What should you do if an older person complains of not sleeping well at night?
Experts do believe that “normal aging” brings on some changes to sleep. (See this post for more on how sleep changes with aging.) Basically, older adults tend to get sleepy earlier in the evening, and tend to sleep less deeply than when they were younger.
So it’s probably not realistic to expect that as you get older, you’ll sleep as long or as soundly as when you were younger.
That said, although aging by itself does change sleep, it’s also quite common for older adults to develop health problems that can cause sleep disturbances. So when your older relatives say they aren’t sleeping well, you’ll want to help them check for these. Figuring out what’s going on is always the first step in being able to improve things.
And remember, getting enough good quality sleep helps maintain brain health, physical health, and mood.
In this article, I’ll cover the top causes of sleep problems in older adults. I’ll also tell you about what approaches have been proven to work, to help treat insomnia and sleep problems in older adults.
Last but not least, if you (or your older relative) have experienced the very common combination of waking up to pee at night and difficulty sleeping, I highly recommend listening to this podcast episode, which features a geriatrician who is an expert on this: 092- Interview: Addressing Nighttime Urination & Insomnia in Aging.
5 Common Causes of Sleep Problems in Older Adults
1. Sleep problems due to an underlying medical problem. Although older adults do often suffer from what’s called “primary” sleep disorders, many sleep problems they experience are “secondary” sleep problems, meaning they are secondary to an underlying medical condition whose main symptoms are not sleep related.
Common health conditions that can disrupt sleep in older adults include:
- Heart and lung conditions which affect breathing, such as heart failure and chronic obstructive pulmonary disease
- Gastroesophageal reflux disease, which causes heartburn symptoms and can be affected by big meals late at night
- Painful conditions, including osteoarthritis
- Urinary problems that cause urination at night; this can be caused by an enlarged prostate or an overactive bladder
- Mood problems such as depression and anxiety
- Neurodegenerative disorders such as Alzheimer’s and Parkinson’s
- Medication side-effects
If an older person is having difficulty sleeping, it’s important to make sure that one of these common conditions isn’t contributing to the problem. Treating an underlying problem — such as untreated pain at night — can often improve sleep. It can also help to talk to a pharmacist about all prescription and over-the-counter drugs, to make sure that these aren’t contributing to insomnia.
Alzheimer’s and related dementias pose special considerations when it comes to sleep, which I write about in this post: How to Manage Sleep Problems in Dementia.
2. Snoring, Sleep Apnea, and other forms of Sleep-Related Breathing Disorders. Sleep-related breathing disorders (“SRBD”; it’s also sometimes called sleep-disordered breathing) is an umbrella term covering a spectrum of problems related to how people breathe while asleep.
Sleep apnea is a common condition which is important to diagnose since it’s been associated with many other health problems (especially in middle-aged adults). In sleep apnea, a person has frequent pauses in their breathing during sleep. The most common form is obstructive sleep apnea (OSA), in which the breathing pauses are due to obstructions in the breathing passages. OSA is often associated with snoring. A less common form is central sleep apnea, in which the breathing pauses are related to changes in the brain.
How common it is: The likelihood of having sleep-disordered breathing disorders goes up with age. It’s also more common in men, and in people who are overweight. In one study of 827 healthy older adults aged 68, 53% were found to have signs of SRBD, with 37% meeting criteria for significant sleep apnea. Interestingly, most participants did not complain of excess sleepiness.
Why it’s a problem: Studies have found that untreated OSA is associated with poor health outcomes including increased mortality, stroke, coronary artery disease, and heart failure. However, studies also suggest that these associations are strongest in people aged 40-70, and weaker in older adults. For older adults with symptomatic OSA, treatment can reduce daytime sleepiness and improve quality of life.
What to do if you’re concerned: Helpguide.org’s page on sleep apnea has a useful list of common symptoms and risk factors for sleep apnea. You can also ask the doctor about further evaluation if you’ve noticed a lot of daytime sleepiness. To be diagnosed, you’ll need to pursue polysomnography (objective sleep testing) either in a sleep lab or with a home sleep testing kit.
