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Sleep disorders in the elderly
Medical expert of the article
Last reviewed: 04.07.2025
It is well known that sleep changes with age, but it has not yet been proven whether these changes are part of normal aging or a pathology.
And one of the reasons for the ambiguity may be due to the different lifestyles in the regions, differences among individuals.
[ Symptoms sleep disorders in the elderly
The most widely held belief that older people sleep less turns out to be false, since the total sleep time of older people does not decrease. Daytime naps and sleep redistribution compensate for poor nighttime sleep.
One of the leading symptom complexes of sleep disorders in the elderly is insomnia. Insomnia is understood as the inability to sleep and is a symptom complex, not a diagnosis. Patients may complain of difficulty falling asleep and maintaining sleep, frequent nighttime awakenings, early rising with the inability to resume sleep, fatigue, irritability, and impaired concentration under stress. Insomnia is often accompanied by unwanted daytime drowsiness.
Forms
Transient insomnia is the result of some acute stressful situations, which can be hospitalization, operations, loss of a loved one, retirement. Usually this unfavorable condition can pass on its own within a week.
Chronic insomnia. If insomnia due to age-related changes and other conditions bothers the patient for a month or more, then we can talk about the onset of a chronic form of insomnia.
About 1/3-1/2 of patients who suffer from chronic insomnia have mental disorders. The main symptoms of this sleep disorder in the elderly are: anxiety, irritability, fatigue, cognitive impairment.
It can be very difficult to assess and treat patients who have been taking sleeping pills for a long time - their side effects are sometimes indistinguishable from the symptoms of insomnia.
When collecting anamnesis, it is necessary to pay attention to chronic diseases, the manifestations of which can lead to insomnia. These include: osteoarthritis, nocturnal dyspepsia, nocturnal exacerbation of chronic obstructive pulmonary diseases, cardiac asthma, nocturia (due to improper prescription of diuretics, urinary incontinence or inflammatory processes), thyroid diseases or night headaches. Many patients suffering from depression complain of the inability to maintain sleep or early rising.
One of the causes of sleep disturbance in the elderly due to frequent awakening is sleep apnea syndrome, characterized by complete or partial cessation of breathing for more than 10 seconds due to obstruction of the upper airways (due to the closure of the lower part of the soft palate, the back of the tongue and the back wall of the pharynx). Sleep apnea syndrome is one of the leading causes of sudden death at night.
In addition, sleep can be disrupted by an inadequate daily routine, late meals, insufficient physical activity, excessive consumption of coffee and alcoholic beverages.
Specific sleep disorders in older adults
Depression-associated insomnia syndrome
Typical of depression is getting up early and not being able to fall asleep afterwards.
Insomnia associated with medications used in the treatment of the cardiovascular and respiratory systems. Thus, discontinuation of sedatives causes withdrawal syndrome; expectorants containing ephedrine and beta-agonists can increase the time it takes to fall asleep; the same effect has been noted with caffeine-containing drugs. Antihypertensive drugs of the beta-blocker group (propanolol) can cause breathing difficulties in patients with asthma and chronic obstructive pulmonary diseases, drugs such as reserpine (adelfan, triresid) often cause depression and insomnia, and alpha-1-blockers can cause sleep disorders in the elderly.
And H2-histamine blockers (mainly cimetidine), used for peptic ulcer in the elderly, can cause nocturnal delirium. Sinemet or Nacom can lead to nightmares. Diuretics prescribed at night cause nocturia, which causes interrupted sleep.
Restless Legs Syndrome
Occurs at night and is described as a sensation of running on some surface. Symptoms of sleep disorders in the elderly are relieved by direct movement of the legs and return when they are stationary. This syndrome must be differentiated from cramps, in which the patient wakes up from pain in the calves and muscle spasm, and not from a sensation of movement.
