Sleep and seniors: Insomnia isn't inevitable as you age

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:

• You have a harder time staying asleep
• You sleep lighter
• You wake up three or four times each night

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
As you age, you're more likely to develop health problems that could cause your sleep patterns to change. Examples include:

• Arthritis
• Osteoporosis
• Heartburn
• Cancer
• Diabetes
• High blood pressure
• Parkinson's disease
• Alzheimer's disease
• Incontinence
• Gastroesophageal reflux disease (GERD)
• Stroke
• Chronic obstructive pulmonary disease (COPD)
• Asthma
• Heart disease
• Enlarged prostate

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
Anxiety, depression and other emotional problems can make it harder to sleep at night. At the same time, not sleeping at night can add to your anxiety and depression. Understand that anxiety and depression can be serious conditions. Don't hesitate to tell your doctor if you have feelings of sadness or anxiousness that keep you up at night. These feelings can be treated.

Medications
Some common medications can make it difficult to fall asleep or stay asleep, including:

• Antidepressants
• Beta blockers
• Bronchodilators
• Calcium channel blockers
• Corticosteroids
• Cardiovascular drugs
• Decongestants
• Gastrointestinal drugs

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.

Lifestyle changes
As your responsibilities and daily activities change, your body adjusts accordingly. You might not get as much exercise as you did in the past. Being in a more rested state during the day means that your body doesn't feel the need to sleep like it used to. If your doctor says it's OK, increase your daily activities, for example, by taking a walk or spending more time in the garden.

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.

Sleep disorders
Some sleep disorders are more prevalent among older adults, including sleep apnea and restless legs syndrome. Both can wake you up in the middle of the night. If you think you might have either condition, talk to your doctor. Your sleep partner might be aware of your sleep disorder because loud snoring or movement might wake him or her up. Your partner might be able to give your doctor some information about your sleep behavior.

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:

• Rapid heart rate
• Sweating
• Trembling
• Shortness of breath
• Hyperventilation
• Chills
• Hot flashes
• Nausea
• Abdominal cramping
• Chest pain
• Headache
• Dizziness
• Faintness
• Tightness in your throat
• Trouble swallowing
• A sense of impending death

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.

Risk factors

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:

• A family history of panic attacks or panic disorder
• Significant stress
• The death or serious illness of a loved one
• Big changes in your life, such as the addition of a baby
• A history of childhood physical or sexual abuse
• Undergoing a traumatic event, such as an accident or rape

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

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.

Medications
Medications can help reduce symptoms associated with panic attacks, as well as depression if that's an issue for you. Several types of medication have been shown effective in managing symptoms of panic attacks, including:

• SSRIs. These medications are in the class of antidepressants called selective serotonin reuptake inhibitors. Because these medications are generally safe and have a low risk of causing serious side effects, SSRIs are typically recommended as the first choice in medication options to treat panic attacks. They include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) and sertraline (Zoloft).
• SNRIs. These medications are in the class of antidepressants called serotonin and norepinephrine reuptake inhibitors. They include duloxetine (Cymbalta) and venlafaxine (Effexor, Effexor XR).
• TCAs. These medications are in the class of antidepressants called tricyclic antidepressants. While effective, they pose a risk of serious side effects, including heart and blood sugar problems. They include desipramine (Norpramin), imipramine (Tofranil) and nortriptyline (Pamelor).
• Benzodiazpines. These medications are mild sedatives. They belong to the group of medicines called central nervous system (CNS) depressants. Benzodiazepines may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses. These include alprazolam (Xanax), clonazepam (Klonopin) and lorazepam (Ativan).
• MAOIs. These medications are in the class of antidepressants called monoamine oxidase inhibitors. Because they can cause life-threatening side effects and require strict dietary restrictions, they're not commonly prescribed. They include phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan) and selegiline (Emsam).

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.

Psychotherapy
Psychotherapy, also called counseling or talk therapy, can help you understand panic attacks and panic disorder and how to cope with them. The main type of psychotherapy used to treat panic attacks and panic disorder is cognitive behavioral therapy. Some experts recommend that you have therapy with a psychiatrist or psychologist with experience in treating panic disorder.

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.

Prevention

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.