Whether or not you pursue an official diagnosis for SRBD, avoiding alcohol (and probably other sedatives) is likely to help.
3. Restless leg syndrome (RLS). This condition causes sensations of itching, crawling, or restlessness as a person is trying to fall asleep. The symptoms are unpleasant but not usually painful, and improve with movement. The exact biological underpinnings of this problem remain poorly understood, but it seems to be related to dopamine and iron levels in the brain. Most cases are not not thought to be related to neurodegeneration.
How common it is: Studies suggest that 5-15% of the general population meet criteria for RLS, but only 2.5% of people are thought to have clinically severe symptoms. Poor health, older age, low iron levels, and being female are some risk factors. It also tends to run in families.
Why it’s a problem: RLS has been associated with depression, anxiety, and sleep-onset insomnia. It can also get worse with certain types of medication.
What to do if you’re concerned: Read up on RLS (Helpguide.org’s page seems very good) and then talk to a doctor. Generally, you don’t need polysomnography but you should probably be checked for low iron levels. You can read about possible non-drug and pharmacological treatment options at Helpguide.org.
4. Periodic Limb Movements of Sleep (PLMS). This condition is not easily treatable, but I’m listing it since I’ve discovered it’s much more common than I realized. PLMS causes intermittent movements while asleep, usually in the lower limbs. It can affect the toes, ankles, knees, or hips. The movements may or may not wake the person up; they can be annoying to a bed partner.
How common it is: Studies estimate that 45% of older adults experience PLMS. Many such older adults are otherwise healthy. However, PLMS is also often associated with other sleep problems, such as restless legs and sleep apnea. Experts believe that it’s fairly rare for people to experience clinically significant sleep disturbances solely due to PLMS.
Is it a problem? PLMS can be an issue mainly because it’s associated with other sleep problems. Most people who experience PLMS don’t notice it much, although some do find it bothersome. Only a few studies have attempted to treat isolated PLMS, and it’s not clear that there is a reliable way to treat this. In its 2012 guideline on treating restless leg syndrome and PLMS, the American Academy of Sleep Medicine concluded that there was “insufficient evidence” to recommend pharmacological treatment.
5. Insomnia. Insomnia means having difficulty falling asleep or staying asleep, despite the opportunity to do so (e.g. being in bed), and experiencing decreased daytime function because of this. I consider this the grand-daddy of all sleep problems, because it affects so many people in middle-age and older age.
How common is it: Very common, and it becomes even more common with aging. One study found that 23-24% of older adults reported symptoms of insomnia.
Why it’s a problem: Insomnia has been associated with anxiety, depression, fatigue, worse quality of life, cognitive decline, and a variety of other worse long-term health outcomes.
What to do if you’re concerned: The main thing to do is assess the problem, by tracking sleep and using a sleep journal. And then seek help. For older adults, it is especially important to not simply rely on prescription or non-prescription (e.g. alcohol, over-the-counter pills) substances to help with sleep. That’s because all such substances worsen brain function and increase the risk of cognitive decline. (See “4 Types of Brain-Slowing Medication to Avoid if You’re Worried About Memory” for more details.)
Proven Ways to Treat Insomnia in Older Adults
Insomnia is a very common complaint among family caregivers and older adults. Fortunately, research has shown that it’s possible to treat insomnia effectively, although it does often take a little time and effort.
Why Sedatives Aren’t the Way to Go and Proven Ways to Taper Off Them
Before I go into the recommended treatments, let me say it again: you should only use sedatives as a last resort. That’s because most medications that make people sleepy are bad for brain function, in both the short-term and long-term.
Benzodiazepines such as lorazepam, alprazolam, diazepam, and temazepam (Ativan, Xanax, Valium, and Restoril) are also habit-forming. It can be a lot of work to wean people off these drugs, but research has proven it’s possible.
