Getting older brings numerous changes in daily patterns of living, and sleep is one of the most pronounced shifts. Most older adults experience a harder time falling asleep, wake more frequently during the night, and find themselves getting up earlier in the morning than they did when they were younger, according to the National Library of Medicine.
"These changes can make sleep feel lighter and less restorative, but older adults still need adequate sleep," says Dung Trinh, M.D., an internist at MemorialCare Medical Group and chief medical officer of Healthy Brain Clinic in Irvine, CA, adding that age itself is rarely the sole cause of sleep problems in the elderly. "Many sleep problems in seniors are caused by medical, psychological, or environmental factors rather than aging alone."
That's good news, because it means sleep quality may improve once surrounding factors are addressed. Let's take a closer look at what happens with sleep as you age, along with sleep strategies that can help.
In This Article:
Why Seniors Have Trouble Sleeping at Night
With aging comes subtle shifts in your circadian rhythm—the body's "clock" that influences sleep timing. Those shifts can change your sleep schedule, says Dr. Trinh, causing older adults to go to bed earlier and wake up earlier.
Although total sleep time may be the same as when you were younger, you may be spending more time in bed because of an increase in sleep disruptions or because you find it tougher to fall asleep. But natural changes to your body clock aren't the only reason you might be struggling to maintain good sleep quality. There are several potential culprits that make it harder for older adults to sleep well at night.
Chronic Pain and Arthritis
Chronic pain and poor sleep often create a negative feedback loop, explains Dr. Trinh. Pain from arthritis, neuropathy, back problems, or other conditions can make it difficult to find a comfortable position, fall asleep, or remain asleep throughout the night. At the same time, inadequate sleep can increase sensitivity to pain and make the next day's discomfort feel more intense. Addressing the pain itself is therefore an important part of treating insomnia.
"Depending on the cause, treatment may include physical therapy, regular appropriate exercise, stretching, supportive pillows or positioning, heat or cold therapy, topical medications, and carefully selected oral medications," he says. "Medication timing may also be adjusted so that pain is better controlled during the night without causing excessive sedation."
Medications That Cause Sleep Problems in Seniors
Medication review is an important part of evaluating insomnia in older adults, because some medications can directly stimulate the nervous system and make it harder to fall asleep, says Dr. Trinh. Those can include:
- Corticosteroids for inflammation
- Decongestants for allergies
- Psychiatric medications for depression or anxiety
- Beta-blockers for high blood pressure
Diuretics, often used for blood pressure or heart conditions, can lead to repeated nighttime trips to the bathroom if taken too late in the day, Dr. Trinh adds. Other drugs may have the opposite effect and cause excessive daytime sleepiness, which can lead to more napping and make nighttime sleep more difficult.
"Sedating antihistamines, some pain medicines, certain anxiety medications, and other centrally acting drugs can also increase confusion or disrupt normal sleep patterns," he says. "Timing matters as well. Sometimes moving a medication to morning rather than evening can help, although this should be done under medical guidance." He emphasizes that you should not stop prescribed drugs on your own; instead, bring a complete medication and supplement list to your clinician or pharmacist for review.
Frequent Nighttime Urination
Regularly waking up more than once during the night to urinate is called nocturia, and it can have several causes, such as drinking too many fluids right before bed or taking a diuretic to control an issue like high blood pressure. Cleveland Clinic notes that other factors may contribute to the condition, including:
- Diabetes
- Enlarged prostate
- Heart disease
- Menopause
- Reduced bladder capacity
- Restless legs syndrome
- Sleep disorders such as sleep apnea
- Urinary tract infection
Nocturia is common, especially if you're in your 50s or older, says Dr. Trinh. Addressing the issue starts by looking at why you might need to pee more than once during the night, and that can lead to changing your medication schedule, checking for any underlying medical conditions or issues like type 2 diabetes or a UTI, or simply reducing how much liquid you drink in the couple hours leading up to bedtime.
Sleep Apnea
Sleep apnea is a condition characterized by repeated stops and starts in breathing during sleep and is considered potentially serious because it inhibits airflow into the lungs. Loud snoring is the most common symptom, but that doesn't mean everyone who snores has this disorder, according to Dr. Trinh.
"Snoring by itself is the sound created when air moves through a partially narrowed upper airway during sleep, and many people snore without having sleep apnea," he says. "Sleep apnea is concerning because breathing repeatedly becomes significantly reduced or stops altogether."
Warning signs include loud, habitual snoring combined with witnessed pauses in breathing, followed by gasping, choking, snorting, or sudden awakenings. You may also experience morning headaches, dry mouth, poor concentration, irritability, frequent nighttime urination, or excessive daytime sleepiness.
