Society of Certified Senior Advisors: Secondary Insomnia in Older Adults: Don’t Take It Lying Down

Insomnia in Older Adults

Older adults are often sleep-deprived, but it doesn’t have to be that way.

Despite the insidious myth that they need less sleep than they used to, they need restful slumber each night. Not only is getting good rest at night key to living longer, it is a must for living well. While a study found that some doctors dismiss older adults’ complaints about not getting enough sleep, sleep medicine specialists advise that people over 60 get between 7 to 9 hours of rest a night.

Insomnia is a menace to nearly half of all adults in the U.S. over the age of 60. Since the sleep thief robs them of the one free thing that helps them stay healthy, strong, and active, it is key to understand the reasons for sleep deprivation. Fortunately, everyone can adapt healthy sleeping habits at any age. Difficulties with sleep should not be treated as an inevitable part of aging. Instead, “these sleep complaints are often secondary to medical and psychiatric illness, the medications used to treat these illnesses, circadian rhythm changes, or other sleep disorders,” according to Dr. Sonia Ancoli-Israel, Professor of Psychiatry at the University of California San Diego.

Unfortunately, getting the much-needed rest does not get easier as we get older. There are two general types of insomnia with which doctors diagnose older adults: primary and secondary. Primary insomnia is a condition that arises independently of other ailments; secondary insomnia results from other physiological troubles. It does not help older adults that most of the focus on treatment is one that assumes the insomnia is primary, while most cases of insomnia among the seniors are secondary, brought on by other medical conditions or drug side effects. In fact, people with secondary insomnia have been found to be more impaired during the day than people with primary insomnia.

“Insomnia is more common for seniors, partly because of health issues, partly because of the anxiety and the concerns of aging, and sometimes because of medication,” says Jack Gardner, a sleep medicine neurologist at Baylor Medical Center in Waxahachie, Texas.

What Causes Secondary Insomnia in Older People

Thermoregulation issues. As we age, the body’s ability to maintain a healthy core temperature can become compromised. The reason we sometimes see older people wearing a sweater on a hot day is that their body heat production is off. Most body heat is owed to metabolism in the core organs and muscles, but by the time we are 70, we lose 30 percent of muscle mass and our physical activity decreases. Menopause, too, comes with its own thermoregulation problems. Thermoregulation affects sleep because it’s a trigger both for falling asleep and for waking: We tend to feel tired at night when our temperature declines (that’s why falling asleep in a cooler room is ideal) and wake up in the morning when our temperature rises.

The best way to counteract thermoregulation troubles is to keep up with exercise (safe weight lifting can help build and maintain muscle mass even after 60).

A wide range of injuries and advancing illnesses. Over time, the longer we live, the more chronic illnesses, conditions, and injuries accumulate that can keep us up at night. The sudden appearance of insomnia can be one of the first signs that a serious illness is ahead. For example, in a 2012 study researchers found that sleep problems were the strongest early predictor of Alzheimer’s. Sometimes the conditions themselves do not affect sleep, but the side effects or interactions caused by prescription medications do.

The more common sleep thieves that cause secondary insomnia include:

Weight gain

Back pain

Menopause

Parkinson’s disease, dementia, and other neurological disorders

Prostate enlargement, bladder failure, and other issues that cause incontinence

Arthritis

Heart disease

Cancers

GI problems

Respiratory issues

Sleep-specific conditions. As we age, the likelihood of sleep disorders increases as well. Often, they are secondary in the sense that they are caused by non-sleep related factors. Older adults are at greater risk for restless leg syndrome, sleep apnea, narcolepsy, and snoring. The risk for sleep apnea and snoring problems increases with weight gain.

How to Treat Secondary Insomnia

Even when we cannot entirely eliminate sleep troubles, the good news is that most of us—at any age—have at our disposal the means to curbing it. Here are some things that sleep-deprived older adults dealing with secondary insomnia should keep in mind:

Talk to your doctor about underlying conditions. Whether the insomnia is caused by thermoregulation issues, various health conditions, diseases, or injuries, or sleep disorders, working with one’s primary physician to treat the underlying causes of sleep disturbances is a must.

Ask your doctor if your specific type of sleep troubles may be an indication of other diseases.

Ask your doctor or pharmacist about drug interactions and side effects that may be interrupting your sleep.

Ask your doctor about natural supplements such as melatonin and valerian root.

If your doctor prescribes sleeping pills, ask about the long-term plan and monitor the side effects. At least 20 percent of older adults use a prescription sleeping aid. Keep in mind that sleeping pills work, but often cause dependency and lose their efficacy over time and many have troubling side effects. “Older adult insomnia is often treated pharmacologically,” according to Dr. Martita A. Lopez, “but older adults are especially vulnerable to adverse effects from hypnotic medication, such as memory impairment and impaired daytime performance.”

Incorporate healthy sleep hygiene. Finally, older adults with insomnia should take the same steps that anyone should when tackling primary insomnia at any age:
- Avoid caffeine in the afternoons and evenings.
- Do not watch TV or use the computer an hour or two before bedtime.
- Try to go to bed at the same time each day.
- Exercise during the day.
- Avoid alcohol two hours before bed or using it in lieu of sleeping aid. While it can help us fall asleep fast, the arousals produced by alcohol can bring on sweats, headaches, waking after 3 a.m., and fitful dreaming.
- Avoid drinking an hour before bed and try to empty your bladder before falling asleep.
- Sleep in a dark, quiet, and cool room. Be mindful of your own thermoregulation issues, and work to offset them.
- If you sleep with a partner and she or he snores, look into sleeping with earplugs or other options to make sure your sleep is not disturbed.
- Sleep on a comfortable mattress. Older adults suffering from back pain ought to be mindful of proper alignment and pressure points as they pick a mattress. For the people who lost muscle mass, body weight, and who have osteoarthritis or rheumatism, a change of mattress from firm to medium-firm or medium can be in order.
- Try establishing a routine of mindfulness meditation.

The bottom line for older adults suffering from insomnia is that whether it’s caused by underlying conditions or medication side effects, they can take charge of curbing their sleep troubles. Even people saddled with some daunting health challenges—like chronic back pain or Alzheimer’s—can and should take measures to improve their sleep, and thus at least slow down the progress of diseases.

Research continues to show that sleep and exercise are the fountains of youth that can help older adults not only live longer lives, but also enable them to be fully present and awake for them.

	- By Agnes Green
Agnes Green is a researcher for the sleep science hub Tuck.com. She holds two masters degrees in the social sciences from the University of Chicago and Northwestern University. She sleeps most soundly after a kettlebell workout in Portland, Oregon.