Your mother says she hasn't slept well in months. She falls asleep in her chair after dinner, then lies awake from 2 a.m. She's started taking an over-the-counter sleep aid, and lately she seems groggy and unsteady in the mornings.
Insomnia is common in older adults, and the fixes are often simpler and safer than pills. Here's what families should know.
What insomnia is
Insomnia is trouble falling asleep, staying asleep, or waking too early and not being able to get back to sleep3. It can be short term, lasting days or weeks, or chronic, lasting months. People with insomnia often feel tired, irritable or foggy during the day.
Sleep patterns change with age. Older adults tend to get sleepy earlier in the evening, wake earlier in the morning, and spend less time in deep sleep1. But older adults still need about the same amount of sleep as younger adults, about 7 to 9 hours a night1. Poor sleep is not simply a normal part of aging.
Why sleep matters
Poor sleep affects more than energy. In older adults, it's linked to falls, trouble with memory and concentration, depression, and worse health overall1. Daytime sleepiness can make driving dangerous. Treating insomnia can improve mood, thinking and safety. If your parent sleeps too much rather than too little, see elderly sleeping a lot.
Common causes in older adults
| Cause | Examples |
|---|---|
| Health conditions | Pain, arthritis, heart failure, breathing problems, acid reflux |
| Bladder problems | Waking to urinate several times a night |
| Medicines | Some for blood pressure, asthma, depression; steroids; diuretics taken late |
| Mood | Depression, anxiety, grief |
| Sleep disorders | Sleep apnea, restless legs syndrome |
| Habits | Long naps, caffeine or alcohol, irregular schedule, screens at night |
| Environment | Noise, light, an uncomfortable bed or room temperature |
Often more than one factor is involved. Finding and treating the underlying cause, such as pain or depression, may improve sleep more than any sleep aid. See chronic pain in the elderly and depression in the elderly.
Sleep habits that help
In the long run, changing lifestyle and sleep habits is the best treatment for problems falling and staying asleep2. Try these: go to bed and get up at the same times every day, even on weekends. Get morning daylight and stay active during the day. Limit naps to 20 to 30 minutes, and not late in the afternoon. Avoid caffeine after midday and alcohol close to bedtime. Have a calming routine before bed, like reading, a warm bath or quiet music1.
Use the bed only for sleep and intimacy. If your parent can't fall asleep after about 20 minutes, it often helps to get up, do something quiet in dim light, and return to bed when sleepy. Lying in bed awake and worried can train the brain to link the bed with wakefulness.
Making the bedroom sleep-friendly
Keep the bedroom dark, quiet and comfortably cool. Blackout curtains, a fan or white noise machine, and a comfortable mattress and pillows help. Move the TV out of the bedroom if possible, and put phones and tablets away an hour before bed, since their light can make it harder to fall asleep1. Use a dim night light on the path to the bathroom so your parent can see without turning on bright lights. See fall prevention for the elderly.
Sleeping pills: why caution is needed
Most over-the-counter sleeping pills contain antihistamines, the same drugs used for allergies2. In older adults, these can cause next-day grogginess, confusion, constipation, trouble urinating and falls. Many 'PM' pain relievers contain them too. Check labels for diphenhydramine or doxylamine, and ask the pharmacist before your parent uses them.
Prescription sleep medicines called hypnotics can help reduce the time it takes to fall asleep, but most can become habit-forming and work less well over time2. In older adults they raise the risk of falls, confusion and memory problems. Some people need medicine for a short period2, but it should be used under close supervision. Never stop a prescription sleep medicine suddenly without talking to the doctor. See polypharmacy in the elderly.
Melatonin and supplements
Melatonin and herbal supplements are popular, but their effects are modest and product quality varies, because supplements aren't regulated like medicines. Some interact with other drugs. Ask the doctor or pharmacist before your parent tries any supplement for sleep, and bring the bottle to appointments.
