Insomnia

Medical & mental health

• Pain (arthritis, neuropathy), breathlessness (COPD/CHF), reflux
• Depression, anxiety, grief, loneliness
• Thyroid issues, nocturia (BPH/overactive bladder)
• Sleep apnea, restless legs, periodic limb movements

Lifestyle & environment

• Late caffeine, alcohol at night, heavy evening meals
• Irregular sleep schedule, long daytime naps
• Noise, light, room temperature, uncomfortable bedding
• Screen time in the hour before bed

Timing rules

• Fixed wake-up time daily (set an alarm—even on weekends)
• Bedtime only when sleepy; if awake >20 minutes, get up to a dim-light calm activity, then return to bed when sleepy
• Naps: keep to ≤20–30 minutes and before 2 pm

Evening habits

• Stop caffeine after mid-afternoon; limit alcohol (disrupts sleep later)
• Light snack if hungry; avoid large or spicy meals within 3 hours of bed
• Screen “sunset”: dim lights and screens 60 minutes before bed

Bedroom environment

• Cool, dark, quiet room; consider eye mask/earplugs/white-noise
• Comfortable mattress/pillows; clear paths and nightlights for safety
• Use the bed only for sleep and intimacy (no TV or phone scrolling)

Light & movement

• Morning daylight for 15–30 minutes anchors the body clock
• Daily activity: a walk after breakfast or lunch helps nighttime sleep

Fluids & bathroom

• Hydrate earlier; taper fluids 2–3 hours before bed
• Limit evening caffeine and diuretics; review bladder meds with your clinician

What it is

Structured program (usually 4–8 weeks) that uses stimulus control, sleep restriction, relaxation, and cognitive skills to retrain sleep.

Why it’s first-line

• Works as well as or better than medicines—benefits last
• Safe for older adults; no morning grogginess or falls from sedation

Often preferred (discuss with your clinician)

• Doxepin (low-dose) for sleep maintenance
• Melatonin 1–3 mg 1–2 hours before bed for timing issues
• Ramelteon (melatonin-receptor agonist)

Use with caution or avoid

• Benzodiazepines and “Z-drugs” (falls, confusion, dependence)
• Diphenhydramine/“PM” products (anticholinergic side effects)
• Alcohol to sleep—fragments sleep and raises fall risk

Sleep disorders

• Obstructive sleep apnea (snoring, pauses, waking gasping)
• Restless legs/limb movements (urge to move, evening worse)
• REM behavior disorder (acting out dreams)

Medical triggers

• Thyroid imbalance, pain, reflux, COPD/CHF
• Nocturia from BPH/overactive bladder; diuretic timing
• Medicines: steroids, stimulants, late-day caffeine, decongestants

30–60 minutes before bed

• Dim lights → warm shower → gentle stretches → breathing 4-6
• Write tomorrow’s to-dos to quiet mental chatter
• Set phone on Do Not Disturb; charge outside the bedroom if possible

Bed safety

• Nightlights along the path to the bathroom
• Clear floors; supportive shoes if you rise at night
• Keep water and glasses within reach to avoid searching in the dark

How much sleep do older adults need?

Most do well with 7–8 hours. Quality and consistency matter more than exact number.

Is melatonin safe?

Often well-tolerated at low doses (1–3 mg). Higher doses can cause grogginess—start low and review with your clinician.

Why do I wake at 3 am?

Common with early bedtimes, stress, pain, reflux, or sleep apnea. Use the 20-minute rule: quiet activity in dim light until sleepy again.

When to see a sleep specialist?

Snoring with pauses, acting out dreams, persistent insomnia despite CBT-I, or if medicines are needed beyond short-term.