Healthy sleep & insomnia in older adults

Common sleep challenges and causes of insomnia in older adults

Sleep is vital for everyone, and while older adults tend to sleep less as they age, this bodily function is still incredibly important for maintaining good health. Here, we are taking a closer look at the common challenges faced by older adults when looking to maintain healthy sleep patterns, as well as how sleep patterns change over time, common sleep disorders, common causes of insomnia, tips for promoting healthy sleep, when you should seek medical advice, and how to support an older loved one if they are struggling with sleep issues. At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about sleep in older adults, we can help.

Why is sleep so important at all stages of life?

Throughout life, sleep is an important bodily function for everyone, from new born babies all the way to older adults. No matter what age you are, sleep helps with everything from boosting physical health, to facilitating recovery, to providing emotional stability. It is essential for optimal functioning in day-to-day life, and provides increased energy levels and an overall higher quality of life. If you have ever spent a night or two with no sleep, or poor sleep, you will likely know the many ways this can affect you. For different age groups, sleep can offer different benefits:

In children and younger people, sleep helps to support growth, cognitive development and emotional regulation
In adulthood, sleep improves cognitive function, enhances memory and mood, and promotes immune function and metabolic health
In older adults, getting adequate, quality sleep can help to manage chronic health conditions, support mental health, and improve quality of life in older age

There is a common misconception that older people require less sleep than younger people, but research actually shows older adults need roughly the same amount of sleep as other adults – an average of 7 to 9 hours a night. However, older adults do tend to go to sleep earlier and wake earlier than they may have done when they were younger, and various other factors can lead to them spending less hours in deep sleep each night.

How do sleeping habits change as we age?

As we get older and go through different life stages, our sleep patterns change. New-born babies sleep an average of16 hours a day, while new parents may sleep only a few hours a night. A person going through a stressful period at work may lack sufficient sleep, while someone on an extended holiday may experience longer sleeping hours due to being more relaxed. Someone on a night shift at work could lack sleep, and we all experience more sleep when the clocks wind back in autumn. Older adults tend to experience lighter sleep and wake up more frequently during the night due to a reduction in deep sleep. This also happens when our circadian rhythms change, and we begin to go to bed earlier and wake up later. These changes are to be expected in older age, but they can also result in things like daytime napping, low mood throughout the day, and could even lead to conditions like insomnia if not addressed early.

What are some common causes of insomnia in older adults?

Insomnia is a condition that causes difficulty sleeping. According to the Sleep Foundation, 10-30% of people live with insomnia, and those aged 60+ are thought to be more susceptible to this sleep disorder. Older people tend to experience bouts of insomnia due to a number of factors. These could include:

Physical health conditions – Chronic illnesses such as arthritis, diabetes and heart disease can have a big impact on sleep, and could lead to an older person developing insomnia. This may happen if they struggle to get to sleep in the first place, or if they wake up multiple times during the night due to physical symptoms that are difficult to ignore when trying to sleep.
Pain – Pain is a common issue when it comes to sleep, with up to half of older adults living with chronic pain experiencing sleep issues. Pain can keep them awake at night, and the lack of sleep can also significantly increase their pain-related distress and disability.
Sleep conditions – As well as insomnia itself, other sleep conditions can impact quality of sleep, such as restless leg syndrome and sleep apnoea. These conditions can affect both getting to sleep and staying in deep sleep.
Medication side effects – Both prescription and over-the-counter medications can cause a number of side effects, and in some cases these could include trouble sleeping or disrupted sleep. Some over-the-counter painkillers also contain caffeine, so always check the ingredients. According to the National Council on Aging, around 46% of older adults take 5 or more medications a day, so there is a chance this could negatively impact sleep.
A poor diet – Diet has a big impact on sleep quality. For example, getting sufficient fat, carbohydrates and protein is thought to positively impact quality of sleep, whereas foods that contain caffeine or drinking alcohol could reduce sleep quality. This can lead to fatigue during the day, a general feeling of sluggishness, and further trouble sleeping at night.
Stress – Stress can affect mental health and physical health, so understandably this can impact sleep too. Whether you have thoughts racing through your mind that make it difficult to get to sleep, or your stress is more unconscious, both can impact your sleep duration and quality over time.
Lack of exercise – Often we need exercise throughout the day that allows us to expend enough energy so that we feel tired at night. This does not need to be vigorous exercise; even a walk or moving around the house more can help to improve your health and sleep.
Hormone and body changes – As we age, our hormones change, which can lead to less sleep. Changes in melatonin production and circadian rhythms can affect sleep patterns, and this can continue over time as we age.
Lack of daily routine – Not having a regular bedtime routine can impact quality of life, but it can also impact quality of sleep. Having a regular bedtime routine helps to trigger the body so it knows when it is time to sleep and when to wake.
Environmental factors – Too much noise, an uncomfortable bed, a partner that snores, or a room that is too warm are all environmental factors that can impact sleep quality and keep a person up at night.
Caffeine – Excessive caffeine consumption can lead to sleep difficulties, as this is a stimulant that can make you feel more awake. This can be helpful sometimes, but should be avoided if you want to get to sleep or improve your sleep quality.
Mental health conditions – Someone with anxiety, depression, or a form of cognitive decline may also experience insomnia as a side effect, whether due to having a lot on their mind (similar to stress), or on an unconscious level.

If one or more of the above factors is relevant to you, you can address what is stopping you from sleeping by getting a consultation with a doctor, and making lifestyle adjustments that will promote sleep, such as the tips mentioned below.

How might an older person improve their sleep?

