The causes of insomnia in older adults can be divided into two main categories:

1. Normal Aging Changes in the Brain

As individuals enter their “golden years,” the brain deteriorates, much like other organs in the body. This aging process can impact sleep in the following ways:

• Nighttime sleep duration decreases.
• It takes longer to fall asleep once in bed at night.
• The duration of the light sleep phase (when semi-conscious) increases, while the deep sleep phase decreases or may be absent.
• Frequent awakenings during the night may occur.

Therefore, even if older adults are physically and mentally healthy, they may experience reduced sleep or difficulty sleeping. It is important to note that while these individuals may perceive themselves as having insomnia, they do not typically exhibit signs of daytime sleepiness.

2. Disease-Related Factors:

2.1 Caused by Current Medications

Some types of medication, particularly those affecting the central nervous system—such as those for seizures or Parkinson’s disease—can cause insomnia. Additionally, components in medications not directly related to the brain, such as alcohol or opium derivatives in cough syrup, can disrupt sleep. Furthermore, older adults who have used sedatives or sleeping medications for extended periods may experience bouts of insomnia.

2.2. Caused by Frequent Urination
Many older adults experience conditions such as diabetes, enlarged prostates (in men), or urinary incontinence. Some also take diuretics for hypertension or heart disease, which can lead to frequent urination during the night, thereby affecting sleep quality.

2.3 Pain
Pain and discomfort can indirectly affect sleep in older adults. These symptoms may stem from bone-related disorders and arthritis in the knees or neck, causing chronic pain. Additionally, gastrointestinal disorders such as indigestion, acid reflux, bloating, and constipation can also contribute to disrupted sleep.

2.4 Dementia and Depression
Older adults with dementia often experience disturbed sleep-wake cycles and may confuse day and night. Depression and anxiety can also impact sleep, causing patients to go to bed on time but wake up at 03:00 hours or 04:00 hours and be unable to return to sleep.

2.5 Other Factors
Sleep-related breathing disorders can affect an older adult’s sleep. Sometimes, when an elderly patient falls asleep, the part of the brain that controls breathing is suppressed, causing the patient to stop breathing for a short period. The brain then prompts the body to breathe again, which can lead to waking up and interrupting sleep. Additionally, during sleep, the tongue may obstruct the airway, resulting in snoring. Severe obstructions can prevent oxygen from entering the airway and lungs, triggering the brain to prompt breathing and potentially waking the patient.

Obstructive sleep apnea is common in men, overweight patients, and older adults. It can often be effectively treated with continuous positive airway pressure (CPAP). This therapy involves delivering a continuous flow of air through a mask worn over the nose during sleep, which helps keep the airway open.
 
Since there are numerous causes of insomnia, it is important to obtain the patient’s detailed medical history, including their sleep patterns. A thorough physical examination by a doctor is essential to accurately diagnose the underlying cause of insomnia specific to each patient.

• Avoid afternoon naps. If necessary, limit them to less than one hour and avoid napping after 15:00.
• Refrain from consuming alcohol or caffeinated drinks, such as coffee, especially in the evening.
• Avoid eating heavy meals before bedtime. Drinking milk or other warm beverages can promote better sleep.
• If you experience urinary problems, avoid excessive water intake four to five hours before bed. Take small sips of water as needed.
• Increase physical activity or exercise during the day, but avoid strenuous exercise within six hours before bedtime.
• Maintain a consistent schedule for meals, medications, housework, exercise, and bedtime to help regulate your biological clock.
• If you are not sleepy at bedtime or have trouble sleeping while in bed, get up and do something instead of staying in bed.
• Keep your bedroom quiet, peaceful, and at a comfortable temperature.
• Practice meditation to calm your mind.
• Avoid purchasing over-the-counter sleeping medications. Insomnia in older adults should be managed under the guidance of a doctor

• Healthline Media UK, Ltd. What to know about insomnia in the elderly. Available from: https://www.medicalnewstoday.com/articles/insomnia-in-the-elderly [Accessed 2 December 2024].
• WebMd. What to know about insomnia as you age. Available from: https://www.webmd.com/healthy-aging/insomnia-in-elderly [Accessed 2 December 2024].