Middle insomnia: what it is and how to beat it

From saga.co.uk

By Patsy Westcott

Waking repeatedly in the night and being unable to sleep again is the form of insomnia most suffered by older people. But there are ways to boost your chance of a better night’s sleep 

It’s 3am and you’re awake. You turn over, plump up the pillow, adjust the duvet and try a different position. You take a sip of water, realise you need the loo, tell yourself it can wait, then decide it can’t, and drag yourself to the bathroom. By the time you get back into bed, you’re wide awake and thoroughly fed up. However hard you try, sleep won’t come. 

If this sounds familiar, you’re not alone. Doctors call it middle insomnia, or sleep-maintenance insomnia, and it’s especially common in older people.

How common is middle insomnia?

“Sleep efficiency is undoubtedly more challenging as we get older,” says consultant neurologist Professor Guy Leschziner, professor of neurology and sleep medicine at Guy’s and St Thomas’ Hospitals.

Around half of older people report difficulty dropping off or staying asleep. Of these, sleep-maintenance insomnia, defined as multiple awakenings or prolonged wakefulness in the middle of the night, affects 50 to 70%.

“Typically, people report waking at 2, 3 or 4am and being unable to fall asleep again for hours,” says psychologist and sleep expert Dr Lindsay Browning of Trouble Sleeping.

Why are older people more affected?

“There are several destabilising influences on sleep that come with age,” says Prof Leschziner, author of The Nocturnal Brain: Nightmares, Neuroscience and the Secret World of Sleep.

“They include weakening of the brain circuitry that controls when we fall asleep, when we wake up and how stable sleep is, together with changes in the secretion of the sleep hormone, melatonin.

“Melatonin is the main chemical signal to the brain that it’s time to go to sleep and stay asleep. With age, its nocturnal peak is much lower, making it harder to maintain sleep,” he explains.

What physical changes can cause middle insomnia?

Certain physical aspects of getting older play a role too. They include: 

• Bladder weakness or irritability
• Joint and back pain or stiffness
• Menopausal symptoms such as night sweats or anxiety
• Medications, such as blood pressure-lowering beta blockers and calcium channel blockers, antihistamines, steroids and some antidepressants  

Medical conditions can also be culprits according to Prof Leschziner. Common offenders include:

• Obstructive sleep apnoea (OSA), in which breathing repeatedly stops and starts during sleep
• Periodic limb movement disorder (PLMD), which causes repetitive, uncontrollable jerking or twitching of the limbs
• Restless legs syndrome (RLS) a neurological condition that creates an irresistible urge to move the legs

“People with these conditions often feel as though they haven’t had any sleep,” says Prof Leschziner. In fact, this can be a trick of the brain, making you feel as though you haven’t slept a wink when you may actually have been drifting in and out of sleep.

What should you do if you’re affected?

Both experts agree that it’s best to not to lie there tossing and turning as this strengthens the association between bed and wakefulness.

“If you feel like you have been awake for about 20 minutes or more, it can help to leave the bedroom and go somewhere else,” says Dr Browning.

Prof Leschziner suggests sitting in dim lighting and doing something fairly unstimulating until you feel sleepy again. Dr Browning, meanwhile, recommends doing something “pleasant and engaging” to take your mind off not sleeping.

As she explains: “The aim is not to make yourself sleepier. It’s to take your mind off the fact you’re awake. This can reduce the link between bed, wakefulness and frustration, so that when you return to bed, sleep is more likely to follow naturally.”

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Distracting and/or calming activities could include:

• Reading
• Watching TV
• Listening to the radio
• Creative activities such as puzzles, word searches or colouring books
• Humming a favourite tune to calm the brain and vagus nerve  

And what shouldn’t you do?

One of the biggest mistakes is checking the time. “Calculating how much longer it is until morning, and how annoyed you are that you’ve woken up can increase anxiety, making it harder to go back to sleep,” says Dr Browning.

She recommends setting an alarm for the latest time you need to wake up. “If you wake in the middle of the night, ask yourself: ‘Has my alarm gone off yet?’ If it hasn’t, it’s not morning, and you can try to go back to sleep.’

Another thing to avoid is scrolling on your phone. This can make it harder to get back to sleep because it strengthens that connection between being in bed and being awake and mentally switched on, and secondly, because the content of what you scroll may leave you feeling alert, agitated or distracted.

Instead, she suggests trying a calming breathing exercise or what experts call cognitive shuffling: mentally listing random, unrelated words or objects to gently distract the brain.

Should you have a snack?

