Poor sleep is one of the most common complaints in elderly—and one of the most undertreated. Sleep problems cause daytime fatigue, cognitive issues, falls, depression, and caregiver exhaustion (when they're up, you're up). Understanding why elderly sleep changes is the first step to finding solutions.
Some sleep changes are normal with aging: earlier bedtimes, earlier waking, lighter sleep, more nighttime awakenings. But difficulty falling asleep, staying asleep for most of the night, or severe daytime fatigue are not normal and deserve treatment.
Why Elderly Don't Sleep Well
Medical Conditions
Pain (arthritis, neuropathy), urinary frequency, heart failure, COPD, restless legs, sleep apnea—all disrupt sleep significantly.
Medications
Many drugs interfere with sleep: steroids, beta blockers, some antidepressants, diuretics (cause nighttime bathroom trips), stimulating medications.
Sleep Disorders
Sleep apnea is very common in elderly (often undiagnosed). Restless leg syndrome, periodic limb movements, REM behavior disorder.
Circadian Rhythm Shifts
The body clock shifts earlier with age (hence 4 AM wake times). Reduced melatonin production. Less exposure to sunlight exacerbates this.
Mental Health
Depression and anxiety are common in elderly and significantly impact sleep. Often presents as early morning waking.
Poor Sleep Habits
Too much time in bed, daytime napping, irregular schedule, TV in bedroom, caffeine or alcohol use.
Dementia
Causes day-night reversal, wandering at night, sundowning. Sleep disruption can also worsen dementia symptoms.
Environment
Facility noise, uncomfortable bed, too hot/cold, unfamiliar surroundings after a move.
Sleep Hygiene: The First Step
Before medications, try behavioral approaches—they're often more effective and don't have side effects.
Consistent Sleep Schedule
Same bedtime and wake time every day—including weekends. No sleeping in to "catch up." The body clock needs consistency.
Limit Time in Bed
Only go to bed when sleepy. If not asleep in 20 minutes, get up and do something boring until drowsy. Bed is for sleep, not lying awake.
Morning Light Exposure
Bright light in the morning (30+ minutes) helps reset the circadian rhythm. Outdoor light is best; light therapy boxes work for homebound.
Limit Daytime Naps
If napping is necessary, one nap maximum, 20-30 minutes, before 3 PM. Long or late naps destroy nighttime sleep.
Evening Wind-Down
Dim lights 1-2 hours before bed. Avoid screens (phones, tablets, TV). Calm activities: reading, gentle music, warm bath.
Additional Tips
- No caffeine after noon—elderly metabolize caffeine more slowly
- No alcohol within 3 hours of bed—it fragments sleep
- Cool, dark, quiet bedroom—around 65-68°F is ideal
- Limit fluids before bed—reduces bathroom trips
- Daily exercise—but not within 4 hours of bedtime
- Treat pain—take scheduled pain medication before bed if needed
Sleep Medications in Elderly
Sleep medications are problematic in elderly. Most increase fall risk, cause confusion, and can cause dependence. Use cautiously and only when other approaches fail.
The American Geriatrics Society Beers Criteria lists many sleep medications as potentially inappropriate for elderly due to serious side effects. Always discuss risks vs benefits with the doctor.
| Medication | Issues in Elderly | Risk Level |
|---|---|---|
| Diphenhydramine (Benadryl, Tylenol PM) | Confusion, falls, urinary retention, constipation, dry mouth | Avoid |
| Benzodiazepines (Valium, Ativan, Xanax) | Falls, fractures, confusion, cognitive impairment, dependence | Avoid |
| Zolpidem (Ambien) | Sleepwalking, confusion, falls, morning drowsiness—use lowest dose only | Caution |
| Melatonin | Relatively safe; 0.5-3mg typical dose; timing matters more than dose | Safer option |
| Trazodone | Often used for sleep; low dose (25-50mg); can cause morning grogginess | Caution |
| Mirtazapine | Antidepressant with sedating properties; can increase appetite (good or bad) | Caution |
| Ramelteon (Rozerem) | Melatonin receptor agonist; fewer side effects but less potent | Safer option |
If Medications Are Necessary
- Start low—often half the adult dose
- Use short-term—not indefinitely
- Review regularly—try periodic tapering
- Watch for morning effects—drowsiness, confusion, falls
- Avoid combinations—don't mix sleep aids
When to See a Doctor
Sleep Apnea Warning Signs
Very common in elderly and often missed. Look for:
- Loud snoring with pauses in breathing
- Gasping or choking during sleep
- Excessive daytime sleepiness despite "enough" sleep
- Morning headaches
- High blood pressure that's hard to control
Sleep apnea worsens heart disease, increases stroke risk, and impairs cognition. Treatment with CPAP can be life-changing.
