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.
Barbie S. says
You mentioned using an “at home” sleep testing kit. Do you have a recommendation for a certain brand or where I could find one online?
Thank You!
Nicole Didyk, MD says
At home sleep tests can be used in some people who are being worked up for obstructive sleep apnea, but many require a lab study to get the diagnosis right. Rather than ordering a test device, I would recommend seeing a sleep doctor to make sure it’s right in your particular case. They might even be able to provide one at no cost.
Robert says
I have a question. I sleep for about 7 hours per night, but too much of it is REM and zero of it is deep (N3).
I’ve read that taking the following, about 1/2 hour before bed, could help induce some deep sleep –
Phosphatidylserine 600mg
L-theanine 200mg
Zinc 15mg
L-taurine 1000mg
Magnesium 250mg
Melatonin .5mg
My question is whether it is advisable to take all six of these on the same night? Or how to proceed?
Thank you.
Nicole Didyk, MD says
I don’t know enough about those herbal supplements to know if they are safe to be taken all at once, and I wasn’t aware that that particular combination was recommended as a treatment for sleep issues.
It’s difficult to know how much REM sleep or other stages of sleep a person is having without a sleep study in a laboratory. To determine the time spent in the stages of sleep, electroencephalographic activity (EEG), eye movements (ie, electrooculogram [EOG]), and submental electromyographic activity (EMG) are measured.
If you’ve had a sleep study, and the findings are not enough REM sleep, your sleep physician should be able to give you some advice about supplements. I did find this review of supplements for insomnia, here: https://pubmed.ncbi.nlm.nih.gov/20965131/. The overall conclusion is that they’re not very effective.
Jennifer says
My mother is 87 and cannot sleep! It amazes me how long she goes without sleep! Nothing over the counter helps, it almost has a reverse effect and keeps her awake. She is on xarelto for blood clots. She calls me crying because she never sleeps and walks the floors all night! Her doctor gave her trazodone, this does not help. Please help!
Nicole Didyk, MD says
Sorry to hear that you mom is struggling with sleep.
It can take some work and effort to iron out sleep problems in older adults, and pills are almost never the answer.
Often people are sleeping more than they realize, so it may be that your mom is getting some sleep after all. Daytime sleeping can be hard to notice too, if people are “nodding off” in front of the TV or when reading. Or taking a nap because they feel exhausted from a poor night’s rest.
Reviewing medicaitons and caffeine intake is a good idea. Xarelto (rivaroxaban) doesn’t seem to be associated with insomnia. Medical conditions that can disrupt sleep include depression, dementia and chronic pain. These are treated differently (not with sleeping pills) and it usually takes a medical professional to help diagnose and treat.
If all of that has been reviewed, then cognitive behavioural therapy for insomnia might be the answer. I made a YouTube video about that, which you can watch here: https://youtu.be/mZgWtBsZvZM. There;s also an excellent website that reviews the hazards of sleeping pills and alternatives: http://www.mysleepwell.ca
NickH says
Loving this article. Its rare to see so many questions and comments below an article. Real people questions and experiences and answers by real, caring doctors.
I am a 42yr old, male. i rarely drink and have zero medications. Im in pretty good shape. Have exercised most of my life up until this past year, year half with covid, but starting to get back more often but i am weaker than i used to be. On top of that i am having relationship issues that gives me anxiety and stress. Along with other things like career and finance. Now i realize all of these mentioned problems are very common problems that adds to the problem at hand. So here i am trying to manage it.
I am going thru in what i believe is Sleep Maintenance Imsomnia. I am a chronic ipad user before bed. Sometimes 20mins sometimes 45mins. And during the day i also sit in front of a computer for hours for work and for leisure. I have been doing this for YEARS and YEARS! But sleep was rarely an issue. i would fall asleep at whatever time, and wake up 6 and a half to 7 hrs later. I have stress and anxiety before but it rarely effected my sleep.
That is up until exactly 8 days ago when i went on vacation. Flight time didnt allow me to sleep for 24hrs. I went to bed around 1am, my usual, and woke up at around 5am and wide awake. I feel alert like i just slept 7hr straight. Next day 12am and woke up at 4am. Same thing over the next few days all the way up until today. Its becoming a pattern and i am TERRIFIED of the repercussions.
My question is i have had relationship issues before. I have stress and anxiety before. But i don’t wake up 4 hrs later. I will still get 6-7 hrs no matter what time i fall asleep. I wake up after 6-7hrs.. Why just 4hrs now ?! Is it because i didn’t sleep for 24hrs due to my flight time and it threw everything off ??
In the past 8 days, i don’t have a problem falling asleep. But i wake up 4 hrs later and i am wide awake. Please help me.
Nicole Didyk, MD says
As a Geriatrician, I usually help with older adults with sleep issues, rather than those in middle age.
