Older parents waking up at night: how can family help?

As people get older, they tend to go to bed and wake up earlier, sleep more lightly and wake more often during the night. This is a common change with age. The things that most often wake older parents are trips to the toilet, aches and pains, long naps or dozing off in front of the TV in the evening, and too little daylight. Family can help by getting them outside for daylight and movement during the day, cutting back on evening drinks, keeping the bedroom comfortably cool, and lighting the path to the bathroom. Loud snoring with what look like pauses in breathing, strong sleepiness during the day, or confusion at night are reasons to take them to a doctor.

If you live with your parents, or visit them back in their home province, you have probably heard "I woke up so many times last night." This article draws on the US National Institute on Aging (NIA), Sleep Foundation, Cleveland Clinic and the UK's NHS to explain how sleep changes with age, what tends to wake older people, and what you and others at home can do.

Is waking up often at night a normal part of getting older?

Partly, yes. The NIA says older adults tend to go to bed earlier and wake up earlier than younger adults, their sleep tends to be shorter and lighter, and they may wake up more often during the night. But waking so often that they feel sleepy or drained during the day is not something they simply have to put up with.

Early to bed, up before dawn

Sleep Foundation explains that the body clock shifts earlier with age, so many older adults feel tired early in the evening and wake very early in the morning. A parent who is up at four or five for the market or to offer alms to the monks, and who went to bed at eight, may already have had a full night. It helps to look at how many hours they sleep in total and whether they feel alert during the day, rather than only at what time they wake.

Lighter sleep means waking more easily

Sleep Foundation says older adults spend more time in the lighter stages of sleep and less time in the deeper stages, which can lead to waking more often and more broken sleep. A motorbike in the soi, a barking dog or someone moving around the house, which they would once have slept through, can now wake them during those lighter stretches.

They still need the same amount of sleep

The NIA says older adults need about the same amount of sleep as all adults, seven to nine hours a night. Sleep Foundation calls the belief that older people need less sleep a misconception, and says feeling very sleepy during the day is not a normal part of ageing.

What makes older parents wake up several times a night?

On top of lighter sleep, several everyday things can wake them, and many of them are things the household can help adjust.

Trips to the toilet

Sleep Foundation says night-time urination increases with age and may affect up to 80% of older adults, adding to broken sleep. Cleveland Clinic lists common causes as drinking a lot before bed, especially alcohol, fizzy drinks or caffeine, some medicines that make you pee more, and a habit of waking up to pee even when you don't need to. In Thailand's heat, many people drink little during the day and then catch up in the evening, which means getting up at night.

Aches and pains

Sleep Foundation says pain and discomfort keep some older adults from resting properly, and the two feed each other: less sleep can mean more pain. If pain is getting in the way of sleep, talk to a doctor.

Long naps and dozing off early

Sleep Foundation says about 25% of older adults nap, compared with around 8% of younger adults, and that long naps and naps later in the day can make it harder to fall asleep at bedtime and disturb sleep at night. A familiar scene: Dad dozes on the sofa for an hour after dinner, then lies wide awake once he goes to bed, or wakes again soon after.

Staying indoors with little light

Sleep Foundation says light is one of the most powerful cues for the body clock, yet many older people get little daylight, averaging around one hour a day. Retirement can also loosen the daily schedule, and living alone or seeing fewer people can bring stress and worry that affect sleep too.

Regular medicines

Sleep Foundation says almost 40% of adults over 65 take five or more medicines, that many over-the-counter and prescription drugs can affect sleep, and that combining several can have unexpected effects. If your parent starts waking more after a new medicine, do not let them stop it or change when they take it on their own. Ask the doctor or pharmacist who gave it.

What can family do during the day?

Night-time sleep starts with the day. Much of the advice from the NIA and Sleep Foundation is easy for adult children to do together with their parents.

Same wake-up time, and get outside

• The NIA advises going to sleep and getting up at the same time each day, including weekends and when travelling.
• Sleep Foundation says light helps set the body clock. Invite your parent for a morning walk to the market, to water the plants out front, or to have their morning coffee by a bright window, rather than staying in a room with the curtains drawn all day.
• When the midday sun is fierce, choose bright shade, and make sure they drink enough during the day.

