Insomnia: What You Need to Know as You Age

Fatal Familial Insomnia: Symptoms, Causes, and Treatment

Insomnia: What You Need to Know as You Age | Johns Hopkins Medicine

Fatal familial insomnia (FFI) is a very rare sleep disorder that runs in families. It affects the thalamus. This brain structure controls many important things, including emotional expression and sleep. While the main symptom is insomnia, FFI can also cause a range of other symptoms, such as speech problems and dementia.

There’s an even rarer variant called sporadic fatal insomnia. However, there have only been 24 documented cases as of 2016. Researchers know very little about sporadic fatal insomnia, except that it doesn’t seem to be genetic.

FFI gets its name partly from the fact that it often causes death within a year of two of symptoms starting. However, this timeline can vary from person to person.

It’s part of a family of conditions known as prion diseases. These are rare conditions that cause a loss of nerve cells in the brain. Other prion diseases include kuru and Creutzfeldt-Jakob disease. There are only about 300 reported cases of prion diseases each year in the United States, according to Johns Hopkins Medicine. FFI is considered one of the rarest prion diseases.

The symptoms of FFI vary from person to person. They tend to show up between the ages of 32 and 62. However, it’s possible for them to start at a younger or older age.

Possible symptoms of early stage FFI include:

  • trouble falling asleep
  • trouble staying asleep
  • muscle twitching and spasms
  • muscle stiffness
  • movement and kicking when sleeping
  • loss of appetite
  • rapidly progressing dementia

Symptoms of more advanced FFI include:

  • inability to sleep
  • deteriorating cognitive and mental function
  • loss of coordination, or ataxia
  • increased blood pressure and heart rate
  • excessive sweating
  • trouble speaking or swallowing
  • unexplained weight loss
  • fever

FFI is caused by a mutation of the PRNP gene. This mutation causes an attack on the thalamus, which controls your sleep cycles and allows different parts of your brain to communicate with each other.

It’s considered a progressive neurodegenerative disease. This means it causes your thalamus to gradually lose nerve cells. It’s this loss of cells that lead to FFI’s range of symptoms.

The genetic mutation responsible for FFI is passed down through families. A parent with the mutation has a 50 percent chance of passing on the mutation to their child.

If you think you might have FFI, your doctor will ly start by asking you to keep detailed notes about your sleeping habits for a period of time. They might also have you do a sleep study.

This involves sleeping in a hospital or sleep center while your doctor records data about things such as your brain activity and heart rate.

This can also help rule out any other causes of your sleep problems, such as sleep apnea or narcolepsy.

Next, you may need a PET scan. This type of imaging test will give your doctor a better idea about how well your thalamus is functioning.

Genetic testing can also help your doctor confirm a diagnosis. However, in the United States, you must have a family history of FFI or be able to show that previous tests strongly suggest FFI in order to do this. If you have a confirmed case of FFI in your family, you’re also eligible for prenatal genetic testing.

There’s no cure for FFI. Few treatments can effectively help manage symptoms. Sleep medications, for example, may provide temporary relief for some people, but they don’t work long term.

However, researchers are actively working toward effective treatments and preventive measures.

A 2016 animal study suggests that immunotherapy may help, but additional research, including human studies, are needed. There’s also an ongoing human study involving the use of doxycycline, an antibiotic.

Researches think it may be an effective way to prevent FFI in people who carry the genetic mutation that causes it.

Many people with rare diseases find it helpful to connect with others who are in a similar situation, either online or in a local support group. The Creutzfeldt-Jakob Disease Foundation is one example. It’s a nonprofit that provides several resources about prion diseases.

It can be years before the symptoms of FFI start to appear. However, once they start, they tend to get rapidly worse over the course of a year or two. While there’s ongoing research about potential cures, there’s no known treatment for FFI, though sleep aids may provide temporary relief.


How Breathing Exercises Can Help You Beat Insomnia

Insomnia: What You Need to Know as You Age | Johns Hopkins Medicine

Finally, I came across a method that had the least research to back it up, but seemingly the most promise for me. It’s called 4-7-8 breath and it sounded relaxing, something you might do in a yoga class. It was developed by physician-author Andrew Weil and its proponents claim it will put you to sleep in a jiffy – 60 seconds. 