Having something to eat in the middle of the night is not a good idea either, as it can train your body to wake up expecting food at that time. Instead try a light snack before bed, such as a piece of wholemeal toast with nut butter or a glass of warm milk.

And while we’re on food and drink, bear in mind that eating late in the evening, as well as caffeine and alcohol, are well-known sleep disruptors.

Are there any treatments?

According to the British Geriatrics Society, it’s best to steer clear of sleeping pills if you can. Older people are more susceptible to their sedating effects, which can lead to daytime drowsiness and a higher risk of falls and serious injury.

The good news is there are plenty of non-pill options and, even if you have struggled with insomnia for decades, you can still improve your sleeping habits.

“Long-standing insomnia is often maintained by unhelpful behaviours and anxiety about sleep itself, and this can be changed,” says Dr Browning.

CBT-I (cognitive behavioural therapy for insomnia) uses a range of techniques to tackle the habits and thought patterns that keep insomnia going – such as going to bed earlier to compensate for sleep loss or worrying about how you will function the next day – as well as so-called sleep restriction or sleep compression.

These techniques involve working out how long you usually spend asleep then strictly limiting the time you spend in bed to that time. It sounds counter-intuitive to deliberately restrict your sleep to treat insomnia, but over time it creates mild sleep deprivation. “Eventually, the sleep pressure that builds up as a result stabilises your sleep pattern, enabling you to gradually increase the amount of time you spend asleep in bed,” explains Prof Leschziner.

The Sleepio app, which uses CBT-I, is recommended by NICE (National Institute for Health and Care Excellence) and is thought to be especially beneficial for over 65s.

What matters, both experts agree, is not to accept broken nights as something you have to put up with. Once you understand what lies behind them, small changes to your routine can make a real difference and help you back to more restful nights.

Types of insomnia

• Short-term (acute) insomnia: lasts for less than three months and is often triggered by stressful events, jet lag or changes in the environment, such as a heatwave or extreme cold.
• Long-term (chronic) insomnia: lasts for three months or more and is often linked to underlying medical, psychological or lifestyle factors.
• Sleep-onset insomnia: difficulty dropping off at the beginning of the night. This is the kind most common in younger adults
• Sleep-maintenance (middle) insomnia: frequent awakenings during the night, or waking in the middle of the night and struggling to drop off again. This is the one most commonly suffered by older people
• Insomnia with early morning awakening: when you wake up very early in the morning, e.g. 5am.

If poor sleep is causing anxiety, frustration or daytime fatigue, speak to your GP or a sleep professional. 

https://www.saga.co.uk/magazine/health-and-wellbeing/middle-insomnia-what-it-is-and-do-you-have-it

New digital platform treats insomnia and anxiety in seniors

From news-medical.net

Cognitive behavioural therapies for insomnia (CBT-I) are increasingly being delivered online in order to improve accessibility. However, although insomnia and anxiety frequently occur together in older adults, few interventions address both conditions simultaneously. A new digital platform developed by researchers at the Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), in collaboration with Concordia University, Université Laval and the Université de Montréal, aims to fill that gap.

The results of a clinical trial, published in the journal Age and Ageing, highlight the feasibility and effectiveness of the program, with promising applications for improving mental health and sleep among older adults.

An accessible program designed for seniors

The research team conducted a randomized controlled trial involving 80 adults aged 65 and older who were experiencing insomnia. The eCBT+ program consists of a seven-week intervention featuring one 30-minute interactive video module per week.

Insomnia and anxiety are very common among older adults. Although cognitive behavioural therapy (CBT) is the first-line treatment for insomnia, access remains very limited because of the availability of trained professionals and the high cost of treatment."

Dr. Thien Thanh Dang-Vu, neurologist, laboratory director at CRIUGM and professor in Concordia University's Department of Health, Kinesiology and Applied Physiology

Accessible on computer, tablet or smartphone, this platform is the first of its kind available in French. It was specifically designed for older users, with adjustable features such as text size and contrast settings, as well as scenarios that reflect their everyday experiences.

Significant clinical results

The research team conducted a randomized controlled trial with 80 adults over the age of 65 suffering from insomnia. The study aimed to assess the usability, acceptability and preliminary efficacy of the eTCC+ program compared to a waitlist control group. 

In terms of usability, participants rated the platform as user-friendly and intuitive, achieving a usability score of nearly 70 per cent. Acceptance of the platform was driven primarily by its ease of use and the perceived usefulness of the program.

