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Insomnia causes and risk factors

Key points

  • Insomnia is caused by a mix of predisposing factors (age, gender), precipitating factors (stress, illness, medications), and perpetuating factors (poor sleep habits, worrying about sleep).
  • Common risk factors include being over 60, being female, having mental health conditions (anxiety, depression), chronic pain, sleep apnea, restless legs syndrome, and certain medications.
  • Lifestyle factors like caffeine, nicotine, alcohol, irregular sleep schedules, and screen time before bed are major triggers that you can change.
  • For people with dementia, sleep problems are very common and often linked to damage to the brain's internal clock — focus on routine, light exposure, and managing sundowning.
  • Always rule out underlying medical causes (like sleep apnea, UTI, or medication side effects) before assuming insomnia is 'just part of aging' or dementia.
  • A sleep diary is a simple, powerful tool to share with your doctor — it turns vague complaints into clear data.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Start a sleep diary for one week: each morning, note bed time, time to fall asleep, number of night awakenings, daytime naps, caffeine, and exercise.

  2. Check for untreated conditions that worsen insomnia: sleep apnea, restless legs syndrome, chronic pain, heart failure, or urinary tract infection. If new or worsening, schedule a doctor visit.

  3. Review all medications (including OTC) with a pharmacist or doctor for insomnia as a side effect. Ask: 'Could any of these be contributing to sleep problems?'

  4. Create a consistent wind-down routine starting 60–90 minutes before bed: dim lights, no screens, calm activity (soft music, reading, gentle stretching).

  5. Limit caffeine to before 2 p.m.; avoid nicotine and alcohol in the evening.

  6. Keep the bedroom cool (around 65°F), dark (blackout curtains or eye mask), quiet (fan or white noise machine), and remove visible clocks.

  7. Encourage morning natural light exposure: open curtains, go for a short walk, or sit by a window.

  8. For dementia, watch for sundowning (increased confusion, agitation in late afternoon). Keep home well-lit evenings, maintain routine, avoid overstimulation after dinner.

What not to do

  • Don't assume persistent insomnia is normal aging; evaluate if it lasts more than a month.

  • Don't try to 'catch up' on sleep with long daytime naps or extra hours in bed—keep naps under 30 minutes if needed.

  • Don't give OTC sleep aids (e.g., diphenhydramine) without checking with a doctor—they can increase confusion and fall risk in dementia.

Practical tools

  • Sleep Diary Template

    A log to track bedtime, wake time, night awakenings, naps, caffeine, alcohol, and medications. Use for one week before a doctor visit to show sleep patterns.

  • White Noise Machine or Fan

    Produces steady sound to mask sudden noises; place away from bed at low volume. Useful for dementia patients sensitive to environmental sounds.

  • Blackout Curtains

    Block outside light for sleep environment. Also use in living area late afternoon to reduce sundowning triggers; pair with a hallway nightlight to prevent falls.

  • Medication Review Card

    Lists all medications plus question: 'Could any cause or worsen insomnia?' Bring to every doctor visit. Ask about SSRIs, bupropion, steroids, beta blockers, diuretics, decongestants.

Discuss with your clinician

If your loved one snores loudly, gasps for air, or has morning headaches — ask about a sleep study for sleep apnea. Untreated sleep apnea can worsen dementia and increase fall risk.

If insomnia lasts more than 30 days despite good sleep habits — ask for a thorough evaluation to check for underlying medical, neurological, or psychiatric conditions.

If your loved one is taking any sleep medications (prescription or over-the-counter) — ask the doctor or pharmacist whether they are still needed, if the dose is appropriate, and if there are safer alternatives. Long-term use of some sleep aids has been linked to increased dementia risk.

If your loved one has restless legs syndrome or acts out dreams (kicking, thrashing, yelling) — ask a neurologist about specific treatments, as these conditions often need different approaches than general insomnia.

If your loved one has dementia and you notice sudden worsening of sleep or confusion — ask about a urinary tract infection (UTI), which can cause dramatic sleep disruption and is easily treatable.

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