How to Go From Wide Awake to Sweet Dreams

        Graphical abstract

        Caring for the Ages editor-in-chief Karl Steinberg, MD, CMD, HMDC, talks about insomnia — how to prevent it and how to address it.
        It’s happened to most of us at one time or another. You go to bed, and instead of falling asleep, you toss and turn. You can’t shut off your mind or relax, and you lie awake. Insomnia isn’t uncommon, especially as a person ages, but it isn’t a normal part of aging. In fact, lack of sleep can contribute to problems with memory, daytime sleepiness, fatigue, depression, and falls.
        There are many possible causes of insomnia, including:
        • Stress and anxiety, including losses such as a move, the death of a loved one, concerns about medical illness, or other major life changes.
        • Poor sleep hygiene, including napping during the day, falling asleep with the TV on, or going to bed and getting up at different times every day.
        • Stimulant intake, ranging from teas and coffees to chocolates or high-sugar candies, energy drinks, and sodas.
        • Drinking, eating, or exercising too close to bedtime.
        • Drinking alcohol, including a glass or two of wine or a cocktail to help fall asleep which can prevent deep, or REM, sleep.
        • Medications, including antidepressants, antihypertensives, Parkinson’s disease treatments, sedatives/hypnotics, and diuretics. (Make sure your practitioner knows about all the drugs — prescription and over-the-counter — that you or your loved one is taking, and consider their effects on sleep.)
        • Physical problems, such as pain, frequent urination, or restless leg syndrome.
        • Neurodegenerative disorders, such as Alzheimer’s disease or other dementias or Parkinson’s disease.
        Don’t try to self-treat insomnia with over-the-counter sleep aids. Many of these are particularly bad for older people. Instead, talk to your practitioner, who will get a complete sleep history, do what it takes to identify the cause of the insomnia, and then suggest treatments — with a goal of improving sleep time and quality and reducing insomnia-related daytime problems. Your practitioner may be able to identify nondrug treatments, such as improving your sleep environment (for example, by reducing light and noise or changing the room temperature), increasing your daytime physical activity, or making behavioral changes (such as reducing your caffeine, sugar, or alcohol intake).
        If the diagnosis suggests that medication is needed to address insomnia, the practitioner will choose the best agent, taking into account other medications that you or your loved one are taking, illnesses and health conditions, and other factors. The medication will be prescribed at the lowest dose, for the shortest amount of time possible. If you or your loved one gets a prescription for medication to treat insomnia, be sure to take it as directed. If you experience any side effects, talk to your practitioner right away.
        You don’t have to face insomnia alone. Talk to your practitioner and learn how you can sleep well and enjoy sweet dreams.

        Questions to Ask Your Practitioner

        • How do I know if my loved one or I have insomnia versus just having a bad week or something?
        • What is wrong with just taking over-the-counter sleep aids, drinking herbal teas, or something else?
        • What lifestyle changes should my loved one or I make to help improve sleep?
        • Is it necessary to wake my loved one or me up at night for blood pressure checks or repositioning?
        • Can insomnia be cured?

        What You Can Do

        • Avoid naps during the day.
        • Try to go to bed and get up at similar times every day.
        • Try to exercise regularly, preferably early in the day.
        • Avoid coffee or other caffeinated beverages, especially late in the day, during the evening, and especially before bedtime.
        • Try to make the room as quiet and dark as possible when you are ready to sleep. Try to use your bedroom only for sleeping and spend your waking hours elsewhere when possible.

        For More Information

        • Choosing Wisely and Consumer Reports, “Insomnia and Anxiety in Older People,”
        • National Sleep Foundation, “Insomnia & Older Adults,”
        • Greta M. Pelegrin, PharmD, “Insomnia: An Overview of Sleep Disorders in the Geriatrics Patient,” Pharmacy Times, Oct. 1, 2004,