I wanted to try it out immediately, so I quickly skimmed the instructions, which note you keep your tongue in one spot, just behind your upper front teeth, for both inhales and exhales. They also said your exhales should be audible, and last twice as long as your inhales. As for the breathing pattern itself: 

  1.  Exhale completely through your mouth, making a “whoosh” sound.
  2.  Inhale “quietly” through your nose to the count of 4.
  3.  Hold your breath (gently) to the count of 7.
  4.  Exhale audibly through your mouth, making another “whoosh” sound, to the count of 8.

On my trial run, I was still awake after 60 seconds, but I did feel more relaxed. I think I nodded off after about 10 rounds. I didn’t stay down for long, though. Having apparently drifted off during Step 3, I woke up gasping for breath.

The next day, I took a closer look at the instructions. In fact, I watched a video of Weil explaining how to do the technique. That’s when I learned you’re only supposed to do four rounds of this breath at one time and practice it twice (at a minimum) daily for four weeks for best results.

The advice to practice the exercise more than once a day reminded me of something Johns Hopkins Medicine’s Salas told me when we were discussing the impact stress can have on sleep. “The more you can get people to recenter — practice a couple of minutes of mindfulness or meditation — throughout the day, the less stress they are going to have when they’re going to bed.”

In the same way some people might watch their caffeine consumption throughout the day in order to better their sleep at night, I began to monitor my stress level using the 4-7-8 breath. I did this midmorning, late afternoon and, of course, at bedtime.

Something shifted.

I began getting into bed earlier each night, perhaps because taking time out to think about sleep throughout the day primed me to prioritize sleep at night.

Or maybe I was becoming relaxed enough that the thought of getting into bed was more appealing than it was anxiety provoking.

Whatever the reason, something was putting the brakes on my insomnia and driving the numbers in my Fitbit sleep log up.

About two weeks in, on a Wednesday night, I logged 7 hours, 55 minutes. The very next night I logged 7 hours, 51 minutes. On Friday, I dipped slightly to 6 hours, 31 minutes, but I was back on track at 7 hours, 27 minutes on Saturday, 7 hours, 53 minutes on Sunday and a steady stream of 7-hour-plus nights followed.

My mind is sharper, I’m happier, less irritable, more productive. I’m off the roller coaster for now and, hopefully, for good.


Brain differences linked to insomnia identified by researchers

Insomnia: What You Need to Know as You Age | Johns Hopkins Medicine

Johns Hopkins researchers report that people with chronic insomnia show more plasticity and activity than good sleepers in the part of the brain that controls movement.

“Insomnia is not a nighttime disorder,” says study leader Rachel E. Salas, M.D., an assistant professor of neurology at the Johns Hopkins University School of Medicine. “It's a 24-hour brain condition, a light switch that is always on. Our research adds information about differences in the brain associated with it.”

Salas and her team, reporting in the March issue of the journal Sleep, found that the motor cortex in those with chronic insomnia was more adaptable to change — more plastic — than in a group of good sleepers.

They also found more “excitability” among neurons in the same region of the brain among those with chronic insomnia, adding evidence to the notion that insomniacs are in a constant state of heightened information processing that may interfere with sleep.

Researchers say they hope their study opens the door to better diagnosis and treatment of the most common and often intractable sleep disorder that affects an estimated 15 percent of the United States population.

To conduct the study, Salas and her colleagues from the Department of Psychiatry and Behavioral Sciences and the Department of Physical Medicine and Rehabilitation used transcranial magnetic stimulation (TMS), which painlessly and noninvasively delivers electromagnetic currents to precise locations in the brain and can temporarily and safely disrupt the function of the targeted area. TMS is approved by the U.S. Food and Drug Administration to treat some patients with depression by stimulating nerve cells in the region of the brain involved in mood control.

The study included 28 adult participants — 18 who suffered from insomnia for a year or more and 10 considered good sleepers with no reports of trouble sleeping. Each participant was outfitted with electrodes on their dominant thumb as well as an accelerometer to measure the speed and direction of the thumb.

The researchers then gave each subject 65 electrical pulses using TMS, stimulating areas of the motor cortex and watching for involuntary thumb movements linked to the stimulation.

Subsequently, the researchers trained each participant for 30 minutes, teaching them to move their thumb in the opposite direction of the original involuntary movement.

They then introduced the electrical pulses once again.

The idea was to measure the extent to which participants' brains could learn to move their thumbs involuntarily in the newly trained direction. The more the thumb was able to move in the new direction, the more ly their motor cortexes could be identified as more plastic.