For instance, in this randomized control study, many older adults who had been on benzodiazepines for sleep (mean duration of use was 19.3 years!) were able to taper off their sleeping pills. 63% were drug-free after 7 weeks. (Yeah!)
Plus, in my own personal experience, it becomes extremely difficult once a person has started to develop a dementia such as Alzheimer’s, because then their behavior and thinking can get a lot worse if they are a little sleep-deprived or anxious. (In the short-term, almost everyone who tapers off of sedatives has to endure a little extra restlessness while the body adapts to being without the drug.) But letting them continue to use their benzodiazepine puts us in a pickle, because it also keeps them from having the best brain function possible, is associated with faster cognitive decline, AND increases fall risk.
I hope you see what I’m getting at. If either you or someone you care for are taking benzodiazepines for sleep or anxiety, and you aren’t dealing with a dementia diagnosis, now is the time to do the work of trying to get off these drugs. (If you are dealing with a dementia diagnosis, you should still ask the doctors for help trying to reduce the use of these drugs, but it will all be harder. It’s still often possible to at least reduce the doses being used.)
The key to successfully stopping sedatives for sleep is to very slowly taper the drug under medical supervision, plus add cognitive-behavioral therapy or other sleep-improving approaches if possible.
For more on this topic, and for a handy (and research-proven) consumer handout that helps older adults stop benzodiazepines, see “How You Can Help Someone Stop Ativan.” This article also addresses the question of whether it’s ever okay for an older person to be on benzodiazepines.
Now, let’s review some proven approaches to improving sleep in older adults.
Proven ways to treat insomnia in older adults:
- Cognitive-behavioral therapy for insomnia (CBT-I). This means special therapy that helps a person avoid negative thought patterns that promote insomnia, along with regular sleep habits, relaxation techniques, and other behavioral techniques that improve sleep. It has a good track record in research, as described in this NPR story. A new study also confirmed that CBT-I also benefits people who have insomnia combined with other medical or psychiatric conditions.
- CBT-I can be done in person, and is also effective when done through online programs. Two online programs with proven clinical efficacy are Sleepio (see here for the study) and SHUTi.
- CBT-I may incorporate several techniques such as stimulus control, and sleep restriction therapy. This Mayo Clinic page has a nice list of specific behavioral therapy components that might be included in CBT-I for insomnia.
- Brief behavioral treatment of insomnia (BBTI). This is a shorter variant of CBT-I; it’s designed to be delivered in 4 weeks. It also has a good track record in research.
- A study also found that BBTI was effective in reducing nighttime urination.
- Mindfulness meditation. A randomized control trial published in April 2015 found that mindfulness meditation was more effective than “sleep hygiene,” to improve the sleep of older adults with a variety of sleep disturbances. Older adults assigned to mindfulness completed a weekly 2-hour, 6-session group-based course.
- Local in-person courses to learn mindfulness are often available; search online to find one near you. They may also be available at certain senior centers.
- An online version of the course used in the study is available here.
- Several smartphone based apps propose to help people with mindfulness. They are reviewed in the scholarly literature here. I personally have used Headspace in the past and liked it.
- Exercise. Exercise is often thought of as a treatment for insomnia, but the evidence seems weaker than for CBT-I. A review article published in 2012 concluded that the effect is modest. A more recent randomized trial comparing CBT-I to tai chi, for insomnia in older adults, found that CBT-I was more effective.
- Although exercise is obviously very important to health, don’t rely on it as the primary way to try to solve sleep problems.
- It’s also possible that exercise may help insomnia, but a fascinating small study suggested that in people with chronic insomnia, it can take a few months for exercise to have an effect on sleep.
Are there any medications or supplements that are safe and effective?
Benzodiazepine drugs and sleeping medications such as zolpidem (brand name Ambien) are definitely risky for older adults, as they dampen brain function and worsen balance. If you or your loved one is depending on such medications to sleep, I recommend you get help tapering off, as described above. Most older adults can learn to sleep without these medications, although it can take a little effort to wean off the drug and learn to get to sleep without them.
