Dealing With Insomnia

I’ve always had trouble sleeping, but lately, my insomnia has gotten worse. What can I do?

It is commonly thought that people need reduced sleep as they age. While sleep patterns can change throughout one’s lifetime, older adults need to tune into their individual body’s needs to determine how much sleep they need each night. Some may notice that they continue to need 7 to 9 hours a night, but fall asleep earlier/later or wake up earlier/later than they used to. When reporting insomnia, we frequently here from older adults that they fall asleep on the late side, wake up a few hours later to use the bathroom, and then are unable to fall back asleep. If they do manage to sleep again, it isn’t until early in the morning, and they unfortunately sleep later than intended, which leaves them groggy throughout the day, and reinforces falling asleep late again the following night. A vicious cycle. If you find that you are unable to fall back asleep after using the bathroom because you are ruminating, worrying, or experiencing thought loops (aka re-living something or going over the same thing endlessly in your mind), it’s possible your insomnia has an underlying cause of anxiety.

Current recommendations to assess and treat insomnia in older adults first include ruling out medical causes (sleep apnea, neurological conditions, etc.) If your sleep disturbance is due to anxiety, however, interventions may include Cognitive Behavioral techniques, tending to sleep hygiene and avoiding watching tv or using other screens a few hours before bedtime, tracking sleep with a monitoring device, writing in a worry journal, or exploring the impact of foods consumed or social/emotional experiences that occur before bedtime, to name just a few.

Some older adults who have lived with insomnia overtime have also found acceptance (yes, acceptance!) of their sleep patterns a welcome relief. Despite the widely held belief that we should sleep straight through every night, some sleep specialists have researched the anthropological likelihood that humans must have had diverse and divergent sleep patterns for survival. (Think early humans taking turns being on watch to protect their sleeping peers from nighttime predators.) While good quality sleep is clearly essential for memory consolidation, cell health, mood regulation, and myriad physiological processes, punishing yourself or responding with anxiety to “sleep fear mongering” never helps anyone actually sleep better.

Sleep medications are an option, but a lot of geriatricians express concern about older adult use. They can be habit forming or contra indicated for use with other medications. Also, they treat the symptom rather than the cause. This doesn’t mean that medication is never indicated for insomnia. It just means that if you want to explore this option, you should seek consultation with a prescriber who specializes in medication management for older adults.

Posted in Hear From Our Clinicians.