Insomnia in older adults

Chronic insomnia – difficulty falling asleep, staying asleep, or waking up too early – is quite common in older adults. Studies have found that 15 to 35% of the older population struggle with insomnia symptoms (Ohayon, 2002).

In older adults, insomnia is linked to increased risk of accidents, physical and mental health issues, and lower quality of living (e.g., Avidan et al., 2005; Buysse et al., 2005). As well, older adults are more likely to experience worse side effects from sleep medication.

One reason for the increased risk of insomnia as we age is because of certain biological and psychosocial changes that make older adults more vulnerable to sleep problems like insomnia. Understanding some of these factors can be really important in navigating some of these potential insomnia pitfalls and supporting optimal sleep health throughout our life.

1. Changes in sleep drive in older adults

Sleep drive, also known as sleep pressure, is our propensity to fall asleep at any given moment. We build sleep drive throughout our day as we engage in different activities, such as exercising, going to work, spending time with friends, etc.

Low sleep drive is one of the main causes of insomnia, because people with insomnia typically engage in behaviours that torpedo the build-up of sleep pressure. For example, cancelling plans or reducing activity, going to bed early, or sleeping in. These behaviours reduce our sleep drive, which is important because sleep drive is related to our ability to produce deep restorative sleep.

For older adults, there are certain lifestyle changes that may be associated with reduced sleep pressure. For example, retirement can be a significant change from a sleep perspective because it can limit activities in an older adult’s life and promote greater resting behaviours. These changes are associated with a weakening of sleep drive build-up.

Moreover, older adults may also limit physical activity because of physical limitations or ailments. Inactivity can lead to feelings of fatigue in addition to further reducing drive to sleep.

These lifestyle changes create a ‘perfect storm’ of reduced sleep pressure that can bring about poor, unrefreshing sleep that contributes to sleep disturbances.

2. Changes in regularity of schedule in older adults

Retirement can also impact the consistency of schedules in terms of bedtimes and risetimes. Because of less commitments, older adults may be able to have a more flexible schedule in terms of when they decide to get up for the day.

Although this can be very beneficial in some ways, the lack of regularity may also lead to inconsistency when it comes to getting up in the morning. Getting up at variable times can lead to experiencing symptoms of jetlag. For example, if a person wakes up 6:00am on Monday and 9:00am on Tuesday, they would experience symptoms of jetlag comparable to travelling from Vancouver to Toronto. This is because their internal clock is not well-matched to the clock on the wall.

3. Changes in sleep needs and circadian rhythm in older adults

Our sleep needs changes throughout our lives. Although some people remember fondly of their teenage years where they could sleep hours on end, we no longer need the same amount of sleep when we get older.

For older adults, there is also a shift in circadian rhythm towards a morning preference (i.e., an early bird). This means that as we age, we begin to sleep and wake up at an earlier time.

Sometimes, people’s expectations of how they should sleep (based on how they used to sleep) can actually lead to sleep problems. For example, an older adult might have slept at 11:00pm and woke up at 7:00am in their thirties, but now they may get sleepy around 9:30pm and get up around 4:30am.

This change may cause the person to feel worried about their sleep; however, this may simply be the new schedule that their body is on. Moreover, if this person tries to force themselves into an 11:00pm to 7:00am schedule, it can lead to them feeling anxious about waking up too early (or cause insomnia because the sleep window does not fit their body’s preference). Some of my older patients sleep anxiety is often relieved when they realize that waking up early in the morning is not an issue; it’s simply what their body prefers!

the early bird gets the worm
Although waking up at 5:00am may not be preferable to everybody, at least you’ll be the one to get the worm!
Photo by Mathew Schwartz on Unsplash

4. Medical and psychological challenges in older adults

Medical and psychological conditions can also lead to sleep disturbances. For example, depression and anxiety is common in older adults, and is associated with insomnia symptoms. Moreover, other physical ailments can also impact sleep, such as chronic pain lightening sleep, and thyroid issues being linked to sleep problems.

Overall, general deterioration of health and insomnia can have a bidirectional effect on each other.

Tips to improve sleep health in older adults

Based on the discussed changes that may increase vulnerability to insomnia in older populations, here are a few tips to optimize sleep health.

1. Stay active and build sleep drive. Keeping to an active lifestyle can be helpful to ensuring that sleep pressure is being built-up throughout the day. This can lead to increased deep and restorative sleep, more energy, and keep our muscles healthy. Staying active can also be a great way to improve mood and reduce other potential ailments, such as chronic pain. Ensure that the activities you include are ones you enjoy and you can stay consistent with – one good way is through the use of activity scheduling strategies!

2. Keep to a regular routine. Establishing regular bed and rise times can be a good way to support sleep health from a circadian rhythm perspective. A good way to set our internal clocks is to get some sunlight as soon as we wake up.

3. Accept changes in our sleep! Our sleep needs and preference for when we prefer to go to sleep and wake up will change throughout our life. It’s important to accept that we may never sleep like we did when we were teenagers. Through acceptance of this fact and following our bodies natural rhythm and sleep needs, we actually end up with some better sleep.

4. Check in regularly with your medical provider. Ensuring that our general health and well-being is taken care of through regular check-ups and adherence to your medical provider’s recommendations can be a great way to optimize sleep health. Just the same as sleep is important in many areas of life; our different facets of health can also impact our sleep.

older adults enjoying yellow flowers
Photo by Jaddy Liu on Unsplash

Summary

  • Old age is a period of vulnerability to different sleep problems like insomnia
  • Changes in our sleep as we age, such as becoming more of a morning bird and sleep needs, are important to recognize in order to properly adjust our sleep expectations
  • Moreover, changes in lifestyles (e.g., retirement) can impact our ability to obtain deep sleep
  • Therefore, keeping to an active lifestyle and a consistent schedule is important to optimize sleep health

Best wishes,

P