Because lack of sleep at night has been linked to decreased memory and concentration during the day, Salas and her colleagues suspected that the brains of good sleepers could be more easily retrained. The results, however, were the opposite. The researchers found much more plasticity in the brains of those with chronic insomnia.

Salas says the origins of increased plasticity in insomniacs are unclear, and it is not known whether the increase is the cause of insomnia.

It is also unknown whether this increased plasticity is beneficial, the source of the problem or part of a compensatory mechanism to address the consequences of sleep deprivation associated with chronic insomnia.

Patients with chronic phantom pain after limb amputation and with dystonia, a neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements, also have increased brain plasticity in the motor cortex, but to detrimental effect.

Salas says it is possible that the dysregulation of arousal described in chronic insomnia — increased metabolism, increased cortisol levels, constant worrying — might be linked to increased plasticity in some way.

Diagnosing insomnia is solely what the patient reports to the provider; there is no objective test. Neither is there a single treatment that works for all people with insomnia.

Treatment can be a hit or miss in many patients, Salas says.

She says this study shows that TMS may be able to play a role in diagnosing insomnia, and more importantly, she says, potentially prove to be a treatment for insomnia, perhaps through reducing excitability.

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Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.



Insomnia: What You Need to Know as You Age | Johns Hopkins Medicine

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Insomnia, which means difficulty initiating or maintaining sleep, is a symptom, not a diagnosis or a disease. It may be due to a lack of sleep or poor quality of sleep.

You’ve probably had nights when you couldn’t fall asleep, no matter how desperately you tried.

When you can't sleep, the ticking of the clock only reminds you of your exhaustion and the endless hours until morning. And perhaps you finally drop off around dawn, only to be jarred awake by the alarm an hour later.

Insomnia is one of the most common sleep complaints. About 1 in 3 adults has bouts of insomnia that last a few days at a time. This is acute insomnia. But 1 in 10 adults suffers ongoing difficulty sleeping, known as chronic insomnia. This is defined as insomnia that occurs more than 3 nights a week for over a month.

Insomnia affects people in different ways. If you suffer from it, you may not be able to go to sleep or you may not be able to stay asleep. You might constantly wake up earlier than you would , perhaps in the wee hours of the morning, and find yourself unable to go back to sleep. 

Women are more ly to have insomnia than men. It is also more common among shift workers, who don't have consistent sleep schedules; people with low incomes; people who have a history of depression; and those who don't get much physical activity.

Around 18 million Americans fail to get a good night's sleep.If you or someone you love is among them, these research findings and expert insights could help you figure out what’s holding you back and what can help.

Insomnia has many possible causes. The reasons you're lying awake when you don't want to be are individual. They can include any or all of these:

  • Medications that interfere with sleep
  • Dietary choices, such as caffeine late in the day, that interfere with sleep
  • Stressful thoughts
  • Depression
  • Recent upheavals in your life, such as a divorce or death of a loved one
  • Hormone changes, such as those accompanying menopause
  • Bedtime habits that don't lead to restful sleep
  • Sleep disorders
  • Chronic pain
  • Medical conditions such as acid reflux, thyroid problems, stroke, or asthma
  • Substances alcohol and nicotine
  • Travel, especially between time zones

What are the symptoms of insomnia?

These are common symptoms of insomnia:

  • Frustration and preoccupation with your lack of sleep
  • Physical aches and pains, such as headaches and stomachaches
  • Impaired performance at work
  • Daytime drowsiness or low energy
  • Difficulty paying attention
  • Anxiety
  • Tension and irritability
  • Depression and mood swings

How is insomnia diagnosed?

You may need to see a sleep medicine specialist to find out what's causing your insomnia. It will be helpful to bring a record of your sleep patterns.

The process of making a diagnosis may include:

  • Your medical history. Your doctor will consider any medical conditions, any medications you're taking, and stressful life changes that could be causing insomnia.
  • Your sleep history. Be prepared to describe your insomnia with details such as how long it's been going on, what you think could be contributing to it, and what your sleep is , such as whether you can barely get to sleep at all or if you wake up too early.
  • Physical exam. The doctor will look for any physical reasons that could be causing sleep problems.
  • Sleep study. You may need to sleep overnight in a sleep lab where researchers monitor your sleep.