Many over-the-counter (OTC) medications that make people sleepy are also a problem, because most of them are “anticholinergic,” which means they interfere with a key neurotransmitter called acetylcholine. A very commonly used anticholinergic is diphenhydramine (brand name Benadryl), a sedating antihistamine that is included in most night-time analgesics, but many prescription medications are anticholinergic as well.
Older adults should be very careful about using anticholinergics often for sleep, or really for anything. That’s because they worsen brain function, and in fact, chronic use of these medications has been associated with developing Alzheimer’s and other dementias. (For more on this, see 7 Common Brain-Slowing Anticholinergic Drugs Older Adults Should Use With Caution.)
Virtually all sedatives are included in the American Geriatrics Society Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.
So those are the medications to avoid if possible.
Now here are a few medications that seem to be less risky, and are sometimes used:
- Melatonin: Melatonin is a hormone involved in the sleep-wake cycle. Several studies, such as this one, have found that melatonin improves the sleep of older adults and does not seem to be associated with any withdrawal symptoms. A 2023 review found that melatonin has a “favorable safety profile” in older adults. However, in the U.S. melatonin is sold as a poorly-regulated supplement, and studies have found that commercially sold supplements are often of questionable quality and purity. So melatonin may work less reliably here than in Europe.
- Ramelteon: Ramelteon is a synthetic drug that mimics the effect of melatonin. A 2009 study reported that ramelteon did not impair middle-of-the-night balance or memory in older adults. However, its efficacy has been questioned; a 2014 meta-analysis concluded that the clinical effect appeared to be “small.”
- Trazodone: Trazodone is an older weak anti-depressant that is mildly sedating. It has long been used by geriatricians as a “sleeping pill” of choice, as it is not anticholinergic and seems to be less risky than the alternatives. A small 2014 study found that trazodone improved sleep in Alzheimer’s patients.
For a detailed and technical review of sleep medicines in older adults, this article is good: Review of Safety and Efficacy of Sleep Medicines in Older Adults.
And again, if you or your older relative has been bothered by the need to urinate at night, I also want to recommend this BHWA podcast episode: 092- Interview: Addressing Nighttime Urination & Insomnia in Aging.
For information on evaluating and managing sleep problems in people with Alzheimer’s or other dementias, see this article: How to Manage Sleep Problems in Dementia.
This article was last updated by Dr. K in January 2024.
Samatha says
I appreciated this article because I do have sleeping problems, including sleep apnea. Thanks for the good tips.
Katherine Dilworth says
Heya, Thank you so very much. Really appreciate the efforts you put into your blog post. Loved the way you explained in detail. Best wishes & Regards.
Akash says
My father who is 61 years of age are facing problems since last 3 months. I can see some patters like :
1) He can sleep for only 3-4 Hrs on every alternate day, but between the alternate days he cannot sleep at all.
2) On every alternate day , he has an urge to go to washroom to urinate ( the frequency is typically is 1 time/hour).
3) He has taken some antibiotics like NEXITO PLUS but at the beginning for a week they work , but now they are not helping.
4) He feels exhausted day by day and facing memory problems.
5) He did not drink nor smoke and has a good overall health, he was sleeping comfortably before last 3 months with no issues. He was sleeping well for about 7-8 hours daily.
If you can please help here, i will really appreciate.
Thanks,
Akash.
Leslie Kernisan, MD MPH says
If your father was sleeping well until 3 months ago and now has developed all these problems, then I would say he certainly needs a thorough and careful medical evaluation to figure out what might be the cause of these problems.
If he has already seen a doctor, then either you need to ask that doctor more questions or otherwise request further evaluation, or you should go see a different doctor. Regardless it’s important to ask the doctor to explain what they think might be going on, what makes them think this, and what they are planning to do next.
Good luck!