"A spouse or caregiver is often the first person to notice the breathing interruptions," Dr. Trinh says. "People with concerning symptoms may need a home sleep apnea test or an overnight sleep study. Evaluation is especially important because untreated sleep apnea can affect cardiovascular health, cognition, mood, and daytime safety."
Along with medical treatment, doctors sometimes recommend sleeping on an adjustable bed with the head at an incline to aid in sleep apnea symptoms.
How Anxiety Makes Sleep Hard
Like chronic pain, anxiety and sleep can form a negative feedback loop: The harder you try to fall asleep, the more difficult it becomes and the more anxious you get, according to Marty Maidenberg, a psychotherapist with Pathways Psychological Services in New York City.
"We start thinking, 'I have to get to sleep, I'm going to be exhausted tomorrow,' and suddenly our brain is even more awake," he says. "We're putting pressure on ourselves to do something that really needs to happen naturally."
It can help to give yourself some time to wind down before bed instead of going directly from a busy day into trying to sleep, he suggests. Turn down stimulation: step away from work and emails, turn off the TV, and create a simple nighttime routine that tells your brain that it's bedtime. Reading, deep breathing, meditation, or simply sitting quietly can help your body and mind slow down.
"If your mind tends to race once your head hits the pillow, try writing things down before you go to bed—your worries, your to-do list, or whatever keeps popping into your head," says Maidenberg. "The idea is to remind yourself that you don't have to figure it out right at that moment. Sometimes just giving yourself permission to let those thoughts wait until morning and having a tangible record of things can take away some of the pressure."
Lifestyle Habits That Affect Sleep
In addition to issues like chronic conditions and medications, what you do during the day can impact your sleep quality, says Dr. Trinh. Specifically, you may have more trouble sleeping if you:
- Are sedentary or have minimal physical activity
- Have less exposure to daylight, since this type of light helps reset your circadian rhythm
- Take frequent daytime naps, especially close to bedtime or lasting hours
- Consume caffeine in the evening
- Drink alcohol or use nicotine products
Inconsistent bedtime and wake schedules can also be a major driver of sleep difficulties, Dr. Trinh adds. Going to bed and waking up at the same time every day strengthens your body clock, making it easier to fall asleep and wake up refreshed.
How Can Older Adults Get Better Sleep?
Despite all these factors at play when it comes to sleep quality, there are some strategies that have been shown to ease sleep difficulties, says Dr. Trinh. One of the most utilized approaches is cognitive behavioral therapy for insomnia (CBT-I). Considered a first-line treatment, this is a short-term structured therapy done with a licensed therapist that involves examining your sleep routine and habits and making meaningful changes.
Other practical ways to get better sleep include:
- Avoid looking at the clock when trying to fall asleep or when you wake in the middle of the night, since that can increase stress and make it more difficult to get back to sleep.
- Choose an adjustable bed that can help position the body at a more comfortable incline.
- Get sunlight as soon as possible in the morning, since this helps reset your body clock and that can subsequently make bedtime easier.
- Limit late naps, caffeine, and alcohol because all of these may make it more difficult to fall asleep at night.
- Maintain a consistent bedtime and wake time.
- Reduce fluids in the evening if appropriate to minimize bathroom trips overnight.
When to Talk to a Doctor About Poor Sleep
"If poor sleep is happening consistently, affecting how you function during the day or changing your quality of life, talk to your doctor," says Partha Nandi, M.D., a clinical associate professor of medicine at Michigan State University and president and chief medical officer at Pinnacle GI Partners in Bingham Farms, MI. "You don't have to simply live with it." He suggests a conversation with your doctor if you're experiencing issues such as:
- Falling asleep while driving or during activities
- Frequent nighttime urination
- Gasping, choking or pauses in breathing during sleep
- Loud, persistent snoring
- New confusion or significant changes in sleep
- Persistent pain that wakes you
- Regular reliance on alcohol, over-the-counter sleep aids or prescription medications to get to sleep
- Significant daytime sleepiness
- Uncomfortable or irresistible urges to move your legs at night
If you've been struggling with insomnia for several weeks and it isn't improving, that's worth discussing as well, Dr. Nandi adds.
Bottom Line
Sleep isn't a nice-to-have, it's a need-to-have. When you are asleep, that's when your brain and body perform essential work to support your memory, mood, metabolism, immune health, and physical recovery, according to Dr. Nandi. Because of that, it's essential to prioritize good habits that can support your sleep quality.
"At every age, good sleep is part of good health," he says. "If you're not getting it, the answer isn't always another pill. Sometimes the most important first step is figuring out what your body is trying to tell you."
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