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March 5, 2020

Insomnia in Older Adults

by David Merrill

Insomnia is more frequent in older adults than in any other age group.

Overview

  • 28% report difficulty falling asleep, and 46% both falling & staying asleep.
  • Leads to deterioration in daytime alertness and functioning.
  • Sleep changes characteristic in late life include:
    • decreased total sleep time
    • frequent arousals (increased % of Stage 1 and Stage 2 sleep)
    • decreased deep sleep (3 and Stage 4 sleep)
    • decreased rapid eye movement (REM) latency & amounts
    • a tendency to exhibit redistribution of sleep (e.g., napping during the day).
  • Many of these sleep changes are similar to those that occur in depression and dementing disorders, although not as severe.
  • Older persons are also more likely to phase-advance in the sleep cycle, with a phase tendency toward “morningness.”
  • Determining underlying causes of insomnia and exploring sleep hygiene key.

Sleep disturbances leading to insomnia in the older adults

  • Primary insomnia
  • Sleep-disordered breathing (i.e., sleep apnea)
  • Nocturnal myoclonus or periodic leg movements
  • Sleep–wake schedule disorder

Secondary causes of insomnia

  • Sleep problems secondary to medication use
  • Anxiety disorders
  • Mood disorders
  • Dementing disorders
  • Comorbid physical illness (e.g., congestive heart failure, chronic obstructive pulmonary disease, nocturia)

DEPRESSION

ANXIETY

About the Author

David Merrill, MD, PhD

David Merrill

David Merrill, MD, PhD, is director of the Pacific Brain Health Center at Pacific Neuroscience Institute. As an adult and geriatric psychiatrist, he specializes in treating patients suffering the behavioral health sequelae of age-related neurodegenerative disorders such as Alzheimer’s disease and Parkinson’s disorder, as well as alleviating depression and cognitive dysfunction within the context of aging.

Last updated: September 11th, 2020