Travel can definitely throw off sleep schedule. It usually takes about 5 days for that to reset, but your experience may be a few days outside of that.
Worrying about sleep is a recipe for insomnia! I would continue to follow your healthy habits, and avoid sleeping pills if you can. The website http://www.mysleepwell.ca for more sleep tips!
C. Eby says
I am interested in your article, but i want to volunteer a different perspective and interested in your thoughts. First about me, i am a 67,years adult male, who recently had a nuclear heart test for my check up. The cardiologists was extremely interested in talking to me after he got the results. He ask me how does a 65 year old man have the heart of a 30 year old? It is not genetics as both my mother and father died at 72 of heart disease.. My secret i have exercised my entire life, meaning clear back to age 10. Last 10 years i swim due to a back surgery, but i plan to keep exercising till i am 90 and there are others like me at the gym.
I have been tested for dementia, none. My diabetes was high with a 8.2 a1c, but over the last 4 years i have successfully reduced it to 5.8, which meaning i have now below threshold for being a diabetic. medication was the key along with starting to take a ginger pill daily. I am on Janiva, glimperide, metformin, and Inkovana. By the way my weight is down due to Inkovana. Medication has solved this problem.
My only health issue is a severe, very severe nerve pain to my groin. I go to a specialist for Pain control, i am on lyrica, cymbalta, 2 yes, two opiods, one being a pain patch which is good for 7 days, and the 2nd opiod is for as needed for pain . People look at me like i am crazy for being on 2 opiods because of all of the negative news about these overdoses, but guess what there are thousands of us using it daily as prescribed and it has given my life back to me as the pain was in my right testicle so the pain was excruciating and by the way, there are many people with this same diagnosis.
By now i am sure you are asking so why are you telling me all of this???? The reason is all of my problems have gone away by exercising, UTLIZING MEDICATION AS PRESCRIBED. Medication has given me my life back
Now to the intersting part. My father and grandfather had severe insomnia, i would wake up at 4 oclock in the morning and my father would be reading a book every morning. I started coming down with the same thing at about age 40 and i went to the doctor and he prescribed the best medication in the world which has allowed me to keep my mental health. My father in his mid to late 50’s started having mental health issues and the small bank he had been running declined to the point that a cease and desist had to be issued by FDIC. I talk with the doctor who was on our board and they wanted me to come back and he said the mental health issues were related to his severe insomnia. Ambien had not been invented in the early 80’s.
When i explained these facts to my doctor in 1999 he said Ambien will allow you to sleep. Guess what, i have been on Ambien for 23 years. Even today it allows me to get a good night sleep. I have a Bachelors in Accounting from a top 20 school, my MBA and i am a CPA. I have no signs of any dementia or memory loss, but it also does not run in the family, but by now you are suggesting i would have a memory loss, yet i am getting ready in July to start my 3rd company at age 67.
My point and the common thread here is medication, exercise and using pills as prescribed has improved my life, so much, yet, while perhaps some medications might effects others, you cannot just say that this medication is bad for everyone. Medication has improved both my physical health and my mental health. I think i can be active to age 90-95, but had my mental health not been restored by ambien, i would hate to think where i might have been at this point. By the way, late at night before we discovered where my pain is coming from, i would take a ambien at night, and it would immediately help me with my pain. Of course i could not take it during the day, but ambien during that time frame had a positive side effect reducing my pain. I can tell you my life has been so thoroughly improved due to Ambien, so i wish people would quit making negative comments about Opiods and ambien, again, my life is so much better.
The other reason is you are making it difficult to continue to get ambien and opiods with all of this negative news. What about the people who are benefitting from these drugs-there are thousands like us yet if you take it as prescribed, you will be fine, plus you have to exercise and keep your health on an even keel. Good luck to you.
Nicole Didyk, MD says
Thanks for sharing such a detailed account of your experience. Living with chronic pain is not easy and it sounds like you’ve worked very hard to manage your health – well done!
Your experience with opioids and a sedative-hypnotic like zolpidem (ambien) sounds like it’s been positive for you, and I’m glad to hear it. Nonetheless, as a category, sedative-hypnotics can contribute to cognitive impairment, falls, broken bones, motor vehicle collisions and head injuries: https://pubmed.ncbi.nlm.nih.gov/23826304/ It’s also on the Beers list of Potentially Inappropriate Medications for Older Adults.
When we share information about the hazards of some medications in older adults, the purpose is to provide people with the information they need to make an informed decision about what’s right for them. If a person is aware of the risks and feels that the benefits outweigh them, they can make that decision for themselves.
Marm says
Hey, my grandfather is 89 and since last year his behaviour has changed. He gets angry at times over silly things, sometimes speakers things which don’t make any sense, in his own home asks us to take him home, his expressions change while being angry as if he isn’t himself… And this has worsened since last month. He only sleeps for 2 hours at night and keeps on speaking nonsensical things the whole night in his loud voice, doesn’t let us switch off the light sometimes, suddenly wants to sit up straight and wants tea and all kind of weird things…
My grandmother is 81 and it’s getting difficult for her.
