Sleep in older people: what changes, what helps, and when to see the GP

The sleeping problems guide from Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust explains that sleep in older people tends to be lighter, with more frequent waking, and that for a typical 70-year-old deep sleep is less than a tenth of the night. It says this is normal and nothing to worry about. The pattern moves too: it becomes more likely that somebody goes to bed sooner, wakes earlier, or drops off during the day. The guide sums it up as sleep that is shorter and more easily disturbed, but that should still be refreshing.

The NICE summary for GPs on normal sleep patterns says the number of times somebody wakes goes up with age and total sleep goes down. It adds that this may be part of ageing, but may also come from other health conditions, from taking several medicines, or from changes in lifestyle. A parent who sleeps a little less and wakes a little earlier, but gets through the day well, is probably getting the sleep they need. A parent who is exhausted, falling asleep over lunch or suddenly muddled needs someone to look for the reason. The elderly care guide covers the wider changes of later life.

Other conditions matter too. The NICE summary on the causes of insomnia lists COPD, heart disease, stroke, Parkinson's disease, diabetes, long-term pain and tinnitus among the conditions that commonly come with poor sleep. If your parent lives with one of these, arthritis and care at home and the other guides in the health conditions section explain the help available. For low mood, the NHS sets out the symptoms of depression, and mental health in later life covers how to raise it and where support comes from, and helping someone who is lonely covers the long, empty days that can end in a doze in the chair.

The NHS pages on restless legs syndrome and sleep apnoea are worth reading if either sounds familiar. The sleep apnoea page says it can be hard for somebody to tell they have it, and that a person who has seen the symptoms can help by going to the GP with them.

The habits on the clock come from the NHS page on insomnia, the Every Mind Matters page on how to fall asleep faster and sleep better, and the NICE guidance for GPs on sleep habits. Common to all of them is a regular getting-up time, the same every day, including after a bad night. The NICE guidance pairs it with more bright light in the morning.

The bedroom counts as well. The NHS says a room that is too hot or too cold, noise and an uncomfortable bed can all cause poor sleep, and Every Mind Matters suggests a room that is quiet, dark and cool. For an older person, dark has a limit: the way to the toilet needs a low light that can stay on. Tea, coffee and cola all contain caffeine, and NICE advises none after midday. It also advises no alcohol or large meals in the two hours before bed. Age UK has its own advice on sleeping better in later life.

Being active helps too. The NHS advises regular exercise, and NICE adds that vigorous exercise is best kept away from the hour before bed. For an older person that might be a walk, time in the garden or a trip to the shops, and exercise for older people has ideas pitched at different abilities. Cutting back on drinks in the evening should not mean drinking less overall. The NHS lists not eating and drinking enough as something that can make people feel lightheaded or faint, and elderly hydration explains how to keep drinks going through the day.

The NICE summary on managing insomnia advises GPs not to prescribe sleeping tablets (hypnotics) to older people. Its notes on the z-drugs, the group that includes zopiclone and zolpidem, say to avoid them in older people if possible because of a greater risk of side effects, including falls and fractures. Among the listed side effects are confusion, dizziness, drowsiness that carries into the next day, and unsteadiness and falls, particularly in older people.

This matters most at night. A person who wakes drowsy from a tablet and walks to the toilet in the dark is at more risk of falling. The NHS page on falls lists the side effects of some medicines as a cause and suggests asking a GP or pharmacist if you think a medicine is affecting your parent's balance.

If your parent already takes a sleeping tablet, do not stop it suddenly. The NHS page on zopiclone says stopping suddenly can cause withdrawal symptoms, and that the doctor will reduce the dose gradually. Ask the GP for a review instead. NICE also mentions a prolonged-release melatonin that GPs may consider for people over 55 with persistent insomnia, for a limited time. That is a decision for the GP. Medicines in later life covers medicine reviews more generally.

1. 1

   Bring the sleep diary

   Two weeks

   Bedtimes, waking times, naps, drinks and how rested your parent felt. It turns a general worry into a pattern the GP can use.
2. 2

   List every medicine

   Including shop-bought

   Prescriptions, painkillers, sleep aids from the pharmacy and supplements, with the times they are taken. NICE asks GPs to look at medicines as a possible cause.
3. 3

   Say what you have seen at night

   You may be the witness

   Snoring and pauses, restless legs, trips to the toilet, pain, confusion or wandering. NICE says an account from a family member can help the GP.
4. 4

   Ask what happens next

   Treatment or referral

   The GP may treat a cause such as pain, low mood or the bladder, offer CBT for insomnia, or refer to a sleep clinic if another sleep disorder is suspected.

Go sooner for anything in the right-hand column of the first table, particularly signs of sleep apnoea, low mood, or being up many times in the night to pass urine. The NHS page on an enlarged prostate lists getting up to pee during the night as a symptom and says to see a GP about difficulty peeing or needing to pee more often. For sleep apnoea, the NHS says the GP may refer your parent to a sleep clinic, where tests are often done at home overnight.

If your parent feels that poor sleep is just age and does not want to go, how to get someone to accept care has ideas for the conversation. The NHS trust guide lists the National Sleep Helpline, run by The Sleep Charity, among organisations that can help.

The trip from bed to toilet is made half awake, in the dark, perhaps drowsy from a medicine, so it needs to be safe. Night care for falls and toilet trips goes through making that route safe, item by item. Pendant alarms and sensors explains what the equipment does and where it stops, and managing incontinence covers pads, bottles and commodes. The NHS says anybody worried about falls can ask the council for a free care needs assessment, which can include changes to make the home safer.

A carer at night makes sense when the equipment is no longer enough: your parent is getting up unsteady several times a night, has fallen, is confused and wandering, or is frightened on their own. A sleeping night suits someone who is up a few times. A waking night suits somebody who is up most of the night or needs care through it. Waking night or sleeping night helps you choose, and overnight care explains how nights are arranged and what a carer does. If you are the one getting up every night, sleep deprivation and the case for a night carer looks at what that does to a family carer.

If your parent is up and unsafe at night, you can search for carers near you and compare their sleep-in and waking night rates. Every carer has had their identity and right to work checked, holds an enhanced DBS check (or PVG in Scotland, Access NI in Northern Ireland) issued within the last 18 months, and has been interviewed online. Every visit booked through PrimeCarers is insured, by the carer's own policy or by cover PrimeCarers arranges where they do not hold one. We do not check qualifications, training or references, so anything a carer says about experience with night care is their own account on their profile, for you to ask about. PrimeCarers is an introductory service, not an agency or a care provider. Carers are self-employed, and you agree the nights and the rate with them directly.