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The Best Insomnia Treatment Options For Older Adults

If you’re having sleep problems such as difficulty falling asleep, staying asleep, or not feeling refreshed when you wake up - you are not alone. 

Significant research has been in progress for decades by practitioners and organizations such as the American Academy of Sleep Medicine in response to the growing problem of sleep disorders in older adults. It has been thought that the aging process alone causes sleep disorders including chronic insomnia. 

While aging has been shown to be a part of the problem, overall health is also a factor along with lifestyle.

Sleep quality can have a major effect on your quality of life. Sleep disorder is something you should discuss with your primary healthcare practitioner because it can be caused by, and conversely, cause underlying healthcare issues. 

Dr. Daniel J. Buysse, a nationally known sleep specialist, wrote in JAMA (The Journal of American Medical Association), “insomnia is one of the most prevalent health concerns in the population and in clinical practice.” He is also credited with saying “sleep health is essential to good health.” Yet clinicians are often reluctant to address sleep disorders because they have a poor understanding of the causes and treatment. Consequently, sleep disorders are underdiagnosed.

Poor quality of sleep can affect your health care issues and present quality of life issues. Increased hypertension as evidenced by higher blood pressure readings or significant and otherwise unexplained spikes in blood sugar may be evidence of sleep disorders. 

Confusion, drowsiness, constipation, dry mouth, and disorientation can increase for those with Alzheimer’s disease or other forms of dementia from sleep deprivation. The resulting daytime sleepiness for anyone can present a risk of falls and disruption of eating and medication schedules.

Poor sleep can result in drowsiness, fatigue, disorientation, and irritability.

What are the Causes of Insomnia in Older Adults?

The treatment for insomnia is influenced by associated causes. Some causes of insomnia or other sleep disturbances in older people include:

  • Lifestyle changes with retirement such as slowing down and becoming more sedentary
  • A lack of exercise
  • Any preexisting mental illness such as anxiety or depression
  • Side effects from medication such as those that cause you to urinate two to three times a night
  • Body temperature changes

Another important issue to consider is some side effects and interactions of medications that can affect sleep. 

Some of the medications that affect sleep include antihistamines, certain (SSRI) antidepressants, anti-inflammatory corticosteroids, several anti-hypertensives, and statins used to reduce cholesterol. 

In many cases, taking the medications in the morning can help reduce their effects on sleep quality. This should be discussed with your physician and pharmacist before making any changes. If you have severe insomnia, discuss with your healthcare provider the possibility of using alternative medications.

Many other medical conditions can contribute to insomnia and other sleep disorders. 

Sleep apnea, when left untreated, can be a dangerous disorder that can cause sleep deprivation and insomnia. Sleep apnea is quite common in geriatric care. Restless leg syndrome is another common cause of sleep disorders.

What are the Treatment Options for Insomnia?

The treatment of insomnia is not as simple as just taking a pill. Additionally, there is no one treatment that is “most effective” for everyone dealing with insomnia. It can take a lot of trial and error to reach your most effective treatment. 

Pharmacotherapy is one aspect. However, some sleep medications such as benzodiazepines like Ativan, Xanax, Valium, and Temazepam can be dangerous for elderly patients. 

Long-term use can cause cognitive impairment, addiction, and withdrawal. Other sleeping pills can be helpful and effective.

Non-prescription (over-the-counter) medication can be very helpful such as supplements like melatonin and valerian, and antihistamine-based drugs such as Unisom and Benadryl (diphenhydramine) medications such as Tylenol PM, Aleve PM, etc. 

  • Melatonin is a naturally occurring hormone in the body that helps induce sleep.
  • Some cardiovascular medications can reduce melatonin levels and taking a supplement may be recommended. 

Remember to always discuss taking medications with your physician first.

Nonbenzodiazepine medications that are available only by prescription include:

  • Ambien (zolpidem)
  • Lunesta (eszopiclone)
  • Sonata (zaleplon) 
  • Ramelteon

They are not without side effects and must be used with care to avoid the risk of falls and other injuries.

Additional forms of poor sleep treatment including evidence-based psychological treatment (EBTs), and Cognitive Behavioral Therapy (CBT) for insomnia can be quite effective for some to understand any underlying inaccurate or negative thought processes that contribute to sleep issues. 

Talk therapy online or in person can also be helpful for those who suffer from stress, anxiety, or the loss of loved ones.

Other therapies can be very effective in treating insomnia. These include:


  • Meditation (including guided imagery and therapeutic breathing)
  • Acupuncture
  • Yoga
  • Music Therapy
  • Bright light therapy

Sleep disturbances disrupt the body’s circadian rhythm which regulates the sleep and wake cycles. 

Keeping a sleep diary of your sleep patterns may provide you with clues as to your specific insomnia issues.

Make note of the following stressors, trauma, and pre-existing disorders that could influence your sleep such as:

  • Restless leg syndrome
  • Alzheimer's disease and Dementia
  • Any effects of medications that cause you to awaken during the night such as urinating
  • Factors in your sleep environment
  • A lack of exposure to sunlight
  • Use of caffeine, alcohol, or nicotine before bedtime
  • Amount of daily screen time (TV or phone)
  • Hours spent napping

How to Prepare for Sleep

One of the best ways to help improve your sleep habits and improve your sleep hygiene is to set and follow a set of interventions to prepare your body and your environment for your best sleep. Some helpful interventions are included in cognitive behavioral therapy techniques such as stimulus control therapy and sleep hygiene. 

Remember, a habit can take a minimum of 21 days to establish and requires adherence to daily practice. To establish the best sleep routine for yourself, make a list and follow it routinely to establish good sleeping habits.

 

  • Go to bed and get up at the same time every day - including weekends and holidays

  • Try not to nap, but if you must, take naps early in the day and limit the time to no more than one hour

  • Limit fluid intake after dinner to avoid frequent urination during the night

  • Avoid disturbing news or television before bed

  • Avoid exercise at least 90 minutes prior to bedtime

  • Limit interruptions from noise or technology

  • Maintain a dark room but have a flashlight or soft lights available if you need to get up

  • Avoid caffeine, alcohol, and nicotine at least one hour before bedtime

  • If you need a snack, eat about an hour before bedtime

  • Don’t let pets sleep with you

  • Take any sleep aids or sedating medications about 30 minutes before bed with a small amount of water

  • When you get into bed, get comfortable, and align your spine so as to reduce any pain issues

  • Quiet your mind, take a few deep breaths, and close your eyes

Successfully managing sleep maintenance can help improve overall health and result in a better quality of life.

Kathy Quan

A Registered Nurse with 40+ years of experience, focusing primarily on home health and hospice care in a variety of roles from Field Nurse to management. She has also written several books and blogs for healthcare professionals and caregivers. In addition, she teaches online courses for nurses and caregivers.

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