Sleep and seniors: Insomnia isn't inevitable as you age
Sleep and seniors: Insomnia isn't inevitable as you age
Insomnia in older adults — Why insomnia occurs and what to do about it.
After years of rising early to work at the office, you looked forward to retirement — a time when you'd toss out that annoying alarm clock and catch some quality zzz's. But now you're finding that even though you'd like to sleep late, you're still rising with the sun. And the sleep you do get overnight isn't as restful.
Having difficulty getting to sleep and staying asleep (insomnia) is common as you get older. But that doesn't mean insomnia can't be avoided. Explore what could be causing your sleeping difficulties. Once you've figured out what's causing your insomnia, there's plenty you can do to get a good night's rest.
What's normal sleep as you age
As you age, your body secretes smaller amounts of key substances that help your body decide when to sleep and when to wake up. Levels of growth hormone, which promotes deep sleep, and melatonin, which regulates your sleeping and waking cycle, decrease as you age. As a result, your circadian rhythm — the internal clock that tells you to go to sleep at night and wake up in the morning — changes. You might find yourself going to bed earlier and waking up earlier.
As you get older, you might find that getting a good night's sleep becomes more difficult. You might find that:
But despite the frustrating disturbances, you still need the same amount of sleep that you needed when you were younger — generally seven or eight hours a night. Because you likely wake up more often during the night and don't sleep as soundly, you may spend more time in bed at night or you might need a nap during the day to get those same eight quality hours of sleep.
On their own, these age-related changes don't usually signify a sleep disorder. If you're experiencing insomnia, your age usually isn't to blame.
Causes of insomnia in older adults
About half of all seniors report difficulty falling asleep and staying asleep. Several different factors can cause this problem.
Health conditions that may contribute to insomnia
Some conditions, such as arthritis, cause pain, which can make falling asleep difficult. Also, if you have chronic pain, you might wake yourself up if you adjust your sleep position during the night.
If you have diabetes, leg edema, enlarged prostate or incontinence, these conditions might cause you to urinate more frequently. Add to that the fact that your bladder capacity shrinks as you age, and you might find yourself getting up at night to use the toilet more often. Getting up so often can make it hard to get back to sleep.
Other conditions, such as heart disease and COPD, can cause breathing difficulties. If you have trouble maintaining steady, rhythmic breathing while you sleep, you might wake up several times in the middle of the night. Waking up like this may prevent you from reaching deep sleep.
Pay attention to what awakens you at night or what keeps you from sleeping. Talk to your doctor about your specific health condition. Changes to your treatment plan may reduce your sleep disturbances.
Anxiety and depression
As you get older, you're more likely to be taking some type of medication. Talk to your doctor about your medications and the chance that they might be causing your sleepless nights. Your doctor might prescribe a different drug that doesn't cause insomnia, or he or she might discuss changing the time of day you take your medication.
Common nonprescription drugs such as alcohol, caffeine and nicotine also can make it harder to fall asleep. Try cutting down on these or eliminating them altogether. Be aware that nicotine withdrawal symptoms and even the nicotine patch can keep you up — but this is usually only a temporary problem.
Do your exercising during the day, or at least more than two hours before you go to bed. Exercise increases your core temperature, making it harder to fall asleep.
You might not spend enough time outdoors these days. Sunlight helps keep your body's circadian rhythm working appropriately. In general, you need about two hours of bright-light exposure each day to help your body gauge when to sleep and when to wake up. If you can't get outside to enjoy the sunshine, talk to your doctor about a light box — a box that emits a bright light that mimics the light given by the sun.
With more indoor time and less activity, you might find it tempting to nap during the day. If you nap for more than 20 minutes, you could find yourself having more trouble getting to sleep at night.
Signs and symptoms
Panic attack symptoms can make your heart pound and cause you to feel short of breath, dizzy, nauseated and flushed. Because panic attack symptoms can resemble life-threatening conditions, it's important to seek an accurate diagnosis and treatment.
Panic attack symptoms can include:
You may have a few or many of these panic attack symptoms. Panic attacks typically begin suddenly, without warning. Panic attack symptoms usually peak within 10 minutes and last about half an hour. But panic attacks have many variations. They may last hours or, on rare occasions, up to a day. You may feel fatigued and worn out after a panic attack subsides. One of the worst things about panic attacks is the intense fear that you'll have another panic attack.
If you have frequent panic attacks, you may have a condition called panic disorder. Panic attacks can greatly interfere with your life — and perhaps even endanger you or others.
Panic attacks can strike at almost any time without warning — when you're driving the school car pool, at the mall, sound asleep or in the middle of a business meeting. And you may fear having a panic attack so much that you avoid situations where they may occur. You may even be unable to leave your home (agoraphobia), because no place feels safe.
It's hard to pinpoint how many people have panic attacks or panic disorder because of diagnostic issues, but it's estimated that 2 million to 6 million Americans have panic disorder. Symptoms of panic disorder often start either in late adolescence or in your 30s. More women than men are diagnosed with panic disorder. Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends.
Factors that may increase the risk of developing panic attacks or panic disorder include:
When to seek medical advice
If you have any symptoms of panic attacks, seek medical help as soon as possible. Panic attacks are hard to manage on your own, and they may get worse without treatment. And because panic attack symptoms can also resemble other serious health problems, such as a heart attack, it's important to get evaluated by your health care provider if you aren't sure what's causing your symptoms.
In fact, many people visit the emergency department or seek care from numerous doctors or hospitals because they believe they have a serious undiagnosed physical condition. You can generally seek help first from your primary care provider for panic attack. If he or she believes your symptoms are indeed related to panic attacks, you may be referred to a psychiatrist or psychologist for treatment.
If you're reluctant to seek treatment for your panic attacks, try to work up the courage to confide in someone, whether it's a friend or loved one, a health care professional, a faith leader or someone else you trust. They can help you take the first steps to successful treatment.
Treatment for panic attacks and panic disorder is very effective. The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities. The main treatment options for panic attacks are medications and psychotherapy. Both are equally effective.
If one medication doesn't work well for you, your doctor may recommend switching to another or combining certain medications to boost their effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in your symptoms. All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Be sure to talk to your doctor about the possible side effects and risks.
Cognitive behavioral therapy can help you change thinking (cognitive) patterns that trigger your fears and panic attacks. It can also help you change the way you react (behave) to anxious or fearful situations. During therapy sessions, you learn to recognize things that trigger your panic attacks or make them worse, such as specific thoughts or situations. You also learn ways to cope with the anxiety and physical symptoms associated with panic attacks. These may include breathing and relaxation techniques.
In addition, working carefully with your therapist, you may re-create the symptoms of panic attacks in the safety of his or her office. This is an important step because it can help you learn to control and master the symptoms so that they don't continue to be a source of intense fear. Doing this can also help you overcome fear of certain situations that you may avoid, such as crowded malls or driving.
Your therapist may suggest weekly meetings when you first start treatment. You may start to see improvements in panic attack symptoms within several weeks, and often symptoms go away within several months.
As your symptoms improve, maintenance therapy with visits once a month can help ensure that your panic attacks remain under control. Eventually you can stop therapy when your symptoms completely go away, which may be a year or so. However, panic attack symptoms do sometimes come back. Seek prompt treatment if they do, and make sure that you're managing any stressful life situations.
There's no sure way to prevent panic attacks or panic disorder. However, getting treatment for panic attacks as soon as possible may help stop them from getting worse or becoming more frequent. Sticking with your treatment plan can help prevent relapses or worsening of panic attack symptoms. Practicing relaxation and stress management techniques can be helpful, too.
Last Updated: 07/06/2006
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