April says
Is he still drinking caffeine? Even decaf or only one cup a day can affect your sleep; that’s true for me and was verified when I found I had the caffeine sensitive gene in the health test from 23 and me
Joe Vosters says
Being able to reposition (for comfort and reduced bedsore risk) is also important to get “good sleep”. Many of our callers (especially Parkinsons) find it impossible to independently reposition (or even get in/out of bed) creating a high risk of injury (and loss of quality sleep) to the spouse/caregiver. Our company FriendlyBeds.com offers special bed equipment for this purpose.
Matt says
Dear Dr. Kernisan,
Excellent evidence based article.
Really appreciate the efforts you put into your blog.
Keep it going.
Matt
Leslie Kernisan, MD MPH says
Thank you!
Gerald Roux says
Thank you Dr. for your very useful and helpful information.
Leslie Kernisan, MD MPH says
Thank you, I’m glad you find it helpful.
Jo Ann says
At my request because of the threat to memory function, my doctor phased me off Restoril and substituted prazosin. Sub-lingual melatonin puts me to sleep, prazosin keeps me asleep. What could long-term effects of this regimen be? (I also take meds for DM2 and depression.)
Leslie Kernisan, MD MPH says
Prazosin was originally used as a blood pressure medication, because it relaxes blood vessels. It is no longer used often for blood pressure control but is used in the treatment of PTSD and apparently also helps reduce nightmares.
I’m not sure what the long-term side-effects might be, but it’s good for you to consider this question and I recommend you ask your doctor and pharmacist for more information.
From a geriatrics perspective, medications like prazosin can cause or worsen a drop in blood pressure when standing, and this has been associated with falls in older adults. So if you’ve had any concerns about falls, light-headedness, or low blood pressure, then this could be an important side-effect of prazosin to check for.
Angela Gentile says
Great article! Thanks for this great overview on sleep problems. I have read recently that lavender essential oil can help people fall asleep. It even has shown benefit for those who have dementia. Any comments on this? Thanks again!
Angela
Leslie Kernisan, MD MPH says
Yes, lavender oil has been studied for insomnia and some studies suggest it can help. It’s also been used in aromatherapy to treat agitation in dementia patients.
Topical therapy usually has a low risk of side-effects, so it’s certainly something that an older person or family could try, to see if it helps.
For oral therapy (i.e. taking lavender oil capsules), my concern would be that we don’t really know what the short-term and long-term risks might be. Furthermore, in the US, herbal supplements are unregulated and chemical studies have shown that the actual ingredients often don’t match with the claimed composition on the label. So I might be hesitant if one of my older patients wanted to try such an oral therapy.
Leslie Kernisan, MD MPH says
Here’s a question a reader posted elsewhere on the site, which I will answer here since it’s related to sleep problems:
Q: “What is known or suspected about the relationship between REM Sleep Behavior Disorder and aging?”
REM sleep behavior disorder is not very common, and affects an estimated 0.5% of adults. It’s a condition in which people move physically during REM sleep; usually the body is almost paralyzed during REM (“rapid eye movement”) sleep.
REM sleep behavior disorder has been linked to brain changes, including the type of neurodegenerative changes that lead to Parkinson’s disease and Lewy Body dementia. For more on this condition, including risk factors, see this page from the Mayo Clinic.
Since brain changes and other risk factors for this disease become more common as people age, this is a problem that mainly affects older adults.
Here are some related scholarly articles (available online for free in PubMed Central) on REM sleep behavior disorder:
REM Sleep Behaviour Disorder in Older Individuals: Epidemiology, Pathophysiology, and Management
Best Practice Guide for the Treatment of REM Sleep Behavior Disorder (RBD)
Beverly says
What about nighttime cramps….toes,feet,legs? Whenever I stretch I develop cramps which require me to exit the bed to apply pressure to the affected area. I’m 74, and have been experiencing cramps for about a year.
BTW, I really enjoy your emails. They are often applicable to me and my spouse who is 77 (soon). The subjects are informative and written in easy to understand non-technical language. You also provide links to allow us to obtain additional insight into the subjects of your writings.