Diagnosis of insomnia begins with a good medical history. The physician will seek to identify any medical or psychological illness that may be contributing to the patient’s insomnia, as well as screen for drug and alcohol use.

The patient may be asked about chronic snoring and recent weight gain, which may lead to the possibility of obstructive sleep apnea. In such cases the doctor may request an overnight sleep test, or polysomnogram, though sleep studies are not part of the routine initial workup for insomnia.

Patients may also be asked to keep a daily diary of their alertness

How is insomnia treated?

You have many options for treatment:

  • Medications to help you get to sleep and stay asleep
  • Change in existing medication if that's what's causing the problem
  • Counseling to help relieve stress and other issues bothering you
  • Change in lifestyle choices that may interfere with sleep
  • Insomnia generally resolves itself when the underlying medical or psychiatric cause is removed. Treating the symptoms of insomnia without addressing the main cause is rarely successful. Most people seek medical attention when their insomnia becomes chronic. Therapies include both nonpharmacologic and pharmacologic treatments. Studies have shown that combining medical and nonmedical treatments typically is more successful in treating insomnia than either one alone.

What are the complications of insomnia?

Insomnia can have serious complications. Poor sleep quality is linked to:

  • Increased risk for heart disease
  • Increased risk for stroke
  • Increased risk for diabetes
  • Excessive weight gain or obesity
  • Depression
  • Increased risk for injury to yourself or others, such as a car accident caused by driving while drowsy

Key points

Insomnia, the term for having trouble sleeping at night, is one of the most common sleep complaints. About 1 in 3 adults has bouts of insomnia that last a few days at a time. Women are more ly to have insomnia than men.

  • Insomnia has many possible causes. You may need to see a sleep medicine specialist to find out what's causing your insomnia.
  • Common symptoms of insomnia include impaired work performance, daytime drowsiness or low energy, difficulty: paying attention and others.
  • Diagnosis may involve a sleep study in which a sleep specialist monitors your sleep.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.


Insomnia: What You Need to Know as You Age

Insomnia: What You Need to Know as You Age | Johns Hopkins Medicine

While the rest of the world is sleeping, some people remain wide-awake due to insomnia. It’s the most common sleep-related problem, with about one-third of adults experiencing insomnia symptoms at any given time. Up to 10 percent have insomnia severe enough that it’s considered a full-fledged disorder.

Experts have different definitions of insomnia, says Johns Hopkins sleep expert Rachel Salas, M.D.

 But insomnia is generally characterized by trouble falling asleep or staying asleep, resulting in a lack of sleep that causes distress or difficulty with daily activities.

If it happens at least three nights a week and lasts for at least one month, you may have what sleep experts call persistent insomnia disorder.

The condition compromises more than your energy levels, so it’s worth recognizing the symptoms and getting help from your health care team. Not getting enough high-quality sleep can increase your risk of depression, weight gain and obesity, type 2 diabetes, high blood pressure, heart disease, and memory and concentration problems. It can even make you look older.


To help ensure that you can fall asleep when you want to—and stay asleep for the quality rest you need—make sleep a priority in your life.

Set aside time for sleep. Keep your cycle of sleeping and wakefulness steady throughout the week, including the weekends, recommends Salas. While most people need 7 to 9 hours of sleep at night, keeping a consistent cycle may be even more important than quantity, she says. Set a bedtime and a wake-up time for yourself, and stick to it.

Get your brain ready for sleep. You can’t make your brain fall asleep on command as if you were stepping on the brakes to stop your car, says Salas. Instead, your brain needs help shifting to sleep. Be sure to follow these recommendations:

  • Establish a presleep ritual before bed. For example, taking a shower and putting on sleepwear might signal your brain that you’re heading to bed.
  • In the evenings, avoid activities that can keep you awake,  drinking coffee, soda, or other caffeinated drinks; smoking; exercising; and eating heavy meals.
  • Give your brain time to unwind. If you need to pay bills or settle an argument, do it during the day, not at bedtime.
  • Avoid light in the late evening. Shut off your electronic devices at least 30 minutes before bedtime. Light keeps your brain primed for wakefulness.

Keep sleep problems from growing worse. Often when people start to have trouble sleeping, the steps they take to cope with their insomnia actually make the problem hang around longer, says Salas. If you have sleepless nights, avoid:

  • Napping during the day. Too much daytime sleep makes you less inclined to fall asleep at bedtime.
  • Drinking alcohol before bed. It may help you fall asleep at first, but it can keep you from sleeping well later in the night.
  • Worrying about your sleep loss. Dwelling on your inability to fall asleep can make it worse. 