Periodic Limb Movement Syndrome
This sleep disorder in the elderly occurs in 45% of patients over 65 years of age. It occurs at night and is characterized by rapid unilateral or bilateral flexion of the big toe and partial flexion of the knee and hip. The movements last 2-4 seconds and are often repeated (sometimes after 20-40 seconds). It is based on age-related disruption of neurotransmitter metabolism in dopamine receptors.
Who to contact?
Treatment sleep disorders in the elderly
- Activities that help normalize sleep:
- eliminate daytime sleep by keeping the patient occupied with something interesting;
- limit fluid intake in the second half of the day, maintaining the daily amount;
- airing the room before going to bed (the temperature in it should not exceed 22 °C);
- the bed should be hard and the blanket should be warm and light;
- A short walk before bed is recommended;
- You can't eat sweets before going to bed;
- It is recommended to take calming infusions;
- taking sleeping pills as prescribed by a doctor;
- the patient should sleep in silence; short reading can help to fall asleep;
- teaching the patient auto-training techniques.
- Tips for patients to improve sleep:
- Follow a daily routine - go to bed and wake up at the same time, both on weekdays and on weekends and holidays.
- Perform routine actions before bed. Perform daily evening exercise (brush your teeth, wash your face, set an alarm) - this creates a good mood for sleep.
- Maintain a calm environment around you. The room where you sleep should be dark, quiet, not too hot or too cold.
- The bed is a place for sleeping. Therefore, do not use it for eating, reading, watching TV, etc., that is, for those activities that are associated with an active lifestyle.
- Avoid bad habits that disrupt sleep. Don't have a late dinner and don't drink coffee or alcohol before bed.
- Exercise regularly. Exercise can help you fall asleep on its own. But avoid exercising late at night, as it stimulates the cardiovascular and nervous systems.
- If you are worried, stop, calm down, relax. Stress and anxiety are the main enemies of sleep. If you can't fall asleep, read a little or take a warm bath.
- Medicinal correction of sleep disorders in the elderly. If we consider the use of sleeping pills in old age, then women use them most often (50%), men - much less often (10%). However, it is necessary to pay attention to the following points:
- Changes in sleep physiology in older adults are not corrected by sleeping pills.
- The use of CNS depressants may impair physiological functions already affected by insomnia (eg, worsen sleep apnea).
- In old age, there is an increased risk of drug interactions (for example, between tranquilizers, alcohol, beta-blockers, beta-agonists, antihistamines, analgesics and other drugs).
- Since drug metabolism is reduced in the elderly, this may lead to undesirable effects (daytime sleepiness).
- The use of sleeping pills increases the risk of death.
Treatment of transient insomnia is not required, but sometimes, to prevent transition to a chronic form, sleeping pills can be prescribed for no more than Z-3 days in a row with subsequent intermittent use. Minimal doses of drugs are prescribed. Preference is given to benzodiazepine drugs (for example, phenazepam - 7.5 mg). Coffee and other stimulants are not prohibited, but should be used no later than 12 hours before sleep.
Before starting treatment for sleep disorders in the elderly, it is essential to inform the patient about normal age-related changes in sleep that can change his or her perception of normal nighttime sleep (and thus relieve most complaints). It is important to remind the patient about the need to maintain adequate physical activity and sufficient communication with friends. A short, refreshing daytime nap often does not disrupt nighttime sleep and sometimes even improves falling asleep at night.
Before starting treatment for sleep disorders in the elderly, it is imperative to stop taking sleeping pills, alcohol, and other sedatives.
For the treatment of insomnia in depression, doxepin (not recommended for glaucoma) or trazodone are preferred.
For the treatment of neurological movement disorders, bromocriptine and L-dopa are usually effective; in more severe cases, opiates are used.
In the treatment of sleep apnea in mild cases it is necessary to avoid sleeping in a supine position, it is necessary to reduce weight; in severe cases, treatment is usually surgical (removal of excess soft tissue of the pharynx - effective in 50% of cases).