Insomnia and Depression in Older Adults: Causes and Treatment

Difficulty sleeping from time to time is normal, but chronic insomnia can contribute to depression in older adults. Read on to explore causes, signs, treatment options, and practical ways to offer support.

A smiling old woman

What is Insomnia?

Insomnia is a sleep disorder that occurs when you do not sleep as much as you should. This may include difficulty falling asleep, trouble staying asleep, waking up too early, or getting poor-quality, unrefreshing sleep. While some people experience insomnia as a short-term inconvenience, for others it can become a persistent and disruptive problem that affects daily functioning, mood, and overall health.

Sleep is essential for physical restoration, brain function, and emotional regulation. When you do not get enough sleep, your body experiences sleep deprivation, which can negatively impact concentration, decision-making, immune function, and mental well-being. The causes of insomnia vary widely and can include stress, medical conditions, medications, lifestyle habits, and mental health concerns such as anxiety or depression.

Older Adults and Insomnia

Insomnia affects all people, especially adults, but older adults(above 60) are particularly vulnerable. As people age, changes occur in both the body and the brain that can interfere with normal sleep patterns. Adults aged 60 and above are more likely to experience difficulty falling asleep, staying asleep through the night, or waking up too early and being unable to return to sleep. These challenges are often the result of a combination of biological, psychological, and medical factors.

Many seniors live with chronic health conditions such as arthritis, heart disease, diabetes, or respiratory problems, all of which can disrupt sleep. In addition, mental health concerns such as anxiety, depression, and cognitive decline can contribute to ongoing sleep disturbances. Age-related changes in the body’s internal clock – also known as the circadian rhythm – can cause older adults to feel sleepy earlier in the evening and wake up much earlier in the morning, leading to shorter and more fragmented sleep.

Certain medications commonly prescribed to older adults may also interfere with sleep quality. Some drugs can cause alertness, frequent nighttime urination, restless legs, or vivid dreams, all of which can interrupt the natural sleep cycle. As a result, seniors may spend more time in bed but feel less rested and more fatigued during the day.

In addition to changes in sleep duration, the structure of sleep itself also shifts with age. Older adults spend less time in deep, restorative sleep and rapid eye movement (REM) sleep, the stages most important for physical recovery, memory, and emotional balance. This lighter sleep makes them more sensitive to noise, light, discomfort, and other disruptions during the night.

When insomnia becomes persistent, it can begin to affect daily functioning. Older adults may feel excessively tired during the day, experience reduced concentration and memory problems, struggle with mood swings, or have a higher risk of falls and accidents. These effects can reduce independence and overall quality of life, making early recognition and proper treatment essential.

While changes in sleep are a natural part of ageing, ongoing difficulty sleeping is not something that should be ignored or accepted as “normal.” Identifying the underlying causes, whether physical, emotional, or environmental, is the first step toward improving sleep health in older adults.

How insomnia increases the risk of depression in older adults

Sleep problems in older adults, especially insomnia, do more than cause tiredness: they substantially increase the likelihood of depression, and research suggests biological mechanisms underlie this risk.

Older adults who sleep less than 7 hours per night, or report “trouble sleeping” or other poor sleep patterns, are significantly more likely to experience depression. A randomized clinical trial with adults aged 60+, participants with insomnia, when exposed to an inflammatory challenge, showed about a threefold greater increase in depressive mood and symptoms compared to those without insomnia. In the same study, for many of the older adults with insomnia, depressed mood lasted much longer (six hours or more) after the inflammatory challenge than it did for those without insomnia. This shows that insomnia doesn’t just co-occur with depression; in many cases, it predates it, raising the risk even among older adults who were previously non-depressed.

Symptoms & Causes of Insomnia

Common Symptoms of Insomnia in Older Adults

• Difficulty falling asleep despite feeling tired

• Waking up multiple times during the night

• Waking up too early and being unable to return to sleep

• Light, broken, or unrefreshing sleep

• Daytime fatigue and low energy

• Poor concentration and memory problems

• Irritability, low mood, or increased anxiety

• Reduced motivation and performance in daily activities

If these symptoms occur at least three times a week for several weeks, they may indicate chronic insomnia and should not be ignored, especially in older adults, as they increase the risk of depression and cognitive decline.