If your insomnia is severe or chronic enough that it’s affecting your quality of life, it’s time to call a doctor. Your primary care provider may be able to treat your problem. However, a sleep-medicine specialist can ly dig deeper into the causes of your insomnia and offer more ways to resolve it.

“Many times my patients will come in with a report of poor sleep, but there are really several undiagnosed sleep disorders underlying that we can treat for them,” Salas says.

Your health care provider should talk to you about your sleep patterns. Be ready to discuss these issues (and perhaps track them in a sleep diary):

  • What time you go to bed and when you get up
  • How long it takes you to fall asleep
  • How deeply you think you sleep
  • How much of your time in bed you actually spend asleep (as opposed to getting up to use the bathroom or staring at the clock)

Your health care provider should ask about your daytime activities too:

  • Do you smoke or drink coffee? How often do you exercise? Do you take naps?
  • What’s going on in your bedroom besides sleeping? Your doctor may ask if you watch TV or run a small business from this room. If your spouse keeps irregular hours, or your dog sleeps—and barks—in your bedroom, mention it.
  • Is your life peaceful right now, or are you worried about your job, a family conflict or another stressful issue?

Your discussion should also cover your mental and physical health:


“A lot of people with insomnia are struggling through life, not realizing there is help available,” Salas says. Health care providers can offer many solutions to relieve insomnia. But you’ll have to help them do some detective work to discover why you aren’t sleeping well. You may also need to change the way you think about sleep, Salas says. Here’s how.

Change your approach to sleep. Your health care provider may suggest that you work with a psychologist who specializes in sleep problems, Salas says.

That’s because the way you think about your insomnia can make it worse.

If you spend too much time in bed worried that you can’t doze off, or you’re lying awake frustrated that you keep waking up, you’re going to start seeing your bed as a stressful place, which feeds the cycle.

A sleep psychologist, working with your sleep doctor, may recommend these approaches:

  • Relaxation techniques before bedtime, such as deep breathing.
  • Identifying your sleep-related worries and learning to set them aside.
  • Encouraging yourself to sleep while you’re in bed. You may need to get bed at a set time no matter how poorly you slept, go to bed at a set time even if you’re sleepy earlier in the evening, and avoid daytime naps. In addition, you may need to get bed and go to another room if you can’t fall asleep shortly after going to bed. This gets you the habit of lying in bed awake.
  • Giving your brain extra help with getting on the right sleep cycle.Exposing yourself to bright light during the day, keeping the lights dim during the evening, and taking the sleep hormone melatonin may be useful, Salas says.

Use medications wisely. “I think patients today are less interested in using medications to aid sleep than in the past,” Salas says. But if you want to pursue a medication to help you sleep, keep these tips in mind:

  • Even if you’re taking a medication, it’s still best to work with your doctor to make other lifestyle changes that will help you sleep better.
  • Most over-the-counter sleep aids contain antihistamines. One effect of these is drowsiness. They’re not a good choice for long-term use, as they can cause dizziness, memory problems, and daytime sleepiness.
  • A number of prescription sleep medications are available. They can have side effects, such as headaches and daytime sleepiness. They may also raise the risk of falls at night, especially in older people. In addition, some sleep aids, particularly older ones, can result in dependence. In general, these are intended for short-term use, not months or years. 

Learn more about the symptoms, diagnosis and treatment of insomnia in the Health Library.

Living With..

If you’ve been having trouble sleeping for a few weeks due to stress in your life, it’s ly to resolve once you get past the troubling event.

However, if you have a stubborn case of insomnia that’s been going on for years, you’ll need to put effort and commitment into resolving it, Salas says.

A sleep expert can help you learn the causes of your insomnia and recommend a plan to treat it. “But you still may need months to get to a better place,” she says.

“The good news is that the research shows you can get past insomnia with the help of your health care providers.”

Remember that insomnia can raise your risk of accidents, including car accidents. If you aren’t sleeping well, use care when driving or operating machinery. Since drugs for insomnia can also lead to daytime sleepiness, follow any warnings about engaging in these activities when taking them. 


