Sleep in the Elderly: Problems, Causes and What Families Can Do

Maria realised something was wrong when her mother started phoning every morning at six o'clock to chat about trivial matters. "I can't sleep anymore, so I sit by the window and wait for it to get light," the 78-year-old woman confided. This is far from an isolated scenario — millions of families face similar situations, and sleep becomes a central concern in the lives of older people and those who love them.

Sleep disorders are not an inevitable consequence of ageing, but rather the result of physiological changes and factors that can be identified and addressed. Understanding these aspects is the first step towards quieter nights and more energetic days for our elderly parents, grandparents, and relatives. When sleep is lacking, memory, mood, immunity, and overall quality of life all suffer.

This guide is here to help families understand why sleep changes in older age, which problems arise most frequently, and — most importantly — what they can do in practical terms to help their loved ones rest more soundly.

Contents

1. How sleep changes with age
2. Common sleep problems in older adults
3. Factors that worsen sleep in the elderly
4. Practical measures for better sleep
5. When to seek medical advice
6. Available medical solutions
7. Frequently asked questions

How sleep changes with age

As we grow older, the architecture of sleep changes naturally. Older adults spend less time in deep sleep — that restorative phase during which the body regenerates and memories are consolidated. Sleep becomes more fragmented, with more frequent awakenings throughout the night.

The circadian rhythm, the internal biological clock that dictates when we should be asleep or awake, also shifts. Many elderly people feel the need to go to bed earlier in the evening, around 8–9 pm, and wake very early, at 4–5 am. This shift in schedule is not a problem in itself, provided the person manages to sleep enough and feels rested.

Key physiological changes

• Reduced melatonin — the sleep hormone decreases with age, making it harder to fall asleep
• Lighter sleep — noise, light, or physical discomfort wakes elderly people more easily
• Nocturnal physiological needs — trips to the toilet become more frequent, interrupting sleep cycles
• Changes in body temperature — difficulties with thermal regulation can disturb rest

Important to bear in mind: these changes are normal, but when they cause persistent fatigue, irritability, or affect day-to-day functioning, they warrant investigation and intervention.

Common sleep problems in older adults

Beyond natural changes, elderly people often experience specific sleep disorders that require careful attention from family members and, where necessary, medical intervention.

Insomnia

Insomnia is the persistent difficulty of falling or staying asleep. In older adults, it commonly manifests as repeated awakenings during the night with an inability to fall back to sleep. Those affected report that they "don't sleep at all anymore" or "lie staring at the ceiling for hours on end," even when objective measurements show they do sleep for a few hours.

Sleep apnoea

Sleep apnoea, which is more common in older adults, involves pauses in breathing during sleep. Family members may notice loud snoring followed by suspiciously quiet moments, then sudden awakenings with a feeling of suffocation. The person wakes tired in the morning, has headaches, and tends to doze off during the day.

Restless legs syndrome

This neurological condition causes unpleasant sensations in the legs — tingling, itching, tension — that are relieved only by movement. Symptoms intensify in the evening and at night, precisely when the person is trying to relax and fall asleep.

Warning signs for family members

• Your loved one constantly complains of fatigue or falls asleep during the day in unusual circumstances
• They snore very loudly or have breathing pauses observed by others
• They wake with headaches, a dry mouth, or night sweats
• They need to move constantly to relieve discomfort in their legs
• They experience marked confusion or disorientation in the morning

Factors that worsen sleep in the elderly

Sleep problems in older adults are often compounded by factors that family members can identify and sometimes address. Recognising these elements is an essential step towards improving the quality of rest.

Medications

Many older adults take multiple medications daily, and some of these can significantly interfere with sleep. Diuretics cause them to wake frequently to use the toilet. Certain heart medications, antihistamines, corticosteroids, or antidepressants can cause insomnia or nocturnal restlessness. It is essential to discuss all treatments and possible alternatives with the doctor if sleep is affected.

Chronic pain

Arthritis, back problems, neuropathies, and other painful conditions intensify at night, when the distractions of daily life are no longer present. Pain makes falling asleep difficult and causes frequent awakenings, creating a vicious cycle — insufficient sleep heightens the perception of pain.

Emotional wellbeing

Depression and anxiety are surprisingly common in older adults, yet often go unrecognised or are played down. People with depression may wake very early in the morning and be unable to fall back to sleep, whilst those with anxiety struggle to fall asleep in the first place, their minds flooded with worrying thoughts.

Lack of physical and social activity

A sedentary lifestyle, spending the entire day indoors, a lack of social interaction, and the absence of a structured routine all reduce the body's natural drive to sleep and disrupt the circadian rhythm. Both body and mind need stimulation in order to signal the right moment for rest.

• Excessive caffeine or fluid intake in the evening
• Heavy meals late at night causing digestive discomfort
• Unsuitable bedroom temperature — too hot or too cold
• Excessive screen time and blue light exposure in the evening
• Long daytime naps that affect night-time sleep

Practical measures for better sleep

The good news is that families can implement a range of concrete measures — both at home and in collaboration with care facilities — to improve the quality of sleep for their elderly loved ones.

Establishing a sleep routine

Consistency is essential for quality sleep at any age, but especially for older adults. Try to establish a regular bedtime and wake time together, even at weekends. A relaxing pre-sleep routine — a warm bath, light reading, gentle music — signals to the body that the time for rest is approaching.

