- Features of the sleep patterns of older people
- Common causes of sleep disturbance
- 'Dangers' of sleeplessness
- Advice for patients to avoid sleeplessness
As we get older, we need less sleep. This reduced requirement for sleep may result in the older person complaining that they suffer from insomnia when, in fact, this is a normal consequence of ageing. Reduced activity levels or mobility may also make the older person more likely to take naps during the day which, of course, will result in needing less sleep at night.
The relatives of many older people often attribute daytime sleeping to the fact that older people need more sleep and are napping because they are tired. They may not consider that the sleeping may be a symptom of boredom or just a habit after eating.
Putting an older relative to bed early so that they can get some rest and give the family a break does not mean they will spend the following 12 hours asleep! The answer to this problem is not sleeping tablets but an attempt to identify and cope with altered sleep patterns and needs.
Features of the sleep patterns of older people
- Fragmented sleep associated with frequent wakening.
- A longer time is needed to get off to sleep.
- REM sleep is unchanged but occurs earlier in the night than in younger people.
- Night-time sleep loss is usually compensated for by daytime napping. Patients and relatives often don't count this as sleep.
One in four male 60-65 year olds needs to get out of bed at night to urinate. This rises to 90% of the very old. The rate also increases for women, but not as substantially. Many elderly people will not consider this a cause of poor sleep, thinking that they should be able to return to sleep immediately, as they did when younger.
The pain of arthritis may also keep an elderly person awake. Judicious use of pain relief may be more effective than sleeping tablets in the long term.
Fear, anxiety, bereavement and depression will cause sleeplessness at any age. They are more commonly found in older age groups and thus these issues must be addressed. Conditions such as angina and palpitations may lead to insomnia due to secondary anxiety.
Poor sleep patterns are a predictor of depression in the elderly and changed surroundings may cause insomnia, which is usually temporary.
Common causes of sleep disturbance
- Shortness of breath (dyspnoea).
- Generalised itching (pruritus).
- Prostate gland enlargement in men (benign prostatic hypertrophy, BPH).
- Leg cramps.
'Dangers' of sleeplessness
- No serious medical consequences or complications.
- Depression and anxiety over not sleeping enough.
- Inappropriate day sleep, eg. during social events.
Advice for patients to avoid sleeplessness
- Avoid napping by day.
- Do not go to bed until tired.
- A pre-sleep ritual is important. It should be calming and familiar.
- Try a pre-bed warm drink (no caffeine), a bath, an easy reading novel or magazine.
- Try a new electric blanket to ensure that the bed is warm and safe.
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