Home sleep tests are now widely available and covered by Medicare—no overnight lab stay required. Talk to the doctor if you suspect apnea.
Other Reasons to Call the Doctor
- Sudden change in sleep pattern—may indicate infection, medication issue, or other medical problem
- Acting out dreams—REM behavior disorder, can indicate neurological issues
- Restless legs—uncomfortable sensations requiring movement; very treatable
- Depression symptoms—hopelessness, withdrawal, appetite changes along with sleep problems
- Sleep problems causing falls—nighttime bathroom trips, medication-related grogginess
Special Situations
Sleep problems in dementia require different approaches. Sundowning, day-night reversal, and nighttime wandering are common. See our guide: Dementia Sleep Problems.
Sleeping in the Hospital or Facility
Hospitals and care facilities are terrible for sleep—bright lights, noise, vitals checks, unfamiliar environment. Advocate for:
- Clustering care (fewer interruptions)
- Dim lighting at night
- Familiar items from home
- Earplugs and eye masks if tolerated
- Regular sleep-wake schedule despite being in facility
Caregiver Sleep Deprivation
If your parent's sleep problems are destroying your sleep:
- Consider bedroom monitors instead of checking in person
- Use motion-sensor alarms for wandering
- Get respite care to catch up on sleep
- Ask family to share night duty
- Consider whether 24-hour care is needed
Caregiver sleep deprivation is a safety issue—tired caregivers make mistakes and have car accidents. Your sleep matters too.
When It's Just "Old Age"
Some sleep changes can't be fixed and must be accepted:
- Earlier sleep timing—if they sleep 9 PM to 4 AM, that's 7 hours. It may be their new normal
- Lighter sleep—elderly spend less time in deep sleep. They wake more easily
- More awakenings—waking once or twice is common; falling back asleep is the goal
- Changed needs—some elderly genuinely need less sleep than before
Focus on quality of sleep and daytime function rather than number of hours.
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Explore Caregiver ResourcesFrequently Asked Questions
Why do elderly people have trouble sleeping?
Sleep changes with age: less deep sleep, more night awakenings, and earlier bedtimes/wake times. Common causes of poor sleep include chronic pain, frequent urination, sleep apnea, restless leg syndrome, medication side effects, depression, anxiety, dementia, and poor sleep habits. Medical conditions and their treatments often disrupt sleep. Evaluation by a doctor can identify treatable causes.
Is it normal for elderly to sleep a lot during the day?
Mild daytime drowsiness can be normal with age, but excessive daytime sleepiness isn't. It may indicate poor nighttime sleep, sleep apnea, medication effects, depression, dementia, or underlying illness. Sleeping more than 9 hours total (night plus naps) is associated with increased health risks. If your parent sleeps excessively, consult their doctor to rule out treatable causes.
Are sleeping pills safe for elderly?
Most sleep medications increase fall risk, cognitive impairment, and next-day drowsiness in elderly patients. The American Geriatrics Society recommends avoiding benzodiazepines and most sleep aids for older adults. If medication is necessary, safer options may include low-dose trazodone or melatonin under medical supervision. Non-medication approaches (sleep hygiene, cognitive behavioral therapy for insomnia) should be tried first.
How much sleep does a 70 year old need?
Most adults 65+ need 7-8 hours of sleep per night, though individual needs vary. The quality of sleep matters as much as quantity. Older adults spend less time in deep, restorative sleep stages. If your parent sleeps 7-8 hours but still feels unrefreshed, they may have a sleep disorder like sleep apnea. Consistent sleep schedules help maintain healthy sleep patterns.