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Understanding Insomnia: What It Is and How to Spot the Signs in Your Loved One

Insomnia is a common sleep disorder that makes it hard for your loved one to fall asleep, stay asleep, or get back to sleep after waking up too early. It can leave them feeling tired, irritable, and confused during the day, and it often drains your energy as a caregiver too. The good news is that once you know what to look for, there are concrete, gentle steps you can take to help improve their sleep and your own peace of mind.

Key points

  • Insomnia means trouble falling asleep, staying asleep, or waking too early and not being able to get back to sleep, leading to daytime tiredness and confusion.
  • Common causes include stress, medical conditions (like heart failure, arthritis, Parkinson's, Alzheimer's), sleep disorders (sleep apnea, restless legs), and lifestyle factors (caffeine, alcohol, nicotine).
  • Keep a sleep diary for one to two weeks to identify patterns and share with the doctor.
  • Create a consistent, calming bedtime routine and a sleep-friendly environment (cool, dark, quiet).
  • Do not ignore loud snoring or acting out dreams — these may be signs of sleep apnea or REM sleep behavior disorder.
  • Always talk to a doctor before using sleep aids, and consider non-drug approaches like CBT-I, which is very effective.

What Is Insomnia?

Insomnia is broadly defined as dissatisfaction with sleep. It is a sleep disorder that can make it hard to fall asleep, stay asleep, or cause you to wake up too early and not be able to get back to sleep. Most adults need 7 to 9 hours of sleep a night, but insomnia can drain energy, affect mood, and impact health, work performance, and quality of life. At some point, many adults experience short-term insomnia lasting days or weeks, often due to stress or a distressing event. However, some people have long-term insomnia that persists for months or longer. Insomnia is the most common sleep disorder, with about one-third of adults reporting some insomnia symptoms, and 10 to 15% reporting problems with daytime functioning.

Why Does Insomnia Happen?

Insomnia can be triggered by many things, especially in older adults and those with dementia. Common causes include stress, anxiety, depression, chronic pain, and medical conditions like heart failure, arthritis, Parkinson's disease, and Alzheimer's disease. Sleep-related disorders like sleep apnea (which causes breathing to stop during sleep) and restless legs syndrome (which causes an uncomfortable urge to move the legs) can also disrupt sleep. Lifestyle factors play a big role too: caffeine, nicotine, and alcohol can all interfere with sleep. Caffeine and nicotine are stimulants that keep you awake, while alcohol may help you fall asleep but prevents deeper stages of sleep and often causes waking up in the middle of the night. As we age, we are more likely to develop these conditions and take medications that can further disrupt sleep. For people with dementia, sleep disturbances are very common and can worsen dementia symptoms.

What Are the Symptoms of Insomnia?

The key symptoms of insomnia include difficulty falling asleep, difficulty staying asleep, waking up too early and not being able to get back to sleep, and waking up feeling tired or unrefreshed. These sleep difficulties must occur at least three nights a week for at least three months to be diagnosed as chronic insomnia disorder. Insomnia can be short-term (acute, lasting less than 30 days) or long-term (chronic, lasting 30 days or longer). In people with dementia, sleep disturbances can also look like sleeping too much (up to 16 hours a day) in early and middle stages, or acting out dreams (yelling, screaming, or moving) especially in Lewy body dementia. Sleep deprivation from insomnia can lead to increased confusion, safety concerns for both the person with dementia and the caregiver, and worsening of dementia symptoms.

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 to two weeks. Write down bedtime, time to fall asleep, number of night wakings, wake time, and daytime mood (e.g., tired, irritable, confused). This reveals patterns to share with the doctor.

  2. Create a consistent bedtime routine: same time each evening, dim lights, play soft music, offer a warm non-caffeinated drink, and read a short story. This signals the brain to wind down.

  3. Make the bedroom cool, dark, and quiet. Use blackout curtains and a white noise machine. Remove TVs, computers, and phones from the room.

