Sleep problems in older adults: night waking, daytime dozing and evening restlessness

With age, sleep can become lighter and more broken, and people may go to bed and wake earlier. But constantly waking tired, frequent dozing during the day or sleepless nights are not “a natural part of ageing”; there is often a cause that can be addressed.

Common causes of poor sleep

• Frequent night-time urination, pain, breathlessness or reflux
• Depression, anxiety, loneliness
• Some medicines and caffeine in the evening
• Inactivity, little daylight and long naps during the day
• Snoring and pauses in breathing during sleep (sleep apnoea)
• Restless legs and conditions such as dementia and Parkinson’s

A drug-free sleep routine

• Get up and go to bed at the same time every day, weekends included.
• Get daylight in the morning, ideally with a short walk.
• Limit daytime naps to 30 minutes, before or early in the afternoon.
• Cut down on tea and coffee after midday; avoid heavy evening meals.
• Dim screens in the evening; follow a calming routine (warm shower, music, prayer or reading).
• Keep the bedroom cool, dark and quiet.
• If sleep will not come, get up and do something quiet in low light rather than lying awake for hours.

Caution with sleeping tablets

Sleeping tablets and some sedatives can cause morning grogginess, confusion and falls in older adults. Do not start a sleeping tablet without a doctor’s advice or take medicine from a neighbour or another family member, and do not use over-the-counter “sleep aids” without checking with the doctor. A medicine taken for a long time should not be stopped suddenly; plan any reduction with the doctor.

A safe night-time environment

Waking at night increases the risk of falls. Prepare a motion-sensor night light on the route from bed to toilet, a phone and glasses within easy reach of the bed, non-slip slippers and a clear path. Make sitting on the edge of the bed for a few seconds before standing a habit.

Evening restlessness in dementia

Some people with dementia become more restless, wander and grow more confused in the late afternoon and evening. Regular activity and daylight during the day, putting the lights on before dusk, a calm setting and a familiar routine can help. Restlessness that starts suddenly or gets markedly worse may be due to infection, pain or medication and should be reported to the doctor.

When to see a doctor

See a doctor if a sleep problem has lasted several weeks and affects the day, if there is loud snoring with pauses in breathing, shouting or violent movements during sleep, or if the sleep problem comes with changes in mood.