Anxiety & Insomnia in Older Adults

It can feel like the chicken or the egg scenario: What came first — sleeplessness or anxiety? You may worry about not being able to fall asleep, but being awake in bed is also fueling your worry. 

About half of seniors in the United States have difficulty sleeping, and adding anxiety into the mix can make those sleeping problems worse. While sleeping patterns do change as you get older, the chronic exhaustion and racing thoughts you might experience are not a “normal” part of aging that you need to just deal with. Learn how anxiety and insomnia in the elderly relate, and steps you can take to sleep better and worry less. 

Key takeaways

• Sleep and anxiety issues often co-occur; one can cause the other, and each can make the other worse.
• Age-related changes in the body, as well as life transitions, can cause anxiety and sleep issues when there may not have been a concern before. 
• Therapy can help break the cycle of anxiety and insomnia by finding new coping strategies and changing behavior patterns. Over time, you can learn to sleep better and manage anxiety symptoms. 

The connection between anxiety and sleep in seniors

Anxiety and sleep have a bidirectional relationship, meaning each one can make the other worse. Being anxious can cause you to have trouble sleeping, and in turn, poor sleep can increase anxiety. 

When you’re anxious, your nervous system is on high alert, which can cause tense muscles and racing thoughts. This is known as hyperarousal, where your body can’t come down from that state of alertness to relax. 

While aging naturally causes you to have lighter sleep (and therefore, less deep, restorative sleep), anxiety can add a layer of emotional distress that can make falling back asleep more difficult. This can lead to insomnia, a sleep condition where you have trouble falling asleep or staying asleep. 

Insomnia on its own can be hard enough, but the combination of anxiety and insomnia can create a cycle that makes both conditions more intense and harder to manage. It’s not just staring at the ceiling; it’s staring at the ceiling with a racing heart or catastrophic thinking.

Why the anxiety/insomnia cycle hits harder in later life

Some of the life transitions that are common in the later years, such as retirement, loss of a spouse, or decreased mobility, can create a baseline low-level anxiety that often flares up at night. 

Anxiety and sleep issues in seniors don’t just have a psychological component. Changes in your brain and body can make you more likely to have nighttime anxiety. 

When you get older, your body naturally makes less melatonin, the hormone that controls your body’s 24-hour clock. You might notice you have more difficulty sleeping than you did in the past. 

Research shows the body also becomes increasingly more sensitive to cortisol (the stress hormone) as you age. This can make your body less resilient to stress as you get older. 

You or your loved one might notice you’re taking more medications in the retirement years as well. Some common medications come with potential side effects that can cause anxiety-related sleep problems, including:

• Diuretics (water pills) that can cause you to need to get up frequently to use the bathroom at night
• Some blood pressure medications, including beta blockers, that decrease melatonin levels 
• Thyroid medications like levothyroxine have side effects like jitters and a racing heart, which can mimic anxiety 

Breaking the cycle: Lifestyle and behavioral shifts

There are several things you can try at home to help you or an older loved one break the sleep/anxiety cycle. Here are some ideas.

Use your bed only for sleep

According to the American Psychological Association, spending a lot of time in bed trying to sleep can have the opposite effect of feeling sleepy. You can find yourself tossing and turning, and yes, becoming increasingly anxious about it all. 

One way to help you sleep better with less anxiety is known as stimulus control. Use your bed only for sleeping, and avoid using it for other activities such as reading or watching TV. The goal is to train your brain that your bed is only used for sleep, and when you’re in it, it’s time for sleep. 

Refrain from a nightcap

Despite what the movies and books say, a nightcap — also known as an alcoholic beverage — isn’t going to help you sleep. In fact, it can even cause your sleep issues and anxiety to worsen. 

It’s true that alcohol initially makes you drowsy, but research shows it can cause increased anxiety and wakefulness later. Instead of alcohol, reach for a soothing cup of warm milk or decaf tea. 

Decrease the pressure to sleep

Much of the advice surrounding sleep troubles related to anxiety is to tell the person to “just relax.” If you’ve ever tried to follow that advice and then find yourself even more tense and anxious, you’re not alone. 

Research says you can flip the script, known as “paradoxical intention.” Trying to get to sleep can feel like a form of performance anxiety — the more you try to sleep, the more you can’t. Give yourself permission to stay awake as late as you need to, which reduces the pressure that’s fueling the anxiety. 

Create a peaceful bedtime routine

Having healthy sleep habits, known as sleep hygiene, is more than being screen-free at night, although that’s important too. 

Good sleep hygiene encourages restful sleep, which is a useful strategy that creates a safety signal for your brain. Using a soft heavy blanket, turning on some white noise, and creating a very specific bedtime routine can signal to your body that you’re safe and you can sleep. Try a warm bath or shower, dim the lights, and spend some time listening to relaxing music or reading. 

How therapy can help with anxiety and sleeplessness

If you’ve been trying strategies on your own but they aren’t helping you sleep better, or you’re still feeling anxious, it might be helpful to look into therapy. 

Cognitive behavioral therapy for insomnia (CBT-I) is an effective, well-researched form of therapy that focuses on the stress and anxiety either caused by, or as a result of, sleep concerns. The idea is that through therapy, you learn new ways of coping with anxiety and changing patterns of thoughts or behaviors around sleep and anxiety.

Talk therapy in general with a licensed therapist or social worker can be useful to talk about your anxiety symptoms and learn new ways of coping with stress. Therapy isn’t just about digging up past hurts, but about learning practical tools to de-escalate the nervous system in real time. 

Therapy, including CBT-I, can help treat the root cause — anxiety — rather than just the symptom, which is poor sleep. 

Sailor Health therapists provide CBT-I and other mental health care services to older adults. All of our providers accept Medicare, and most of our patients have a $0 copay. We make therapy more accessible by offering sessions via computer, smartphone, or landline, so you can speak with your therapist from the comfort of your home. Get started today - we’ll help match you with an experienced therapist who understands what you’re going through, and you could begin treatment as little as 24 hours later.

Anxiety & Insomnia FAQ

Can anxiety medication help with sleep problems in the elderly?

Yes, anxiety medications can help with sleep problems in older adults, but they do come with risks such as falls, confusion, and becoming dependent on the medication. Oftentimes, healthcare providers offer non-medication options first, such as therapy and lifestyle changes.  

Is it normal for older adults to wake up with a racing heart?

No, it’s not normal for older adults to wake up with a racing heart, but it can happen if you have anxiety. Medication side effects and normal age-related hormone changes can also cause you to feel like your heart is racing at bedtime. 

How does sleep apnea relate to anxiety symptoms?

Many people who have sleep apnea also have anxiety. Sleep apnea is a health condition where you have many pauses in breathing throughout the night. Anxiety can make sleep apnea worse by making it harder to fall asleep, and sleep apnea can also cause symptoms of anxiety. 

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