Prevalence and impact on Spain's older population
Insomnia among older adults in Spain has been growing for over a decade. The Spanish Neurology Society estimates that nearly 4 million people over 65 suffer significant sleep disturbances, of whom more than 1.5 million meet the criteria for chronic insomnia. Unlike previous generations, current data reflect greater awareness of the problem — yet under-detection remains high, as many older adults do not mention sleep difficulties to their doctor, considering them a normal part of ageing or resigning themselves to a symptom they believe to be inevitable.
Insomnia has a direct impact on quality of life. Affected older adults report greater daytime fatigue, reduced concentration, lower mood, and a heightened perception of chronic pain. IMSERSO studies indicate that untreated insomnia significantly reduces social participation and functional autonomy, accelerating the onset of dependency. The person who does not rest well avoids activities, progressively isolates themselves, and enters a cycle that deteriorates their physical health as well as their emotional and cognitive wellbeing.
Consequences for physical and mental health
The physical health repercussions of chronic insomnia in older adults are wide-ranging and well documented. It is associated with a higher risk of cardiovascular disease, hypertension, type 2 diabetes, and obesity. Chronic sleep deprivation disrupts hormonal and metabolic regulation mechanisms — factors that are especially critical in old age. The immune system is also affected: older adults with chronic insomnia show greater susceptibility to infections and a weaker vaccine response, according to recent studies from the Spanish Immunology Society.
In terms of cognitive health, the relationship between insomnia and cognitive decline is bidirectional and concerning. During deep sleep, the brain carries out metabolic clearance and memory consolidation processes. Sustained deprivation of these sleep phases promotes the accumulation of beta-amyloid, a key marker of Alzheimer's disease. Research presented at AAIC in 2024 confirms a 40% increase in the risk of cognitive decline in older adults with chronic insomnia — a figure that underscores the urgency of addressing sleep as a measure for preventing cognitive deterioration.
Emotionally, insomnia and mental health are closely intertwined. Lack of sleep worsens symptoms of anxiety and depression, which in turn make it harder to fall and stay asleep. This cycle is particularly common among older adults who live alone or who have recently experienced significant losses, for whom nighttime becomes the moment of greatest emotional vulnerability.
Risk factors and barriers to treatment
Several factors make older adults particularly vulnerable to insomnia. The circadian rhythm changes with age, shifting the sleep-wake cycle earlier and reducing time spent in deep sleep. Polypharmacy, common in this age group, can interfere with sleep: diuretics, beta-blockers, corticosteroids, and certain antidepressants frequently disrupt nocturnal rest. The presence of chronic pain, nocturia, and sleep-related breathing disorders are additional factors that affect a significant proportion of older adults.
Loneliness and social isolation are significant additional risk factors. Without social routines to anchor the daily rhythm, regular physical activity, or cognitive stimulation, the natural sleep cycle deteriorates. Older adults living alone or in care settings with limited stimulation are especially vulnerable. The absence of meaningful interactions during the day reduces homeostatic sleep pressure and encourages extended daytime napping that disrupts nocturnal rest.
Access to appropriate treatment remains a major barrier. Cognitive behavioural therapy for insomnia (CBT-I) is the first-line treatment recommended by European guidelines, but its availability within Spain's public health system is limited. As a result, reliance on hypnotics and benzodiazepines is disproportionately high: AEMPS estimates that a third of older adults with insomnia use them long-term, with risks of tolerance, dependency, and increased likelihood of falls.
The role of social companionship in sleep hygiene
Research on sleep hygiene in older adults highlights the importance of maintaining structured daily routines, regular social activity, and a sense of purpose. These factors help regulate the circadian rhythm and reduce nocturnal cognitive hyperarousal — the tendency to ruminate over worries during the night — which is one of the main triggers of insomnia in this age group. Older adults who participate in social activities during the day report better sleep quality in IMSERSO studies.
Hermet contributes to this approach by providing personalised daily conversations that structure the day, reduce feelings of loneliness, and offer a space to voice concerns before they accumulate. By keeping communication routines active and providing companionship during the day, these services complement clinical interventions and may contribute to better nocturnal rest, especially for older adults who live alone or have limited social contact.