I also very much like the “personal touch” comments. Thank you
Leslie Kernisan, MD MPH says
Thank you for this detailed and specific feedback re the articles here; it’s nice to know you find the info useful and very helpful to know just what it is that you appreciate!
Nighttime cramps is a great question, as they are indeed common in older adults. For the basics, see this MayoClinic article “Night Leg Cramps.”
Basically, you want to first make sure they aren’t being caused or exacerbated by medications or underlying medical problems. Diuretics are a common medication that can make them worse.
For treatment, a randomized trial published in 2012 found that a 6 week nightly stretching program reduced nighttime cramps. You can read the full article — which includes pictures showing the stretches — for free here.
It used to be common for doctors to prescribe quinine for nighttime cramps, but that’s now quite discouraged because 2-4% of people can have serious side-effects from quinine, including palpitations and bleeding problems. That said, quinine is in tonic water so some people do take 6 oz of tonic water at night for cramps. If you are interested in trying this, I recommend you talk to your doctor first to see if you have any particular medical problems that predispose you to side-effects from quinine.
Another medication that is sometimes recommended for nighttime leg cramps is diphenhydramine (brand name Benadryl) but I of course am STRONGLY against that advice for seniors, because that’s a brain-slowing anticholinergic drug which has been linked to developing dementia.
Good luck, and thank you again for your comment and terrific question.
Susan Libby says
I’m surprised you don’t mention magnesium for cramping. Many older adults are deficient in magnesium due to medications and diet. I’ve found a good quality magnesium citrate supplement very helpful.
I also love your blog and refer others to it! Thanks!
Susan
Leslie Kernisan, MD MPH says
Thank you, glad you find the site helpful.
Yes, a few studies suggest magnesium can help with insomnia (see here and here).
However, I would recommend that an older adult check with their doctor before beginning a magnesium supplement. Decreased kidney function (fairly common among seniors and many don’t realize they have it) impairs magnesium excretion, so it seems wise to check on kidney function and magnesium levels before taking a supplement regularly.
Thanks for bringing up this comment.
Linda Levine says
I found out on a yearly check up that my magnesium level was very low. I am 77. I have Crohns disease and adsorption of some nutrients is an issue. I use to get horrific cramping in my toes, feet and legs. Since I increased my magnesium I rarely get those cramps any longer. Ever so grateful.
I’m a Canadian and wish we had Geriatric General Practitioners My wonderful caring G.P. passed away and I cannot find one that I feel safe with. I’m starting someone new….again.
Nicole Didyk, MD says
Hi Linda. I’m glad you found out about your magnesium levels and are able to supplement them.
I’m Canadian too, and there are some family physicians with additional certification in Geriatrics in Canada. They would have done a fellowship in “Care of the Elderly” which is an additional 6 months to a year of training. Many of these physicians work in specialized settings like retirement homes or rehab centres but some of them have family practices as well. You can always ask your family physician for a referral to a Geriatrician if there’s a particular concern like falls, memory or mood changes, pain, complex medications or incontinence.
Best of luck building a strong relationship with your new primary care provider and thanks again for your comments!
Michael Hickman says
A few years ago, when I mentioned to my Chiropractor that I had been having periodic leg cramps at night, he said it sounded like dehydration. I assumed he meant I should be drinking more water in general, so I tried that and it just made me pee more at night, but I began keeping a glass or bottle of water on my night stand. The next time I was awakened with leg cramps (after I tried beating on my leg to no avail), I had the presence of mind to grab the water bottle from my night stand and quickly take a sizeable swallow; the cramp eased immediately! I have had the same result with every episode of nighttime leg cramps since.
Nicole Didyk, MD says
That’s interesting. Leg crams are very common, affecting up to 40% of those over 80 at least 3 times a week.
This article is a good review of nighttime leg cramps: https://academic.oup.com/ageing/article/45/6/776/2499229. They list dehydration as a potential contributing factor to leg cramps, but it’s not clear that drinking water can banish the symptoms in the way you describe.
