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Poor sleep can lead to long-term health problems for older adults, UTSW specialists say

It's a common misconception that older adults need less sleep than those younger, but many get fewer hours due to insomnia and various health problems, including sleep apnea and heart trouble.

In addition to a reduced quality of life, long-term health consequences of poor sleep include high blood pressure, weight gain, stroke, heart attack, diabetes, memory problems, and even increased risk of death, said Deborah Freeland, M.D., Assistant Professor of Internal Medicine and a member of UTSW's Division of Geriatric Medicine.

Dr. Freeland and Lessley Chiriboga, M.D., M.P.H., Assistant Professor of Psychiatry in UTSW's Peter O'Donnell Jr. Brain Institute, said it's vital to identify the source of insomnia and other health problems so the best treatments can be started.

"Make a concerted effort to understand your sleep needs, what may be limiting them, and work with members of your medical team," said Dr. Chiriboga, who specializes in geriatrics. "They may recommend tests or referrals to other specialists to determine what is causing your sleep quality to diminish."

Medical causes of insomnia can include obstructive sleep apnea, restless leg syndrome, joint pain, chronic heart or lung diseases, reflux, or nighttime urination, all of which can be treated. Medications can disrupt sleep and should be modified if needed. Alcohol use also causes problematic sleep with early awakenings and less deep sleep. 

According to the American Psychological Association, about half of older adults deal with insomnia, which can cause fatigue, confusion, tension, and mood changes like anxiety and depression. Production of melatonin, a hormone the brain produces in response to darkness to encourage sleep, slows as we age. Sleep deficits also can lead to the risk of falls for the elderly. 

Dr. Freeland said older patients having trouble sleeping should be careful while using prescription sleep aids, which she said are not meant for long-term use.

"Many of them contain diphenhydramine, a common medication used for allergic reactions, and these should be avoided," she said. "This medication can have many problematic side effects including lasting confusion, falls, memory issues, constipation, and dry mouth. It's better to address behavioral changes, underlying medical issues, and medication side effects than use medications for sleep."

Melatonin, which can be purchased over the counter, is safe for long-term use as a sleep aid, Dr. Freeland said. She also said Cognitive Behavioral Therapy-Insomnia (CBT-I), which is performed by psychologists, is one of the best ways to treat insomnia without medications.

Both doctors offered several tips for building beneficial nighttime sleep habits: 

  • Follow a regular schedule of going to bed and waking.
  • Avoid naps, especially in the late afternoon and evening.
  • Use your bed only for sleeping.
  • Limit food and liquid intake during the hours before going to bed, avoiding caffeine, alcohol, and smoking.
  • Get regular exercise, but not just before bedtime.
  • Enjoy a warm bath or calming activities like reading or listening to soothing music before bed.
  • Avoid bright lights before bed, including televisions, cellphones, computers, and other devices.

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