"From a clinical perspective, the intervention proved highly effective. Participants who completed the eCBT+ program experienced significant improvements in sleep efficiency and reductions in symptoms of both insomnia and anxiety compared with the control group," says Mathilde Reyt, the study's first author and a postdoctoral researcher at CRIUGM and Concordia University.

"Our findings show that web-based tools offer a promising and clinically relevant approach to promoting sleep and mental health among older adults. This combined digital CBT program represents an important step toward making these treatments more accessible to everyone," concludes Dr. Dang-Vu.

The research team plans to expand its sample size to confirm the program's long-term effects, with particular attention to potential benefits for cognitive function and daytime quality of life among older adults.

https://www.news-medical.net/news/20260609/New-digital-platform-treats-insomnia-and-anxiety-in-seniors.aspx

New Study: This Surprising Mental Trait Could Be the Key to Beating Insomnia

From inc.com

Constantly tired? A simple factor may be contributing to your inability to find high-quality sleep. Here’s what to know 

Could feeling wiser than your years be worsening your days? Possibly. 

A new study published in Sleep found a link between subjective age (the age you feel) and how well you sleep. People with a higher subjective age reported more symptoms of insomnia and feeling more tired throughout the day. The results will be presented at the Sleep 2026 annual meeting in mid-June. 

The study was conducted by the VA Boston Healthcare System, Virginia Commonwealth University, and the National Sleep Foundation. 

The scientists ultimately found that age discrepancy can act as a predictor in overall health and longevity. In the study, age discrepancy is defined as the mismatch between a person’s subjective age, how old a person feels, and their actual, chronological age. Positive values indicated feeling older while negative values indicated feeling younger. The researchers noted that adults who felt older had more symptoms of insomnia, more sleep-related impairments, and lower overall sleep health and regularity.

“These findings suggest how people perceive their own aging may have important implications for sleep and overall well-being,” said Joseph M. Dzierzewski, the principal investigator of the study. “Understanding subjective age could help inform future approaches to support healthier sleep and quality of life across the lifespan.”

To come to this conclusion, the researchers collected survey responses from 3,177 adults with a mean age of 42.8. Participants were asked questions to assess their subjective age, insomnia, overall sleep health, and sleep-related impairment. The subjects were evaluated on their mental health and asked to self-report any physical health symptoms that may affect their sleep.

The scientists used correlational and regression analyses to look at the associations between age discrepancy and sleep. A parallel mediation, a test to see if any predictors affected the outcome through two or more variables simultaneously, was then used to explore the indirect effects sleep had on physical health. 

The scientists found that those who reported feeling older than their actual age had statistically significant poorer sleep and sleep-related impairments. Additionally, they found that those who had higher age discrepancies also had higher rates of insomnia and worse subjective physical health. 

                                                                                                                                                                     Photo: Getty Images

Key takeaways from the research

Dzierzewski told Inc. that this doesn’t have to start in a doctor’s office; it can begin with a simple internal check. “The question is almost like, how are you feeling? Do you feel older? Do you feel younger? Do you feel right on?”

The good news, he said, is that nothing about this picture is fixed. “Your subjective age is certainly changeable, your sleep is changeable. Staying physically active, eating a good healthy diet, and challenging some of those negative beliefs we have about aging.”

He added that consistently feeling older than your age is “not a warning sign, but something you should pay attention to. It’s a sign that your sleep or your health maybe needs more support than you’re giving it.”

And while the study focused on sleep, Dzierzewski thinks the implications can stretch to other areas of your life. Embracing aging more realistically, not chasing youth, and aligning expectations with where you actually are could, he said, bring everything a little more into balance: “All of these things are changeable.”

https://www.inc.com/lucia-auerbach/new-study-this-surprising-mental-trait-could-be-the-key-to-beating-insomnia/91354563

Research Shows Sleeping 6.4 to 7.8 Hours a Night May Help Slow Aging

From verywellhealth.com

By Mira Miller

Key Takeaways

• Sleeping between 6.4 to 7.8 hours a night is linked to the slowest biological aging across multiple organ systems.
• Too little sleep (less than 6 hours) and too much sleep (more than 8 hours) can accelerate biological aging through different pathways.

Getting enough sleep is an essential part of staying healthy throughout the lifespan. New research suggests that the ideal amount is between 6.4 to 7.8 hours, while getting either more or less than is associated with increased biological aging.

                                                 Sleeping too much or too little may speed up aging.   Peera_Sathawirawong / Getty Images

What the Research Shows

Researchers conducted the study, published in Nature, by analysing self-reported sleep data from half a million participants in the UK Biobank and comparing it with data about their biological age. Biological age refers to how slow or fast their organs are aging compared to their actual chronological age.