I’m glad it works for you. Other treatments like quinine pills seem to help, but there does seem to be a placebo effect (the person’s belief that the treatment will help actually produces the therapeutic effect). It could be that this effect is helping you too.
Robert Goldhamer M.D. says
Magnesium to the rescue! I had my first foot cramp a few years ago, middle of the night, away from home. Asked my wife if she had any multiitamins as a source of magnesium, and fortunately she did. It was blessedly effective, and have taken larger doses of magnesium as needed when I first notice a cramp.
Leslie Kernisan, MD MPH says
Many people do swear by magnesium. That said, research has not been able to confirm it works, and a randomized trial published in 2017 was negative:
Effect of Magnesium Oxide Supplementation on Nocturnal Leg Cramps: A Randomized Clinical Trial.
I would recommend that any older adult planning to take frequent magnesium supplements check with their health provider, esp to make sure they don’t have any mild kidney issues that might be affecting magnesium levels.
Stephen Simac says
Magnesium Oxide is the least bioavailable source of Mg. So using that shows an intent to “prove” that a simple mineral supplement can replace patented pharmaceuticals for leg and foot cramps, RLS and many other symptoms. Kidney function of course is important to consider for any prescriptions and supplements.
Gary says
Thanks for the article. I have insomnia and now leg spasms at night. I have been through a lot of physical issues in my life which might have something to do with it. Worry , anxiety because of age is also bringing on stress.
Interesting as the medication for sleeping and alcohol are on my list of trials. Nothing seems to work as I go to bed and always wake up between 2-3 am and can’t get back to sleep 😴.
I am now trying Magnesium supplement to see if it helps.
Best regards
Gary
Nicole Didyk, MD says
Hi Gary and I’m sorry to hear about your leg spasms and insomnia. As Dr. Kernisan points out, insomnia is complex and the approach to managing it can vary depending on which factors are contributing. Leg cramps are a common complaint and again can be related to a number of issues, including medications, dehydration and electrolyte imbalances, and some neurological do=disorders.
Most of the time we recommend some mild exercise (like riding a stationary bike for a few minutes) and stretching the calves before retiring for bed as part of the management plan.
I hope you find some relief and I’m so glad you found the article helpful.
Carolyn Riddle says
I have had some luck with grating a fresh nutmeg pod, about 1/16 teaspoon or less. That’s not a typo. It increases length of sleep, but is mildly hallucinogenic. I don’t use it every night because of extremely vivid dreams that I remember upon waking.
Nicole Didyk, MD says
Doing a quick search in the PubMed database, nutmeg is also called Myristica fragrans, and there have been cases of intoxication and even seizure related to overdose of the spice. The myristica oil does seem to have hallucinogenic properties. I wouldn’t recommend it for anything other than usual household use in baking and seasoning.
Helen Jurie says
I am 80 and for a while had nighttime cramps until I started a glass of water before getting into bed and since doing this I have been fine. Not tea,not coffee just plain water.
Nicole Didyk, MD says
Thanks for sharing your tip! Many older individuals avoid drinking fluid before bed, for fear of having to get up and urinate at night, but it may be that you were dehydrated which can contribute to cramps. Stretching and a little bit of exercise before bed can help too. You might enjoy this article, and thanks for leaving a comment!
Donna says
Our family suffers with leg cramps. The cause for all of us seems to be dehydration and balancing the electrolytes. Too much water can dehydrate as well as not enough. With so many concerned about salt there are many that don’t get enough salt.
Leslie Kernisan, MD MPH says
Thanks for sharing your story. Some people do seem prone to electrolyte imbalances. They can also be caused by medications, or occasionally certain issues relating to the kidneys. If an older person reports frequent leg cramps, I often do check on their electrolytes.
bob reiss says
I used to get occasional leg cramps in bed. (just turned 80) I now eat one banana a day and haven’t had any cramps in years. Supposedly potassium in bananas is good for cramps,
Leslie Kernisan, MD MPH says
Generally, I think eating fresh fruits and vegetables is an excellent idea, so great if it helped with leg cramps. Some research also suggests that stretching calf muscles before bed can reduce cramps.
