I am not sleeping enough or am I?


Insomnia seems to be a common challenge among the elderly - is it a MYTH or a FACT?

What is insomnia?

Insomnia is defined as difficulty in falling asleep, staying asleep or having non-restorative sleep. The lack of sleep causes an inability of the person to function optimally. The problem with sleep has to occur 3 times per week for at least 1 month.[1] Sleep requirements do change throughout life, however insomnia is not a normal part of ageing.[2] In general, the elderly requires 7.5 to 9 hours to function at their best.[3]

Half of the elderly population above 60 years of age have problems with sleeping and it occurs in both men and women.[4,5] As one grows older, the sleep pattern variates due to hormonal changes in the body. There are also structural changes in the brain with ageing that alters the mechanism of sleep.[6]

An elderly person first notices sleeping issues when he or she realises that falling asleep does not come naturally. The sleep is described as broken and the total amount of time spent on really sleeping is reduced. The older person may spend a lot of time in bed but being awake. This leads to daytime sleepiness and napping.

There are many factors that could cause poor sleep. These include a sedentary lifestyle, a lack of exercise, over-consumption of alcohol and cigarette smoking. There are also medical disorders that could affect one’s sleep. Sleeping disorder such as obstructive sleep apnoea; arthritis of joints causing pain; prostate hyperthrophy leading to frequent night-time urination and many other factors could cause poor sleep. Psychological disorders such as stress, anxiety and depression may also contribute to poor sleep. [7,8]

Many are concerned that a lack of sleep will harm them. It is shown that inadequate sleep can cause detrimental effects such as decrease in concentration, which poses a risk to falls. They may also have chronic fatigue that may lead to a worsening of their physical and mental health. Therefore, many elderly would look for help for their sleeping problem. The main concern is the use of over the counter products that may be harmful.

There is no single intervention that could assist in problems with sleeping. However, there are few things that you could do before visiting the doctor.

Tips for better sleep

Antihistamines such as Chlorpheniramine, Hydoxyzine, Diphenhydramine should be avoided as they cause a “hangover effect”.

If you have tried all the above and still find sleeping an issue, do visit your doctor for help. When you visit your physician, you might be prescribed medical treatment. In addition, you may also request for non-medical treatment such as behavioural therapy that could work synergistically with the medical therapy.

For ANY pharmacological therapy prescribed, remember to use the LOWEST dose for the SHORTEST period possible.



  1. Edinger JD, Bonnet MH, Bootzin RR, Doghramji K, Dorsey CM, Espie CA, Jamieson AO, McCall WV, Morin CM, Stepanski EJ. Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group. Sleep 2004; Dec 15;27(8):1567-96.
  2. Mc Call WV. Sleep in the elderly: burden, diagnosis and treatment. Journal Clinical Psychiatry. 2004;6:9-20
  3. Kamel NS, Julie K, Gammack MD. Insomnia in the Elderly: Cause, Approach and Treatment. The American Journal of Medicine. 2006; 119: 463-469
  4. Subramaniam S, Surani S; Sleep disorders in the elderly. Geriatrics, 2007; 62:10-32
  5. Foley DJ, Monjan A, Simonsick EM et al; Incidence and remission of insomnia among elderly adults; an epidemiologic study of 6800 persons over 3 years. Sleep; 1999; 22(S2): S366-S372
  6. Lim ASP, Ellison BA, Wang JL, Yu L, Schneider JA, Buchman AS, Bennett DA, Saper CB; Brain:  Aug 2014
  7. Woodward MC. Managing Insomnia in the Elderly. Journal of Pharmacy Practice and Research. 2007; Volume 37, NO.3
  8. R. Galimi. Insomnia in the elderly: an update and future challenges. Gerontology; 2010: 58: 231-47

DR. ELIZABETH CHONG is a Geriatrician based at Kuala Lumpur General Hospital. Her interests are orthogeriatrics and community geriatrics.