  4. Encourage exposure to natural light in the morning. Open curtains, go for a short walk, or sit near a window. This regulates the body's internal clock.

  5. Build in gentle daytime activity, such as a short walk or light stretching. Avoid vigorous activity within three to four hours of bedtime.

  6. Limit caffeine and nicotine after 2 p.m. Avoid coffee, tea, cola, or chocolate in the afternoon and evening.

  7. If your loved one snores loudly or gasps during sleep, discuss sleep apnea with a healthcare professional.

  8. If restless legs syndrome is present, try gentle leg massages or a warm bath before bed. Avoid caffeine and alcohol. Discuss treatment options with the doctor.

  9. For Lewy body dementia or Parkinson's disease, report acting out dreams (kicking, punching, yelling during sleep) to the doctor. This may indicate REM sleep behavior disorder.

  10. Review all medications with the primary care provider. Some cause daytime sleepiness or disrupt nighttime sleep. A risk-benefit discussion can adjust timing or switch medications.

  11. Seek professional help if sleep problems persist for weeks or interfere with daytime function. Cognitive behavioral therapy for insomnia is effective and evidence-based. A sleep study may be considered if sleep apnea is suspected.

What not to do

  • Do not give alcohol to help sleep. It prevents deeper sleep stages and often causes middle-of-the-night waking.

  • Do not allow long daytime naps, especially in late afternoon. Keep naps short (20–30 minutes) and early in the day.

  • Do not assume excessive daytime sleep (up to 16 hours) in early or middle dementia stages is normal. It may signal a treatable sleep disturbance.

  • Do not use over-the-counter sleep aids without consulting a doctor. Antihistamines can cause confusion and falls in older adults with dementia.

  • Do not force your loved one to stay in bed if wide awake and agitated. This creates negative sleep associations. Get up, do a quiet activity in dim light, and try again after 20–30 minutes.

  • Avoid arguments or emotionally charged conversations in the hour before bed. Discuss difficult matters earlier in the day.

Practical tools

  • Sleep Diary Template

    Create a chart with columns: Date, Bedtime, Time to fall asleep, Number of night wakings, Wake time, Morning mood (rested/tired), Daytime naps (length and time). Fill out each morning and evening for one to two weeks.

  • White Noise Machine or App

    Use a white noise machine or free app to play gentle sounds (rain, ocean waves, fan). Place near the bed at a moderate volume to mask outside noises.

  • Blackout Curtains

    Install blackout curtains or cover the window with a dark sheet to block early morning light and streetlights. Darkness helps maintain sleep.

  • Wind-Down Hour Schedule

    Sample 90-minute pre-bed timeline: 90 min before bed, finish dinner; 60 min, dim lights and turn off screens; 45 min, warm drink and gentle conversation; 30 min, warm bath and pajamas; 15 min, quiet reading or music; 0 min, lights out. Keep the sequence consistent nightly.

  • Doctor Discussion Checklist

    Before an appointment, prepare: sleep diary data, notes on loud snoring or gasping, any acting out dreams, current medication list, and daytime sleepiness observations.

Discuss with your clinician

If your loved one snores loudly, gasps, or makes choking noises during sleep, ask the doctor about a sleep study for sleep apnea.

If they have an uncomfortable urge to move their legs at night, ask about restless legs syndrome and whether iron supplements or other treatments might help.

If they act out dreams (kicking, punching, yelling), ask about REM sleep behavior disorder, especially if they have Parkinson's or Lewy body dementia.

If they are on multiple medications, ask the doctor or pharmacist to review them for any that might cause daytime sleepiness or disrupt nighttime sleep.

Before using any over-the-counter or prescription sleep aids, ask the doctor about risks and benefits, especially for older adults with dementia.

If insomnia lasts more than a few weeks or causes daytime confusion or falls, ask about cognitive behavioral therapy for insomnia (CBT-I) or a referral to a sleep specialist.

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