If you are looking to get more restful, calming and regular deep sleep, there are things you can do, no matter how hopeless it feels when you are in the midst of insomnia. Here are a few things that could help to promote healthy sleep:

Establish a routine – Having a routine is important for multiple reasons, but one of the most vital is the need to maintain a consistent sleep schedule. You can do this by going to bed at the same time every night, and using alarms to wake up at the same time every morning. This may not work straight away, but over time a routine will help your brain and body start to understand when it should be sleeping and when it should be awake.
Optimise your environment – Environment has a big impact on sleep, so make some changes to your bedroom to promote restful sleep. This could mean getting a more comfortable mattress, black-out blinds to keep the room dark, making sure the room is quiet or using white noise if you prefer this, controlling the temperature so the room is cool, and more.
Limit any stimulants – Many people don’t consider what they are eating and drinking before bedtime that could be having a negative impact on their sleep quality. Reduce your caffeine and alcohol intake in the evening, and avoid eating large meals before bed that contain potentially energy-boosting foods, such as sugary snacks. Instead, try having a sleep tea before bed, or a light snack if you are hungry.
Limit naps – Studies find that between 20% and 60% of older adults take naps during the day. Napping can be a good thing if you need to improve your alertness in the daytime, but if you are having frequent midday naps you may be limiting your ability to sleep well during the night. If you are struggling to sleep at night, try cutting out naps or shortening them to see if this makes a positive difference.
Improve your diet – Even just a few small tweaks to your diet can have a big impact on your sleep, such as reducing your sugar intake or limiting processed foods. It may help to try an elimination diet or reduce just one thing at a time for at least a week so you can check if this has any positive impact on your sleep quality. You can read more ideas for improving your diet in our guide to what foods older adults should avoid, and why.
Engage in regular exercise – Getting enough exercise every day could help to improve sleep, so start incorporating more physical activity into your daily routine. This could be adding in an extra walk to your day, spending more time moving around the house cleaning or gardening, or taking part in organised exercise activities at a local group or with a home carer. Remember, while exercise can be helpful for sleep, the opposite can be true if you do vigorous exercise close to bedtime. You can read more about the type of exercises that could help in our guide to fitness and exercise for older adults.
Manage your stress levels – If you suspect stress could be the reason you are not sleeping well at night, practice relaxation techniques such as meditation, breathwork or gentle yoga to relieve some of the effects of chronic stress. Addressing any known causes of stress can also help, such as opening up to a loved one about a health condition, or finding ways to reduce spending to alleviate financial worries.

When is lack of sleep a problem that requires medical attention?

If you are experiencing severe symptoms, you should consult your doctor. These could be situations where daily life is being significantly affected in a negative way, such as extreme daytime fatigue, or cognitive function is becoming impaired. Also, if you are experiencing difficulties with mobility and balance, or falling asleep in dangerous situations, such as when driving, you should speak to a doctor about this. If your lack of sleep is exacerbating existing health conditions, you should also discuss this with your doctor for peace of mind. Sleep issues can become a long-term problem, or could become particularly significant for health and happiness. In these cases, it may be useful to speak to your doctor as they could help in a number of ways:

Offer advice on the potential underlying causes of your sleeplessness
Address any pain or physical symptoms that could be impacting your ability to sleep
Address any mental health concerns you have that could be contributing to the problem
Change or alter doses of any medications that could be affecting you
Address any specific sleep disorders you have, such as sleep apnoea
Talk about any hormone changes that could be contributing to the problem, and offer medication solutions
Discuss possible remedies – both home remedies or medications – that could help you to see improvements in your sleep

Your doctor may recommend medications that could help, however they may alternatively (or alongside medication) recommend therapy options relevant to the underlying cause of your sleep issues, such as cognitive behavioural therapy (CBT) for stress, and lifestyle changes such as a diet plan or exercise recommendations.

How can I help an older loved one get more sleep?

Lack of sleep can be particularly distressing for those experiencing it. It can make small problems seem larger, make us more emotional, and cause general lethargy and low mood. If you want to help an older loved one who is not sleeping well, you can encourage them to try some of the methods mentioned above to see if anything improves their sleep. If you are a caregiver for an older loved one, you could help them to create a bedtime routine that signals it is time to wind down (such as reading in bed), make adjustments to their bedroom to make it a more restful environment (such as low lighting), and help them to make changes to their diet and exercise to improve their overall health and sleep quality. Being there for someone with sleep problems could also mean providing a safe space for them to discuss what is on their mind, any stress that could be a contributor, or simply vent their frustrations about not sleeping. If you think your loved one’s sleep issues are severe and require medical intervention, you should encourage them to visit their doctor for help, or reach out to a sleep clinic or similar service for support and advice. Professional home carers could also help an older adult who struggles with sleep, by:

Providing overnight care and support so they never feel alone
Providing a calm environment in the evenings that makes it easier to wind down
Accompanying them to medical appointments for investigations, such as at sleep clinics
Ensuring any necessary medications are taken correctly
Encouraging them to eat a healthy diet
Providing regular exercise to expend energy

Addressing sleep concerns early is the key to stopping them from spiralling out of control over time. Doing so can help to encourage a healthy sleep routine, as well as enhancing your overall quality of life. While it can be an exhausting thought, especially when you are not sleeping, taking small steps and being proactive in seeking answers and solutions can help you get to the bottom of any sleep issues you are facing. If you feel you or a loved one could benefit from support from a home care professional to help with sleep issues, reach out to your local Home Instead office to find out more. Our Care Professionals are the best of the best, and highly trained to deliver the services you need. We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.

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