Causes of Insomnia in Older Adults

Insomnia in older adults can result from a combination of biological, medical, and lifestyle factors:

1. Age-Related Changes in Sleep

As we age, our circadian rhythm and sleep architecture shift. Older adults often experience:

• Earlier sleep and wake times

• Less deep (slow-wave) and REM sleep

• More frequent nighttime awakenings

2. Medical Conditions

Chronic health issues can interfere with sleep, including:

• Heart disease, diabetes, arthritis

• Respiratory problems (like sleep apnea)

• Neurological conditions (Parkinson’s, Alzheimer’s)

3. Medications

Many prescriptions taken by seniors can disrupt sleep, such as:

• Blood pressure or heart medications

• Stimulants or corticosteroids

• Certain antidepressants or pain relievers

4. Mental Health Factors

Anxiety, stress, and depression can make it difficult to fall or stay asleep, creating a cycle where poor sleep worsens mood.

5. Lifestyle and Environmental Factors

• Excessive caffeine or alcohol consumption

• Irregular sleep schedules

• Noise, light, or uncomfortable bedroom conditions

Treatment Options for Insomnia in Older Adults

First‑line: Behavioral & Non‑Drug Approaches

• Cognitive Behavioral Therapy for Insomnia (CBT‑I) — Widely regarded as the “gold standard” treatment for insomnia, even in seniors. It combines sleep education, improved sleep hygiene, stimulus control, sleep restriction, relaxation training, and cognitive therapy to reshape unhelpful sleep habits and thoughts.

• Sleep hygiene & stimulus control — Includes practices such as maintaining a consistent sleep schedule, using the bed only for sleep (not for wakeful activities), avoiding naps or late caffeine/alcohol consumption, and ensuring a dark, quiet, and comfortable bedroom environment.

• Sleep restriction therapy — Temporarily reducing time in bed to roughly match actual sleep time, then gradually increasing as sleep efficiency improves. This can help reduce time spent awake in bed and can improve overall sleep quality.

These non‑pharmacologic strategies are generally safer and have more durable benefits than routine use of sleep medications in older individuals. Learn more

When Medication 💊 Is Needed

While non‑drug therapy is preferred, sometimes medications may be considered, but with caution:

• Safer pharmacological options for older adults include low‑dose doxepin, melatonin (or melatonin agonists like Ramelteon), or newer dual orexin receptor antagonists rather than older sedatives or benzodiazepines, which carry higher risks in the elderly.

• Because older adults are more sensitive to side effects, such as daytime sedation, cognitive impairment, or increased fall risk, any sleep medication should be initiated at lower-than-usual doses and only after evaluating the potential risks versus benefits.

Additional Considerations for Seniors

• Evaluate and address underlying causes: Sometimes, insomnia in older adults may be “secondary” to other issues — such as chronic pain, restless‑legs syndrome, sleep apnea, or other medical problems. Identifying and managing those underlying causes is often key to improving sleep.

• Tailored treatment plans: Since older adults have distinct sleep physiologies and often take multiple medications, treatment needs to be individualised. A well-informed clinician can help balance behavioural therapy and, if necessary, safer pharmacological options.

  How Jabali Health Supports Older Adults with Insomnia and Depression

  At Jabali Health, we understand that sleep problems and low mood often go hand in hand in older adults. Our approach combines personalized care, evidence-based therapies, and practical guidance to improve both sleep and mental health.

  1. Personalized Assessments

• Comprehensive evaluation of sleep patterns, mood, medical history, and lifestyle factors

• Identification of underlying causes, such as insomnia, depression, or other health conditions

  2. Evidence-Based Therapy

• Cognitive Behavioral Therapy for Insomnia (CBT-I) to help seniors develop healthy sleep habits and overcome negative thoughts about sleep

• Therapy for depression and anxiety, tailored to older adults

  3. Lifestyle & Sleep Guidance

• Support with sleep hygiene, daily routines, and relaxation techniques

• Advice on nutrition, physical activity, and stress management that promotes better sleep and mood

  4. Medication Management (if needed)

• Safe guidance on sleep aids or antidepressants, carefully considering age, health conditions, and other medications

• Focus on minimising side effects and fall risk

  5. Continuous Support & Monitoring

• Ongoing follow-up to track improvements in sleep quality and mental health

• Adjusting treatment plans to ensure the best outcomes for each individual

By combining these strategies, Jabali Health helps older adults sleep better, improve mood, and maintain independence, reducing the risk of depression and cognitive decline

Take Control of Your Sleep and Mental HealthStruggling with insomnia or low mood? At Jabali Health, we provide personalized support for older adults to improve sleep, manage stress, and protect mental well-being.

Book a consultation today and take the first step toward improved sleep and a more positive mood.

[Schedule Your Appointment with Jabali Health]