Johns Hopkins experts continue their work in understanding and treating sleep disorders in ways that can translate into better health today. Notable research you can access includes these findings:

Calm legs don’t stop restless sleep. Restless legs syndrome can persist even when the nighttime urge to move the legs is treated successfully with medication. In a 2013 study, Salas’s colleague Richard Allen, Ph.D., found that elevated levels of glutamate—a brain chemical involved in arousal—may play a role.

Insomnia is not simply a nighttime condition. Salas and her team found differences in the part of the brain that controls movement (the motor cortex) in those with chronic insomnia compared to a group of good sleepers.

They also found more “excitability” among neurons in the same region of the brain among those with chronic insomnia, adding evidence to the notion that insomniacs are in a constant state of heightened information processing that may interfere with sleep. 

For Caregivers

If you’re providing caregiving, you’ll need to watch out for sleep issues in both your loved one and yourself, says Salas.

While sleep issues may increase as your loved one ages or experiences changes in health, you may also be at a higher risk of sleep problems due to stress or odd hours.

Caring for people with dementia may be especially challenging, since they often sleep poorly and may wander or make noise at night. Along with discussing any sleep concerns (about yourself or your loved one) with a health care provider, take these healthy steps.

Listen for your loved one. Sleep apnea is more common in older age. People with sleep apnea frequently stop breathing while they sleep, which causes them to wake up for a short time. This can happen many times at night, but the person with apnea may not remember it. If you hear symptoms of apnea, such as loud snoring and gasping, be sure to bring it to a doctor’s attention.

Moderate naps. It’s best for you and your loved one to get all 8 hours of sleep at one time. But if either of you must take a nap, set an alarm so no one sleeps more than 20 to 30 minutes.

Try a day program. Some research suggests that people with dementia who attend adult day centers have fewer behavioral problems and sleep better on the days they attend. Caregivers may experience less stress on those days as well, so the whole household sleeps better.

Reset rhythms. Is a loved one falling asleep too early and then unable to sleep through the night? Some older adults may actually benefit from a little bright light exposure in the evening—look for full-spectrum bulbs, which mimic natural daylight. Speak with a sleep specialist to initiate a plan using light, since exposure at the wrong times can worsen things.

Soothe into sleep. If your loved one has Alzheimer’s disease or another type of dementia, these steps can help:

  • Keep a consistent schedule in terms of bedtime, wake-up time and meals.
  • Encourage the person to be physically active during the day (but to avoid exercise in the evening).
  • Help your loved one avoid caffeine, nicotine and alcohol.
  • Remind your loved one to use the restroom before bed.
  • Provide some very low lighting in the evening—darkness can be upsetting to people with dementia.
  • Speak in a calm, soothing tone if your loved one wakes up at night. 


Dementia (di-men-sha): A loss of brain function that can be caused by a variety of disorders affecting the brain.

Symptoms include forgetfulness, impaired thinking and judgment, personality changes, agitation and loss of emotional control.

Alzheimer’s disease, Huntington’s disease and inadequate blood flow to the brain can all cause dementia. Most types of dementia are irreversible.

Restless legs syndrome (RLS): A disorder that creates a strong urge to move your legs often because you notice strange or unpleasant sensations: creeping, crawling, pulling, itching, tingling, burning, aching and even electric shocks. When you move your legs, it relieves the strange sensations. The unpleasant feelings are strongest when you are resting or inactive, and they can make it difficult to fall or stay asleep.

Sleep apnea (ap-ne-ah): A disorder in which your breathing repeatedly stops or becomes very shallow as you sleep. Your breathing may pause anywhere from a few seconds to a few minutes. This ongoing condition disrupts your sleep, making you tired during the day and increasing your risk for heart problems, diabetes, obesity and driving or work-related accidents.


Having trouble sleeping? It is not just because of aging

Insomnia: What You Need to Know as You Age | Johns Hopkins Medicine
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Many older adults have sleep problems that can be caused by aging. But other issues also contribute to the prevalence of sleep complaints, and they should be discussed and investigated, experts say.

A national poll conducted by the University of Michigan and released in October found that almost half of those 65 and older have trouble getting to sleep, and more than a third are taking prescription or over-the-counter sleep aids.

Older adults also have problems staying asleep, said Adam Spira, a sleep researcher at the Johns Hopkins Bloomberg School of Public Health. “Good sleep protects against negative outcomes, and those who sleep poorly are at higher risk of functional decline and depression,” he added.

