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Older Adults and Sleep Problems 

Introduction
Sleep problems are common among older adults.  Medical conditions, sleep disorders, and lifestyle factors can contribute to a reduction in sleep quality.  Older adults may have problems falling asleep and remaining asleep or awakening too early in the morning.  Lifestyle changes, treating underlying medical conditions, and medications can be helpful treatments for sleep difficulties.

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Anatomy
Sleep is vital for life, just like eating and breathing.  Sleep allows your body to rest.  It is believed that during sleep your brain performs important functions, such as storing memory and processing brain chemicals. 

In a way, your body goes on “auto-pilot” while you sleep.  Your brain regulates automatic functions for you, such as breathing, heart rate, and blood pressure.  The average adult needs about eight hours of healthy sleep.  After the age of 60, most older adults need only about six hours of sleep, although some researchers debate this.  Although sleep is a complex process that is not fully understood, it is known that a good night’s sleep is important for optimal health and functioning.

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Causes
With increasing age, it may be more difficult for you to fall asleep and remain asleep during the night.  You may wake up earlier and earlier in the morning.  There are many different types and causes of sleep disturbances in older adults.  It is important to have your doctor pinpoint the cause of your sleep problem in order to fix it.
 
A fundamental reason for sleep problems is that with age, the structure of the sleep cycle changes.  Each night you repeat episodes of deep and light sleep.  With age, you spend less time in deep sleep and more time in light sleep, resulting in a less restful night’s sleep.  Some older adults are tired during the day and take naps.  Daytime napping can contribute to a reduced quality of sleep at night.
 
Insomnia, the inability to fall asleep and remain asleep, is a common sleep disorder for older adults.  Acute insomnia is short-term and temporary.  It may result after a stressful event or from jet lag.  Chronic insomnia is ongoing and lasts for more than a month.  Chronic insomnia may be caused by another condition, including anxiety, depression, hormonal changes, alcoholism, chronic pain, thyroid conditions, heart failure, and frequent urination during the night, GERD, and asthma.  Certain medications can interfere with sleep.  Sleep disorders occur more frequently in older adults, including sleep apnea and restless legs syndrome.  People with brain disorders, such as Alzheimer’s disease, may experience a change in their sleeping patterns.  Another type of insomnia, primary insomnia does not result from other conditions, but may occur because of poor sleep habits, such as an inconsistent bedtime routine.

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Symptoms
Sleep problems may cause you to have difficulty falling asleep or remaining asleep.  You may wake up during the night or too early in the morning.  The lack of sleep may cause you to feel tired during the day, moody, and irritable.  You may have a harder time concentrating, performing your usual tasks, solving problems, and remembering things.  Some older people may have problems determining when it is daytime and when it is night.

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Diagnosis
You should talk to your doctor if you experience trouble sleeping at night.  Your doctor will review your medical history, medication list, and conduct evaluations as necessary.  Depending on the suspected cause of your sleep problem, you may be referred to other specialists, such as a sleep medicine doctor, urologist, or psychiatrist.

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Treatment
Sleep problems may be treated with lifestyle changes, medications, or a combination of both.  If you have an underlying medical disorder, such as asthma, your doctor will treat that as well.  Treatment for psychiatric and sleep disorders vary according to the cause of the problem, and may include use of prescription medication.
 
Many cases of insomnia can be corrected with lifestyle changes.  It can be helpful to establish a consistent bedtime routine, eat a healthy diet, exercise regularly, and practice relaxation techniques.  You should refrain from using tobacco products, alcohol, and illegal drugs.  Your bedroom should be used for sleeping and not other activities such as watching television or computer work.  A behavioral therapist, counselor, or psychiatrist may help you resolve issues and guide you to a healthier lifestyle.
 
Prescription medication can be used to help you sleep better.  Some sleep medications are used on an as needed basis and others are for long or short-term use.  You should consult your doctor before trying over-the-counter sleep aids.  Some over-the-counter medications have side effects or interactions with other types of medications.

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Prevention
 You may prevent insomnia by reducing the risk factors that you can control.  It can be helpful to eat healthy, exercise regularly, and practice relaxation techniques.  Counseling may help as well.  Establish a regular bedtime routine and use your bedroom only for sleep and sexual activity.  It is helpful to not use alcohol, cigarettes or nicotine products, caffeine products, illegal drugs, or other stimulants.  If you are diagnosed with a psychiatric disorder such as anxiety or depression, follow you psychiatrist’s recommendations for taking your medication.

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Am I at Risk

Sleep problems for older adults are common.  Some of the risk factors include:


_____ Increasing age is associated with an increase in sleep problems.
_____ Medical conditions can disrupt sleep.  Common causes include anxiety, depression, hormonal changes, alcoholism, chronic pain, thyroid conditions, heart failure, frequent urination during the night, GERD, and asthma.
_____ Sleep disorders, such as sleep apnea or restless legs syndrome, can interrupt a good night’s sleep.
_____ Short-term stressful events increase the risk of sleep problems.
_____ Depression, anxiety, and long-term stress can contribute to sleep problems.
_____ Alcoholism or substance abuse increases the risk of sleep disorders.
_____ Caffeine products, such as coffee, tea, and soda pop, are stimulants and may make it difficult to fall asleep if you drink them too close to bedtime.
_____ Alzheimer’s disease or organic brain syndrome increases the risk for sleep disorders.
_____ Smoking cigarettes and using tobacco products can interfere with sleep because these products are stimulants and may increase alertness.
_____ A lack of regular exercise increases the risk of sleep problems in older adults.
_____ Nocturia, the need to wake up and urinate numerous times during the night, interrupts a restful sleep.  For men, an enlarged prostate gland is a common cause of frequent urination during the night.
_____ Napping or sleeping too much during the day can contribute to poor sleep at night.

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Complications
Lack of sleep can cause problems with thought and behavior.  You may find it more difficult than before to solve problems, pay attention, remember things, and perform your daily tasks at home or at work.  You may feel moody and irritable.  A lack of sleep can contribute to depression, and insomnia can be a symptom of depression.  Researchers are finding that a lack of sleep is associated with an increased risk of injury and car crashes.

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Advancements
Obstructive sleep apnea has also been shown to be more common in the older patient.  This may be due to a number of factors, such as other medical condition, obesity, and decreased muscle tone in the upper airway.  Elderly patients may not report sleeping problems to their doctor because symptoms of snoring, sleepiness, fatigue, nocturia, and memory and concentration problems may be attributed to the aging process itself.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.