The researchers found that sleeping between 6.4 to 7.8 hours was associated with the slowest biological aging across multiple organ systems, including the brain, liver, lungs, immune system, skin, adipose tissue, and pancreas.

"This study suggests that sleeping too little or too much can accelerate biological aging," said Karen Lincoln, PhD, a professor of environmental and occupational health at UC Irvine Joe C. Wen School of Population & Public Health. "It also confirms that sleep is foundational to healthy aging."

Specifically, researchers identified a consistent U-shaped relationship between sleep duration and biological aging, meaning biological aging is lowest in the middle range and increases at both extremes of sleep duration.

Too little sleep is defined as fewer than 6 hours, while too much is defined as more than 8.

Why Does Sleeping Too Much or Too Little Matter?

Shorter and longer sleep duration have distinct biological pathways, Lincoln explained. She said short sleep is a direct driver of accelerated biological aging as it's associated with heightened physiological stress, systemic inflammation, immune dysregulation, and metabolic disruption which can affect cardiovascular, metabolic, musculoskeletal, and neuropsychiatric systems. 

Long sleep, on the other hand, appears to be more concentrated in brain-related and neuropsychiatric outcomes, like depression or cognitive issues, she said. It might be a marker of underlying disease that the body is already managing, or an adaptive response to stress, rather than a direct driver of accelerated aging.

"The findings reinforce that sleep duration isn’t just a lifestyle choice, it is a biological signal," said Joseph Dzierzewski, PhD, a sleep scientist who directs the scientific mission of the National Sleep Foundation. "Deviating too far in either direction can reflect or contribute to accelerated aging across the body."

Where the Study Falls Short

The study does have an important limitation worth noting, Lincoln said: it relies on a single, self-reported measure of sleep by asking participants how many hours they sleep per day, on average.

But Lincoln said sleep is multidimensional and there are a wide range of measures to determine one’s sleep health. For example, sleep regularity measures whether you’re going to bed and waking up at the same time every day, sleep latency measures how long it takes you to fall asleep after you go to bed, and sleep disruptions include whether you have difficulty falling back to sleep after waking up at night.

Sleep disorders like sleep apnoea also impact many adults and are disproportionately underdiagnosed and untreated in many Black Americans, she added.

"While the number of hours you sleep is important, it doesn’t capture sleep quality and represents only one slice of a much richer picture of sleep health," she said.

What It Means For You

Despite the limitations, Dzierzewski said the results provide a biological stamp of approval for the National Sleep Foundation’s widely cited sleep duration recommendations, which state that most adults need 7 to 9 hours of sleep per night and most older adults need 7 to 8 hours of sleep per night.

"The NSF ranges remain the right target for overall health and well‑being," he said. "If your goal is specifically to support healthy biological aging, this study suggests that consistently sleeping in the 7–8 hour zone may be especially protective."

While this may be true for most people, everyone is different, so Lincoln said it's most important to gauge how you feel when you wake up.

If you feel rested, restored, and energised, she said you are likely getting enough sleep, regardless of whether the clock says 6.5 or 7.5 hours. But if you consistently wake up tired, foggy, and have low energy, that is a signal worth paying attention to, even if your sleep duration is within that recommended range.

"Sleep is essential for healthy aging: your brain clears metabolic waste, your immune system recalibrates, and your organ systems repair during sleep," she said. "Good sleep quality is important for your health no matter how you measure it."

https://www.verywellhealth.com/sleeping-hours-and-aging-11978844 

Ask Dr. Steve: Why can’t I sleep when the days are longest?

From standard.net/lifestyle

By Steven Szykula, PhD and Jason Sadora, CMHC

The summer solstice falls in late June, marking the longest day of the year. In Ogden, the sun rises before 6 a.m. and sets after 9 p.m., with twilight lingering past 10 p.m.. For an animal whose biology evolved to fall asleep when it gets dark, this presents a problem.

Many people assume summer should be a season of better sleep — warmer evenings, no school, vacation time. In practice, sleep clinics see a noticeable uptick in summer insomnia complaints. The reasons are biological, behavioural, and environmental. Long evenings delay the body’s release of melatonin, warm bedrooms interfere with the nightly drop in core body temperature that initiates sleep, and looser summer schedules erode the consistency that keeps circadian rhythms aligned.

This week’s column looks at why summer can be quietly hard on sleep, what the research says about light, heat, and schedule, and what to do if you find yourself wide awake at midnight while the sky is still glowing.

