clear floor, a bedside commode if needed, a phone or pendant within reach; see bedroom setup for night safety, motion night lights for seniors and night safety for a parent alone. - A clock the person can read without effort; constant clock-watching raises anxiety, so turn it away if that helps; see talking clock guide.

If you cannot sleep - If awake for about 20 minutes, get up, sit in dim light and do something quiet (listen to soft music, read, gentle breathing), then return when drowsy. Avoid food, screens and bright light. - Do not struggle or watch the clock. - Accept short bad nights; worrying about sleep makes it worse.

Many older adults benefit from a structured approach called cognitive behavioural therapy for insomnia (CBT-I), taught by a psychologist or trained health professional, which is the recommended first treatment for chronic insomnia. Ask the doctor about access. See also best tips to help seniors get sound sleep at night and good nights sleep tips for seniors.

Sleeping tablets, supplements and home remedies

• Sleeping tablets (including those bought over the counter, antihistamine-type "sleep aids" and tablets left over from others) raise the risk of falls, hip fracture, confusion, daytime drowsiness and memory problems in older people, and can worsen breathing problems and sleep apnoea. If a doctor prescribes one, use it as directed and for the shortest time; do not stop suddenly after long use; ask for a review.
• Alcohol may help you doze off but fragments sleep and worsens apnoea and falls.
• Melatonin, herbal products and "sleep" supplements: quality and doses vary, and they can interact with medicines. Ask the doctor or pharmacist before use; see supplements and medicine interactions.
• Warm milk, a warm foot bath, light stretching and prayer are low-risk comforts for most people; see 7 natural home remedies to have sound sleep and use judgement, avoiding hot water on numb feet, for example in diabetes.
• Never give someone else's medicine, and never mix sleeping tablets with alcohol.

Clues to specific problems

• Sleep apnoea: loud snoring, pauses in breathing, gasping or choking at night, morning headaches, dry mouth, daytime sleepiness, high blood pressure. Needs a doctor and a sleep test; sedatives can worsen it.
• Restless legs: an urge to move the legs in the evening, eased by moving.
• REM sleep behaviour disorder: acting out dreams, shouting or hitting out in sleep; can precede Parkinson's disease or dementia; protect the bedroom from injury and tell the doctor.
• Dementia-related night waking: keep daytime light and activity, a calm evening, a safe bedroom; see dementia daily routines.
• Depression: early morning waking with low mood.
• Night sweats, weight loss or fever need a doctor.

When to see a doctor

See a doctor if sleep trouble lasts more than three to four weeks, if daytime sleepiness leads to falls or near-accidents, if there is loud snoring with pauses, if sleep trouble comes with low mood, anxiety, confusion, pain, breathlessness or leg symptoms, if waking to pass urine is frequent, or if the person depends on tablets. Take a sleep diary for two weeks (bed time, wake time, night wakings, naps, caffeine, medicines).

Call 112 for: chest pain, severe breathlessness or choking at night; a stroke sign on waking (face droop, arm weakness, speech trouble); or a fall with injury. Confusion at night that is new and sudden can be delirium and needs urgent review; see delirium in older adults.

Carers and sleep

Night-time caring is tiring. Share nights, nap in the day and ask for respite; see night-time caregiving routines and caregiver burnout signs and prevention.

When to ask a professional

A doctor looks for causes and reviews medicines. A sleep specialist investigates apnoea and other disorders. A psychologist can offer CBT-I. A pharmacist can check for sleep-disturbing medicines. For senior services, call Elderline 14567. In an emergency, call 112.