The American College of Physicians (ACP) defines chronic insomnia as the presence of symptoms of distress and impairment that last for at least three nights a week for at least three months and are not linked to medical or mental problems or other sleep disorders, such as obstructive sleep apnea and restless legs syndrome.

The National Sleep Foundation says older adults need about the same amount of sleep as other adults — seven to eight hours a night.

Changes in sleep occur throughout a person's life, Spira said. In later years, there are decreases in total sleep time, increases in sleep fragmentation and decreases in deep sleep, he said.

Many people experience a circadian rhythm shift as they age, such that they awaken earlier in the morning and do not feel they are able to get enough sleep, said David N. Neubauer, a clinical faculty member in the Johns Hopkins Sleep Disorders Center.

Later in life, there also tend to be other factors that undermine good sleep quality, Neubauer said.

Older adults may have suffered personal losses or have worries about the future, he said.

As a group, older adults also have more health problems, which, along with the medications they take, can be major drivers of sleep problems, Spira said.

However, both older adults who are healthy and those with chronic medical conditions should use caution in taking over-the-counter and prescription sleeping aids, experts said.

Studies show that older people who take sleeping pills, also called sedative-hypnotics and tranquilizers, sleep only a little longer and a little better than those who don't take them, according to Choosing Wisely, an initiative of the American Board of Internal Medicine.

The ACP also says that over-the-counter drugs — diphenhydramine (Benadryl Allergy, Nytol, Sominex and generic), doxylamine (Unisom tablets and generic), Advil PM and Tylenol PM — carry risks for older adults. Next-day side effects include drowsiness, confusion, constipation, dry mouth and difficulty urinating.

Seniors are ly to be more sensitive than others to sedative-hypnotic drugs, which may remain in their bodies longer than in younger people's systems. These drugs are also known to cause confusion and memory problems that can increase the risk for auto accidents, falls and hip fractures.

The ACP recommends that medications, when used, be taken for only a short time (four to five weeks). The Food and Drug Administration advises that if insomnia doesn't go away within seven to 10 days of treatment with drugs, a patient should see a doctor for reevaluation.

Neubauer said prescription medications and over-the-counter drugs should be used only after any possible underlying problems are assessed.

Evaluations should include exploring behavior or schedule changes that might be conducive to sleep and making sure that a patient's use of sleep aids wouldn't pose serious risks for health problems or negative interactions with other medications.

Over-the-counter sleep medications, Neubauer said, are metabolized more slowly and tend to stay in an individual's system longer than prescription drugs.

Dietary supplements that are used as sleep aids and contain plant products, vitamins and minerals — for instance, valerian — appear to be generally safe, although there is little evidence that they work, Neubauer said.

Another common compound used in dietary supplements, melatonin — a naturally occurring hormone that is typically released in the evening and remains elevated until morning — does little to help people fall asleep quicker when taken at bedtime and is more ly to help people when taken a few hours before, studies suggest, Neubauer said.

Behavioral changes can also be effective in tackling sleep issues.

In 2016, the ACP recommended for the first time that cognitive behavioral therapy for insomnia (CBT-I) be the first-line treatment for adults with chronic insomnia.

The ACP's president stated that although there is not enough evidence to directly compare CBT-I and drug treatment, CBT-I is ly to be less harmful, while sleep medications can be associated with serious adverse effects.

CBT-I is a combination of treatments including cognitive therapy, behavioral interventions such as sleep restriction and stimulus control, and helping develop habits conducive to a good night's sleep.

Luis Buenaver, director of the Sleep Medicine Program at Johns Hopkins School of Medicine Department of Psychiatry and Behavioral Science, recommended that a bed be used only for sleep.

It is not for watching television or hanging out, he said.

People should not go to sleep if they are not tired, and people should try to wake up every day at the same time to train their circadian clock, Buenaver said.

The morning wake-up time is a critical period when the circadian system is sensitive to being reset, Neubauer said. “Getting up at about the same time each morning stabilizes our internal rhythm and makes it more ly that we will be able to fall asleep eight hours earlier” than that time, he said.

Because sleep difficulties can result from a multitude of problems, including physical and mental disorders, Neubauer said it's always good to check with a health professional when sleep problems persist.

“We need to emphasize that doctors and patients should begin to think of sleep as a major indicator of health, and doctors should recommend treatment and sleep clinics to patients who are having problems,” said Michael Smith, a professor of psychology and behavioral science at the Johns Hopkins School of Medicine.

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