                                                                  Steven A. Szykula

Q: Why does it feel harder to fall asleep in summer even when I’m tired?

A: Sleep onset is regulated by two interacting systems: a homeostatic drive that builds across the day and a circadian system that times when sleep should happen. The circadian system is exquisitely sensitive to light. When you receive bright light at 9 or 10 p.m. in the evening, the brain delays its release of melatonin, pushing your biological “bedtime” later regardless of how tired you feel. Tiredness and sleepiness are not the same thing.

Q: Should I use blackout curtains?

A: For most adults with summer sleep problems, yes. The goal is not total cave-like darkness but elimination of the light dose that suppresses melatonin in the bedroom. Even modest evening and morning light through a window can shift the rhythm. If full blackout feels disorienting, consider blackout curtains plus a sunrise alarm clock that brings light back in at a chosen time.

Q: Is the heat really a problem, or am I imagining it?

A: It is a real problem. Sleep onset depends on a small but reliable drop in core body temperature, and a hot bedroom blocks this. Research generally points to a bedroom temperature around 65 to 68 degrees Fahrenheit as optimal for most adults. Fans, lighter bedding, and a cool shower before bed help. Sleeping with windows open in Utah summers often traps warm air; air conditioning, where available, usually wins on sleep quality.

Q: My kids are wrecking my sleep schedule because there’s no school. What do I do?

A: Protect a consistent wake time even if bedtime drifts later. Wake time is the single most powerful anchor for the circadian system; bedtime tends to follow. A summer schedule that lets bedtime slide by an hour but holds wake time within thirty minutes will preserve most of the rhythm. A schedule in which both float freely produces the chronically tired, irritable child many parents recognize by August.

Q: Is melatonin a good idea in the summer?

A: For circadian adjustment — not for sedation — low-dose melatonin (often 0.3 to 1 milligram) taken several hours before desired sleep can help reset a delayed rhythm. The high-dose drugstore melatonin (5 to 10 milligrams) is generally not necessary and can produce next-day grogginess. Melatonin is not regulated as a medication in the United States, which means quality varies significantly by brand. Talk to a clinician before starting it long term, particularly for children.

Q: I’m drinking more on summer evenings. Could that be affecting my sleep?

A: Almost certainly. Alcohol shortens sleep latency in the short term but disrupts the architecture of sleep, suppressing REM sleep and increasing night-time awakenings, particularly in the second half of the night. Many people experience the classic pattern of falling asleep quickly after drinks and then waking at three in the morning unable to return to sleep. Two to three drinks is enough to produce this pattern in most adults.

Q: My phone is the problem, isn’t it?

A: It is part of the problem, but not for the reason most people think. The blue light effect on melatonin, while real, is modest at typical phone distances. The bigger issue is content — social media, news, and email keep the brain in a vigilant, problem-solving mode that is fundamentally incompatible with the slowing required for sleep onset. A book or a podcast in a dim room beats a phone, even with night mode enabled.

Q: I’m exhausted but my mind races the moment I lie down. What’s that about?

A: This pattern is called sleep-onset insomnia, and it usually reflects a conditioned association between the bed and wakefulness rather than ongoing exhaustion. The behavioural fix is counterintuitive: do not go to bed until you are sleepy, not just tired, and if you cannot fall asleep within about 20 minutes, get up and do something quiet in dim light until sleepiness returns. This approach, called stimulus control, is a core component of cognitive-behavioural therapy for insomnia.

Q: When does insomnia become a clinical problem rather than just a bad week?

A: The standard threshold is difficulty falling or staying asleep at least three nights per week for at least three months, with daytime consequences such as fatigue, mood disturbance, or impaired functioning. Below that threshold, sleep hygiene adjustments are usually sufficient. Above it, the most effective intervention is cognitive-behavioural therapy for insomnia, which outperforms medication in long-term outcomes.

Conclusion

Sleep is not a luxury that adjusts itself around our schedules; it is a biological process governed by light, temperature, and routine. The summer solstice is a useful reminder that even something as basic as sleep is contextual and seasonal.

The good news is that summer insomnia is among the more responsive sleep problems. Most people who address light exposure, bedroom temperature, and wake-time consistency see improvement within two to three weeks. For those whose sleep problems persist, structured evaluation and treatment work well.

The longest day of the year does not have to mean the shortest night of sleep.

https://www.standard.net/lifestyle/health/2026/jun/06/ask-dr-steve-why-cant-i-sleep-when-the-days-are-longest/