Therapy for insomnia
Cognitive behavioral therapy for insomnia, often called CBT-I, is a structured program that helps people change thoughts and habits that keep them awake. It works well for many older adults and avoids the risks of medicine. It's offered by some therapists and sleep clinics, and through some programs online or by phone. Ask the doctor whether it's available for your parent. It usually takes several weeks of practice, and sleep may feel a little worse before it gets better, so encouragement from family helps your parent stick with it.
Sleep apnea and restless legs
Sleep apnea causes breathing to stop and start during sleep. Signs include loud snoring, gasping or choking at night, and daytime sleepiness. It's common in older adults and raises the risk of heart problems and stroke. A sleep study can diagnose it, and treatment, often with a CPAP machine, can greatly improve sleep4. Restless legs syndrome causes an urge to move the legs, especially at night; low iron can contribute, so blood tests may help. See anemia in the elderly.
Nighttime bathroom trips
Waking to urinate is a common reason older adults sleep poorly. Limiting fluids in the two hours before bed, taking water pills earlier in the day if the doctor agrees, and treating bladder or prostate problems can help. Make the path to the bathroom safe and well lit, or keep a bedside commode for a parent with limited mobility. See incontinence in the elderly.
Sleep and dementia
People with dementia often have disrupted sleep, waking at night, wandering or being confused about day and night. A steady routine, daytime activity and light, limiting naps, and a calm evening can help. Late-day agitation is common; see sundowning. Sleep medicines are especially risky for people with dementia, so talk with the doctor before trying any. If nighttime care is wearing you down, see respite care.
When to see the doctor
Talk to the doctor if poor sleep lasts more than a few weeks, affects daytime life, or comes with loud snoring, gasping, leg discomfort, low mood, or new confusion. A sleep diary helps: for two weeks, note bedtime, wake time, naps, caffeine and alcohol, medicines, nighttime awakenings, and how rested your parent feels. The doctor may review medicines, check for underlying conditions, or recommend a sleep study.
When your sleep suffers too
If you care for a parent who's up at night, your own sleep may suffer. Lack of sleep wears down patience and health. Ask family to share night duty, consider an overnight aide a few nights a week, or look into respite care. Don't ignore your own sleep; see caregiver burnout.
What happens during the day matters
Good nights start in the morning. Exposure to daylight soon after waking helps set the body's internal clock, so encourage your parent to open the curtains, eat breakfast by a window, or take a short walk outside. Regular physical activity, even gentle walking or chair exercises, helps people fall asleep faster and sleep more deeply, though vigorous exercise is best finished a few hours before bed1.
Social contact and purpose during the day help too. Older adults who spend long, quiet days alone often doze in the afternoon and then lie awake at night. A senior center, a class, volunteering or regular visits can give the day more structure. See loneliness in the elderly.
Worry and racing thoughts
Many older adults lie awake worrying about health, money or family. Writing worries down earlier in the evening, along with a short plan for tomorrow, can help clear the mind. Relaxation techniques such as slow breathing, gentle stretching, or listening to calming music or a familiar audiobook can ease the body toward sleep. If anxiety is constant, talk with the doctor; see anxiety in the elderly. Grief after a loss also disrupts sleep for many months, and support can help.
Food, drink and sleep
A heavy meal close to bedtime can cause discomfort and heartburn, while going to bed hungry can also keep a person awake. A light snack, such as a small bowl of cereal or yogurt, is fine for many people. Caffeine hides in tea, soda, chocolate and some pain relievers. Alcohol may help someone fall asleep but leads to more waking later in the night, so it's best avoided as a sleep aid.
An example
Karen noticed her father was groggy and unsteady after starting an over-the-counter sleep aid. His doctor found the pill contained an antihistamine and suggested stopping it. Together they made a plan: a set wake time, a morning walk, no naps after 2 p.m., no coffee after lunch, and a warm shower before bed. The doctor also treated his knee pain and moved his water pill to the morning. Within a month he was sleeping longer and was steadier on his feet. This is an illustration; causes and solutions vary.