Cindy says
I find that most NSAIDs give me leg cramps, especially if I’m taking them frequently. (An occasional ibuprofen doesn’t seem to do this. If I take it full dose through the day, it will however.) Aleve is the worse, but Meloxicam also started giving me Charlie horses after a while.) I don’t see this side effect on the medications warnings though. Any ideas?
Leslie Kernisan, MD MPH says
Hm, I don’t think that’s a common side-effect of NSAIDs, doesn’t ring any bells for me and I don’t see it in my clinical reference for NSAID side-effects. Everyone is an individual and often medications cause certain specific unusual effects in a very small number of people. If you are consistently experiencing this side-effect, all the more reason to avoid NSAIDs. Good luck!
E says
Dill pickle juice sip some before going to bed or eat q pickle rinse mouth ie teeth.
Works but I have no idea why has to be dill though.
Carolyn Riddle says
Probably the vinegar. I’ve heard some people swear by drinking tea with a spoonful of apple cider vinegar daily.
Nicole Didyk, MD says
I have heard of people using apple cider vinegar for a variety of reasons, many of them related to weight loss. I couldn’t find any scientific data that made me recommend it for anything other than salad dressing or to attract fruit flies (which I can personally recommend on both counts).
Maureen says
I have been drinking a teaspoon of apple cider vinegar in warm water with a little honey every morning for several years . I find it controls my arthritis and unexpectedly – tinnitus. When I don’t take it I notice a marked decline in both.
Nicole Didyk, MD says
I’m glad that you found a routine that seems to work for you! I’m not aware of any scientific evidence that would explain the results you’re seeing but it doesn’t sounds as though it’s likely to cause harm.
Fred Gunter says
I am a 69 year old Male. Never an issue with sleep up to two weeks ago. All of a sudden I was sleepless and when I finally dropped off it was for no more than 4 hours a night. Always slept with a sheet and no heavy cover. Been a little chilly but not so bad. Few nights ago I threw a top cover on bed and ever sense slept like a rock. Seems to be a tight window…. if I get a little too warm it wakes me and if too cold can’t sleep hardly at all. Just stumbled on solution.
Nicole Didyk, MD says
Thanks for sharing your experience and pointing out that making changes to your environment is often helpful for sleep, and doesn’t involve pills!
Pam Webster says
Synchronicity! My 79 y.o. sister-in-law can’t sleep much following open heart surgery 18 days ago. She had this surgery (to fix a valve?) 30 years ago the first time and managed to convince her two sons that recovery was going to be a snap. It hasn’t been.
SIL is a lovely creative person, former drama teacher, and self-admittedly neurotic and anxious. Any ideas for what approach to take to help her sleep? Klonopin hasn’t helped and that’s what the surgeon gave her. She sounds weak on the phone and needs lots of reassurance because she’s forgetting things she’s already been told about her condition. I’ll be driving to see her soon, but I’m worried that her busy sons (who have helped her TONS) are not advocating to improve the sleep problem–which seems central to her recovery at this point.
Nicole Didyk, MD says
I would not recommend clonazepam (klonopin) as it can increase the risk of falls and hip fracture in older adults, and is very long-acting, thus likely to hang around the next day. You can read more about benzodiazepines here: /ags-beers-criteria-medications-older-adults-should-avoid-or-use-with-caution/.
Sleep disruption is common after a stay in hospital and factors like anxiety and post-operative pain, as well as medication changes, could be a part of the picture.
Usually as people return to a previous activity level and routine, sleep improves. In the meantime, I often suggest melatonin at a dose of 3 to 6 mg nightly.
For someone living with anxiety and longer term insomnia, cognitive behavioural therapy for insomnia (CBTi) can be effective and safe.
She’s lucky to have such a caring sister-in-law and I’m sure your visit will be much apreciated!