Optimising the sleep environment

The bedroom should be a sanctuary of rest. The room should be dark, quiet, and cool — the ideal temperature is around 18–20 degrees Celsius. Investing in a comfortable mattress and suitable pillows can make the difference between a restless night and a restorative one.

• Use blackout curtains to block out external light
• Eliminate disruptive noise or use white noise to mask it
• Ensure the bed is comfortable and easy to get in and out of
• Keep a visible clock to reduce anxiety about the passage of time

Sleep hygiene — daily habits

What happens during the day directly affects night-time sleep. Encourage your loved one to get exposure to natural light in the morning and at midday — this helps regulate the circadian rhythm. Moderate physical activity, such as walks, is beneficial, but should be avoided in the few hours before bedtime.

1. Limit caffeine after midday — including black tea and chocolate
2. Avoid excessive fluid intake two hours before sleep
3. Reduce or eliminate long daytime naps — a maximum of 20–30 minutes
4. Set aside a designated worry time — a period during the day to discuss concerns
5. Use the bed exclusively for sleep, not for eating or watching television

What families can request in care homes

If your loved one lives in a care facility, the family can work with staff to implement sleep-friendly measures: a flexible schedule adapted to the older person's natural rhythm, varied daytime activities to prevent boredom, exposure to natural light, reduced noise from shared areas at night, and respect for personal bedtime rituals.

When to seek medical advice

Although many sleep problems can be improved through sleep hygiene measures and lifestyle adjustments, there are times when medical intervention becomes necessary. Family members should be alert to signs indicating the need for specialist consultation.

Consult the GP or a sleep medicine specialist if your loved one has persistent insomnia lasting more than three weeks, loud snoring with pauses in breathing, excessive daytime sleepiness affecting their safety (risk of falls or accidents), or if sleep disturbances coincide with sudden changes in behaviour, confusion, or new symptoms.

What to expect from the medical consultation

The doctor will assess the full medical history, all medications being taken, and the specific manifestations of the problem. You may be asked to keep a sleep diary for several weeks to identify patterns. In some cases, further investigations may be needed, such as a sleep study (polysomnography) to diagnose sleep apnoea or other disorders.

• Bring a complete list of medications and supplements
• Note the frequency and duration of the sleep problems
• Describe the impact on daily life
• Mention any associated symptoms — pain, anxiety, low mood

Available medical solutions

Depending on the diagnosis, the doctor may recommend various therapeutic approaches, tailored to the older person's specific needs and general state of health.

Cognitive behavioural therapy for insomnia

Considered by many medical guidelines to be the first-line treatment for insomnia, this form of psychotherapy helps the person identify and change the thoughts and behaviours that disrupt sleep. It is effective and does not involve medication, making it preferable for older adults who are already taking multiple treatments.

Adjusting existing medication

Often, simply changing the timing of certain medications or replacing them with less sleep-disruptive alternatives can resolve the problem. For example, diuretics can be taken in the morning rather than in the evening.

Specific treatments

For sleep apnoea, a CPAP device may be recommended to keep the airways open during sleep. Restless legs syndrome may respond to iron supplements (where a deficiency exists) or specific medications. Chronic pain must be adequately managed to allow for restful sleep.

Sleep medication — with caution

Sleeping tablets and sedatives are prescribed with great care in older adults, as they increase the risk of falls, confusion, and dependence. When necessary, they are used in small doses, for short periods, and under close supervision. Safer alternatives include melatonin or certain antihistamines, but any medication should only be taken on a doctor's recommendation.

Frequently asked questions

How many hours should an older adult sleep per night?

Most older adults need approximately 7–8 hours of sleep per night, similar to younger adults. If the person feels rested and functions well on 6 hours, this is not necessarily a problem, as long as there are no symptoms of sleep deprivation.

Is it normal for my parents to fall asleep in front of the television every evening?

Frequently falling asleep during the day may indicate insufficient or poor-quality night-time sleep. Whilst occasional instances are not a cause for concern, if it becomes a daily habit, it is worth investigating why night-time sleep is not sufficiently restorative.

Can I give my mother herbal tea for sleep without consulting the doctor?

Even natural remedies can interact with existing medications or have adverse effects. It is always advisable to speak with the doctor or pharmacist before introducing any supplement or tea with sedative properties, especially for people who are already on multiple treatments.

How dangerous is sleep apnoea in older adults?

Untreated sleep apnoea significantly increases the risk of cardiovascular disease, stroke, hypertension, and cognitive decline. Diagnosing and treating it can substantially improve quality of life and prevent serious complications.

Should I wake my father if he sleeps too much during the day?

Excessive daytime sleepiness can be a symptom of underlying medical problems or adverse medication effects. Rather than repeatedly waking him, it is better to consult a doctor to identify and appropriately treat the cause.

How long does it take to see results after changing sleep habits?

Improvements may appear gradually, typically within 2–4 weeks of consistently applying sleep hygiene measures. It is important to be patient and persistent — rapid changes are rare, but perseverance does bring results.

Quality sleep is a fundamental right for every person, regardless of age. When your loved one sleeps well, they think more clearly, have more energy, and enjoy life more fully. If you recognise the problems described in this guide, begin with the simple measures you can implement at home, and do not hesitate to seek medical help when needed. An open conversation with your GP can pave the way to quieter nights for the whole family.

This article is for informational purposes only and does not replace medical advice. For specific situations, please consult a specialist.