Move every day

Sleep Foundation says older people who exercise regularly fall asleep faster, sleep longer and report better sleep. The NIA advises regular exercise, but not within three hours of bedtime. A walk around the neighbourhood in the morning or early evening, tai chi in the park, or light housework together all count.

Keep naps short and early

The NIA advises avoiding naps in the late afternoon or evening. If your parent wants a nap, keep it short and soon after lunch. After dinner, when the TV tends to send them to sleep, suggest a walk, washing up together or a video call with the grandchildren.

Caffeine, alcohol and dinner

An afternoon iced coffee or Thai tea from the stall at the end of the soi, beer or whisky with dinner, and a late bowl of rice soup are all things you can help adjust one at a time. The point is not to have them drink less overall, but to drink enough during the day and less in the evening.

How should the bedroom and bedtime be set up?

Temperature and darkness

The NIA advises keeping the bedroom comfortable, neither too hot nor too cold. In a Thai home, a stuffy room can wake them up sweating, but an air conditioner set too cold can wake them too. Set the air conditioner or fan to suit them, and give them a blanket they can adjust themselves. Sleep Foundation says bright lights make it harder to fall asleep, so use curtains to block street lights or porch lights shining in.

Move the TV out of the bedroom

The NIA advises not watching TV or using a computer, phone or tablet in the bedroom. Sleep Foundation suggests keeping the TV in another room and not falling asleep with it on. If a phone stays by the bed for emergencies, mute notifications so the family LINE group doesn't buzz in the middle of the night.

A short routine before bed

The NIA suggests a relaxing routine every night, such as reading, listening to soothing music or a warm bath. For many Thai parents, evening prayers are already part of the routine. Keep it at the same time each night.

If you are also sleeping more lightly yourself, see Lighter sleep with age: how can you adjust your sleep?

How can I help them avoid falls on night-time bathroom trips?

Night waking may not go away completely, so make the trip from bed to bathroom easier. The NIA says poor sleep can raise the risk of falls and accidents, and walking in the dark while still drowsy makes tripping easier.

Light the whole way from bed to bathroom

Many Thai homes have a separate bathroom at the back, raised door sills or floors at different levels. Light these spots and mark them so they stand out, and put a non-slip mat on a bathroom floor that is often wet.

If they sleep upstairs

The NIA advises handrails on both sides of the stairs and light switches at the top and bottom. If the bathroom is downstairs, talk with them about whether their bedroom could move downstairs.

When should I take my parents to see a doctor?

The NIA says that if someone is always sleepy or finds it hard to get enough sleep at night, it may be time to talk with a doctor. Older adults are also more likely to take medicines or have health problems that affect sleep, so family members who see them at night can notice a lot.

Signs worth raising with a doctor

Sleep Foundation says around 20% of older people have excessive daytime sleepiness, which may be a sign of an underlying health problem, so it is not something to write off as just getting old.

If they suddenly become confused, get help straight away

The NHS says to get medical help immediately if someone suddenly becomes confused. Signs include not being able to think or speak clearly, not knowing where they are, struggling to pay attention, or seeing or hearing things that are not there. The NHS suggests asking their name, age and today's date; if they seem unsure or cannot answer, they probably need medical help. In Thailand, call 1669 for an emergency ambulance. While you wait, stay with them, tell them who you are and where they are, use simple words and short sentences, and bring the medicines they take.

Before starting anything new for sleep

The NIA advises talking with a doctor before starting any medicine or supplement to improve sleep. If your parent takes several regular medicines, ask a doctor or pharmacist to look over the full list first. Do not stop, cut down or change the timing of a regular medicine on your own, even if you suspect it is waking them at night.

Note these down before the appointment

• what time they go to bed and wake up, how often they wake at night, and why
• how many times they get up to pee each night
• how much tea, coffee or alcohol they have, and when
• when and how long they nap
• every medicine and supplement they take, and at what time
• what family members notice at night, such as snoring, pauses in breathing or leg jerks

Cleveland Clinic says doctors often ask how many times you wake to pee, what you drink, and which medicines you take and when, so the notes you bring help the doctor see the picture more clearly.

If your parent wakes up and can't get back to sleep because their mind keeps going, see Can't sleep because your mind won't stop thinking?