Insomnia is very common in older adults — around half of people over 65 report sleep difficulties — but it is not an inevitable part of ageing. The most effective treatment is cognitive behavioural therapy for insomnia (CBT-I), recommended by NICE and the NHS ahead of sleeping tablets, alongside simple changes to routine and environment. Sleeping tablets carry particular risks in later life and should not be the main approach.
Why is insomnia more common in older adults?
If you find yourself lying awake at night, turning from side to side, or waking too early, you are not alone. Studies show that around 50% of people over 65 report difficulty sleeping. Our bodies change with the years, and so do our sleep patterns.
As we age, production of melatonin — the hormone that helps govern sleep — naturally declines. Sleep cycles shorten, and we wake more easily from noise, pain and changes in temperature. Treatment therefore has to be tailored to age and to individual circumstances.
What are the common causes of insomnia in later life?
Medications
Many medications common in later life can affect sleep quality — including treatments for blood pressure, diuretics and antidepressants.
Emotional state
Anxiety, depression, loneliness and bereavement can cause difficulty falling asleep and fragmented sleep.
Chronic pain
Arthritis, back pain and neuropathic pain are frequent causes of insomnia that need dedicated treatment.
Life changes
Retirement, moving home and changes in routine can unsettle the body clock.
Sleep apnoea
A common and sometimes undiagnosed condition that causes repeated waking and extreme daytime tiredness.
Needing to pass urine
Nocturia — needing to get up to urinate at night — interrupts sleep and makes it hard to drop off again.
Seven approaches to insomnia worth trying
The good news is that there are many effective ways to improve sleep. The preferred approach today is to begin with non-drug methods — they are safer, are not habit-forming, and help over the long term.
- Keep a regular sleep routine. Go to bed and get up at the same time every day, including weekends. The body clock likes order.
- Create a comfortable sleep environment. A cool, dark, quiet room is the foundation. Consider blackout curtains and earplugs if there is outside noise.
- Limit screens before bed. Blue light from phones and television suppresses melatonin. Switch screens off at least an hour before bed.
- Avoid long daytime naps. If you are tired, a short nap of up to 20 minutes is fine — but lengthy daytime sleep makes the night harder.
- Take moderate exercise. A daily walk, yoga or swimming improves sleep — just avoid strenuous activity late in the evening.
- Limit caffeine and alcohol. Caffeine can stay in the body for up to eight hours. Alcohol may help you drop off but fragments sleep later in the night.
- Use relaxation techniques. Deep breathing, guided meditation and progressive muscle relaxation have been shown to be very effective.
CBT-I — the gold-standard psychological treatment
Cognitive behavioural therapy for insomnia (CBT-I) is considered the most proven treatment for insomnia, and is preferred over sleeping tablets — it is recommended by NICE, the NHS and the American Academy of Sleep Medicine as the first-line treatment for chronic insomnia. It works by changing the thoughts and behaviour patterns that prevent sleep, usually over 6 to 8 sessions with a qualified therapist. Research shows that most people who complete CBT-I report a significant, lasting improvement — unlike sleeping tablets, which often lose their effectiveness over time.
Supplements and herbal remedies
Some people find benefit in supplements such as melatonin (at a low dose of 0.5–3 mg), magnesium, and herbs such as valerian or passionflower. It is important to discuss any supplement with your doctor first — especially because of possible interactions with other medications.
Please note — sleeping tablets in later life: benzodiazepines and similar “Z-drug” medications are not recommended for older adults. They increase the risk of falls, confusion, cognitive decline and accidents. If sleeping medication is used at all, it should be under a doctor’s guidance and for a short period only.
When should you see your GP?
If insomnia lasts more than a month, affects daily functioning, or comes with loud snoring and pauses in breathing, it is important to see your GP. It may be sleep apnoea, which needs assessment and dedicated treatment, often via a sleep clinic. Your GP can also check whether a medication you take is causing the sleep problem and suggest suitable alternatives.
Frequently asked questions
How many hours of sleep does an older adult need?
Most adults over 65 need 7–8 hours a night. Quality matters as much as quantity — deep, continuous sleep is better than long but broken sleep.
Is insomnia dangerous to health?
Chronic insufficient sleep in later life is linked to a higher risk of heart disease, diabetes, cognitive decline, falls and depression. Treating insomnia early is an important investment in overall health.
Is melatonin safe for older adults?
Low-dose melatonin is considered relatively safe and may help regulate the sleep cycle. Still, consult your doctor before use, especially if you take other medications.
Take a short insomnia self-assessment or book an online consultation with Dr Jonathan Kushnir, clinical psychologist (HCPC PYL042430).