All this started way back when he had accident 8 years back and had some minor injury in his lower spine, gradually his sensation in lower half body started to decrease. Sometimes he just can’t feel his legs or lift them to walk and other times he pees or passes stool in clothes.
It was only this till last year but now it’s reached to his brain.
We’ve consulted local doctors but haven’t got any solution yet.
Please HELP.
PLEASE.
Nicole Didyk, MD says
It sounds like a very difficult situation for your family!
The symptoms you describe are very complex with the behaviour change, trouble walking and incontinence. It may all be a worsening of chronic conditions, but those symptoms need to be sorted out by a doctor who can see your grandfather in person. If I were seeing someone with those issues I would do a thorough medication review for starters.
You might find this article relevant. It covers what to think about when you see paranoia or other problems with thinking.
Diana P says
My 95 yo father lives with me so I am very involved in his health care. He has just one functioning artery (also partially blocked) and one functioning lung. A hospice nurse visits once a week and monitors his drug use. He uses a walker but keeps walking to a minimum, just from bed to bathroom to chair all in the same room. He’s fallen twice in the past six months, luckily no serious injuries just bruises. He complains of not sleeping well so he was on trazodone for a while but complained it didn’t work. So, two weeks ago he started on temazepam which has definitely helped. He’s very weak and I do believe his heart will give out soon. Should I be concerned at this point about the long term side effects of the temazepam? Or, could getting sleep override those concerns at this point? Thank you.
Nicole Didyk, MD says
Thanks for your question, Diana.
I can understand being less concerned about addiction or tolerance (needing higher doses of a medication to get an effect) in an older adult. Even if the goals of care are for a better quality of life though, the use of temazepam or other benzodiazepines could have unpleasant side effects like an increased risk for falls and mental dullness or confusion, as well as daytime drowsiness. I like this website, http://www.mysleepwell.ca, which gives a good outline of the hazards of sleeping pills in older adults.
Often, sleep expectations are unrealistic in older adults, especially if there’s daytime napping and inactivity. Many older adults lie in bed between 9 PM and 8 AM but only require about 6-7 hours of actual sleep. You can learn more in my video about insomnia, here.
In the end, it’s a balance of the person’s goals and tolerance for risk. In any case, after a few weeks, I would consider trying to get off of the benzodiazepine and see if it’s still needed.
Krishna says
Hi, my grandmother is 93 years old. She can’t sleep at night and this is going on for like 1 week. She does not even sleep at day time. She looks so tired and anxious. She keeps forgetting a lot of things even our names and keeps saying random stuffs now and then. We gave her sedative 3 days ago and that made her sleep well that night. But after its effect has gone,she went back to not sleeping at all. We can’t take her to the hospital because due to covid, they would test her and if she turns positive, they won’t allow us to see her even if something happens. So what should we do now?
Nicole Didyk, MD says
I can understand your concerns about going to the hospital right now during COVID, but I am encouraging my patients to get medical help in the hospital if they really need it. Avoiding medical care can lead to bigger problems in the long run. A visit to a family doctor might be another alternative.
A new change in sleep patterns in an older person can be a sign of many things: medication side effect, depression, responsive behaviour of dementia, or a medical illness like an infection, heart condition, pain syndrome, or something else. When there’s a sudden change, it’s vital to get a thorough medical assessment to decide what to do next.
I hope you can get your family member the help that she needs.
David says
Can low testosterone and or low growth hormone levels effect sleep in the elderly?
Nicole Didyk, MD says
Most of the data about sleep and testosterone is in middle-aged males, but there does seem to be some association between low testosterone and obstructive sleep apnea. It’s not clear why this relation ship exisits.
I couldn’t find anything recent about growth hormone and sleep, although some older studies (circa 1997) indicate that it seems that older adults have reduced effect of growth hormone releasing hormone (GHRH) on sleep patterns, but supplementing with GHRH didn’t seem to help with improving sleep.
Philip Sazone says
What are the risks associated with Hydroxlyzine and memory loss? I was prescribed 25 mg this by my doctor about a year ago and have taken it quite frequently to calm down and turn my mind off before sleep. However, I have found myself waking up a couple times forgetting where I’m at and having to remind myself of names. Is this common? Should I get off this drug immediately?
Nicole Didyk, MD says
You don’t mention your age, and in older adults (those over 65), we recommend avoiding this mediation. It has those anticholinergic properties that can cause sedation, constipation, dry mouth and confusion.
Effective treatment for anxiety and insomnia usually involves more than just taking a pill, and I usually advise exploring exercise, mindfulness meditation, and cognitive behavioral therapy.
As always, before stopping a prescription suddenly, it’s a good idea to discuss it with your doctor or pharmacist. Good luck!