Sleep and Night-Times in Older Age: What Helps

Ask any family carer what the hardest part is and a lot of them will say the nights. Someone who wakes four times. Someone who gets up and wanders at two in the morning. Someone who dozes all afternoon and is then wide awake and anxious at midnight. Nights wear people down in a way that daytime care does not, because there is no recovery from them.

Some of it is a normal part of ageing. A good deal of it is not, and can be improved.

What changes normally

Sleep genuinely changes with age, and knowing that helps set expectations. Older people typically sleep more lightly, wake more often, go to bed earlier and wake earlier. Total sleep need does not drop as much as people assume around seven hours remains about right for most but it becomes more broken and harder to come by in one stretch.

Waking once or twice and going back off is normal. Lying awake for hours, or being exhausted all day, is not.

What usually causes the problem

• Needing the toilet the most common single reason older people wake. Worth addressing properly rather than accepting, because it is also the leading cause of night-time falls. Our guide on continence covers what can be done, including the point that cutting fluids makes things worse rather than better.
• Pain arthritis, back pain, cramp. Often under-treated because people do not want to bother anyone. Worth raising with the GP, as timing pain relief for bedtime can transform things.
• Daytime napping a long afternoon sleep makes the night worse, and the broken night makes the nap more necessary. Breaking that cycle usually means putting something in the afternoon rather than simply telling someone not to doze.
• Medication diuretics taken too late, steroids, some antidepressants and others all affect sleep. A medication review is often the single most useful intervention.
• Anxiety and low mood particularly after a bereavement, a fall or a hospital stay. Lying awake worrying is extremely common and rarely mentioned.
• Restless legs and cramp both treatable, both frequently dismissed.
• Sleep apnoea loud snoring, pauses in breathing, waking gasping, heavy daytime sleepiness. Under-diagnosed in older adults and genuinely treatable. Worth mentioning to the GP.
• Too little daylight and too little activity someone who does not get outside and barely moves has very little to make them tired.

A word about sleeping tablets

They are worth being cautious about in later life. Sedatives and sleeping tablets significantly increase the risk of falls, confusion and daytime drowsiness in older people, and the benefit often fades while the risks do not. That does not mean nobody should ever take them it means it is a conversation to have properly with the GP, alongside looking at the underlying cause, rather than a first resort. If someone has been on them for years, a review is still worth asking for.

Practical things that help

• A consistent bedtime and getting-up time, including at weekends
• Daylight in the morning even sitting by a window helps set the body clock
• Some physical activity during the day, however gentle
• A short, early afternoon rest rather than a long late one
• Cutting caffeine after mid-afternoon, and watching alcohol it brings sleep on and then breaks it up
• A wind-down routine: the same sequence each evening, lights lowered, television off
• A bedroom that is cool, dark and quiet, with a comfortable mattress
• A night-light and a clear, uncluttered route to the bathroom
• A clock that is easy to read, so waking at 3am does not become a guessing game

When dementia is part of it

Dementia changes nights considerably. Many families describe sundowning restlessness, agitation or confusion that builds in the late afternoon and evening. Someone may get dressed at 2am believing it is morning, or try to leave the house to go to work they retired from twenty years ago.

What tends to help: keeping the day structured and active, plenty of daylight, closing curtains before dusk so the change is less abrupt, keeping the evening calm and quiet, and not arguing with what the person believes is happening. Our guide to dementia care at home covers the wider approach.

Safety matters here too someone who gets up and wanders at night needs a safe route, good lighting, and in some cases a sensor that alerts rather than a locked door.

When the family carer is the one not sleeping

This is the part that gets overlooked. A husband or daughter who has not had an unbroken night in eight months is running on empty, and broken sleep affects judgement, patience and health in ways people underestimate. It is one of the most common reasons a care arrangement at home finally breaks down not because the person being cared for could not stay at home, but because the carer could not keep going.

If that is where you are, this is exactly what overnight care exists for. Sleep-in cover means a Care Professional is in the house overnight and available if needed. Waking night cover means someone is awake and on duty throughout. Even one or two nights a week makes a measurable difference, and it sits comfortably alongside respite for family carers.

When to see the GP

• Sleep problems that have lasted more than a few weeks
• New or worsening night-time confusion
• Loud snoring with pauses in breathing
• Pain that is disturbing sleep
• Daytime sleepiness that is affecting daily life
• Any sudden change, which can indicate infection a urinary tract infection in particular often shows up first as night-time confusion

Related guides from our team

• Overnight Care in Newport, Cwmbran & Chepstow
• Dementia Care at Home in Newport, Cwmbran & Chepstow
• Continence Care at Home
• Preventing Falls at Home
• Respite Care in Newport, Cwmbran & Chepstow

Talk to your local team

If nights have become difficult for your loved one, for you, or for both give us a call. We will talk through what might help, including the things that do not involve us at all.

Call our friendly team today on 01633 740028 or visit our website to arrange a free, no-obligation care consultation.