Aging and Sleep
Regularly getting a good night’s sleep has extensive health benefits across all stages of life. But for older adults, sleeping well can become a challenge. About 50% of adults 65 and older report having sleeping problems.
Sleep has a major role in ensuring healthy brain function, mental health, memory, and motor skills. As a result, difficulty sleeping can have wide-ranging effects on the wellness of older adults.
Learning about how aging impacts sleep can empower people to take steps to improve their daily sleep in order to enhance their quality of life and manage some of the challenges of aging.
How Does Aging Affect Sleep?
It is normal for sleep patterns to change as people age. Compared to young and middle-age adults, older adults tend to get less sleep at night, have more nighttime awakenings, and spend less time in restorative periods of deep sleep. They tend to go to sleep and wake up earlier and are more likely to experience fatigue and daytime sleepiness, including a strong urge to nap.
Aging can also affect sleep because of its impacts on lifestyle and overall health. Changes to daily routines may interfere with sleep, and older adults may encounter sleep difficulties caused by other health conditions or prescription medications.
Some sleeping problems in older adults are tied to biological changes associated with aging.
- Altered sleep stages: During the night, a person cycles through different stages of sleep. Older adults generally spend more time in the lighter stages of sleep, which makes it much easier for them to be unexpectedly awoken. In addition, less time is spent in deep sleep, which affects how refreshed and alert a person feels the next day.
- Circadian rhythm: A small area of the brain coordinates the body’s internal 24-hour clock, which is known as its circadian rhythm. As a person ages, this part of the brain becomes less effective at sensing environmental cues like light and dark, and this makes it harder for the body to maintain a typical daily schedule that is synchronized with day and night. A disrupted circadian rhythm can have broad health effects, including on sleep.
- Sleep schedule: Many older adults experience a shift in their sleep-wake schedule, feeling the urge to go to sleep earlier in the evening and wake earlier in the morning. Sleep duration can also get shorter with age. It is normal for older adults to sleep for six to seven hours rather than for around eight hours.
Aging is frequently accompanied by changes in everyday life that can make it more difficult for older adults to get the sleep they need.
- Retirement: Retiring from work is a significant milestone for many people. Having more free time and flexibility throughout the day leads to a number of lifestyle changes, some beneficial and some detrimental. Without a set daily routine, it may be harder to keep a consistent sleep schedule. Some retirees are also more inclined to take daytime naps, which can affect how tired they feel at the end of the day and lead to an irregular sleep schedule.
- Reduced activity levels: Older adults are more likely to lead a more sedentary lifestyle for a variety of reasons, including physical ailments that limit mobility and reduced social or professional obligations. Decreased activity levels and social isolation can contribute to disrupted sleep patterns and increase the risk of insomnia.
- New stressors: Aging can present new stressors that may affect the quality of sleep. Change in financial status, loss of independence, and grief from the passing of friends or loved ones are all significant stressors for many older adults. Stress and sleep are closely related. Elevated levels of stress can cause sleep problems, and poor quality sleep can make it harder for a person to cope with stress.
Many types of health conditions become more common with aging, and these conditions have the potential to negatively impact sleep.
- Pain: Nearly half of older adults in the United States experience chronic pain. Although there are many ways to help manage pain, for some people, coping with persistent pain is complicated and stressful, increasing the risk of fatigue and sleep problems like insomnia. For example, people who have arthritis often report that they have trouble getting a good night’s sleep due to bone and joint pain while in bed.
- Anxiety and depression: Mental health conditions can be common in older adults, and these conditions are associated with poor quality sleep. In particular, people who have anxiety and depression are more likely to experience excessive daytime sleepiness and insomnia.
- Chronic conditions: Chronic conditions are health problems that usually persist for a long time even though treatments may help manage symptoms. Among older adults, hypertension, diabetes, heart disease, lung disease, and immune disorders can lead to sleep problems. A lack of quality sleep over time can also increase the risk of developing chronic conditions like diabetes, obesity, and depression.
- Medications: Certain medications used to treat physical and psychiatric illnesses experienced by older adults may cause sleep problems, especially daytime sleepiness and insomnia. People who take medications for conditions like depression, anxiety, high blood pressure, or asthma may find it helpful to talk to their doctor about possible sleep-related side effects.
Common Sleep Issues in Seniors
More than half of older adults report poor sleep quality. While the normal aging process can account for many of these sleeping problems, sometimes an underlying sleep disorder is the primary cause of disrupted sleep.
Sleep disorders and other issues can affect sleep in older people.
|Sleep Issue||What is It?||What Can Cause It?|
|Insomnia||People with insomnia have trouble falling asleep and staying asleep.||
|Sleep Apnea||Sleep apnea is a disorder in which breathing is repeatedly disrupted during sleep.||
|Nocturia||Nocturia is characterized by multiple awakenings in the night to urinate.||
|Restless Legs Syndrome||People with restless legs syndrome have a strong, uncomfortable urge to move their legs, which can make sleep difficult.||
|REM Sleep Behavior Disorder||Rapid eye movement (REM) sleep behavior disorder causes people to act out their dreams with movement and speech.||
Excessive Sleep in Seniors
Sleeping too much can also be a problem for some older adults. Regularly sleeping nine or more hours per night or constantly feeling tired throughout the day can be a sign of a sleep disorder or medical condition.
Excessive sleep can occur for many reasons. Oversleeping and fatigue can be a symptom of depression and has been associated with other health issues like diabetes and cardiovascular disease. Sometimes, low energy levels can be due to a medication’s side effects.
Older adults who are frequently getting excessive sleep should talk with a doctor who can check if the oversleeping is due to an underlying medical condition or sleep disorder. Following a consistent sleep schedule and other elements of sleep hygiene may help reduce oversleeping. In addition, older adults may benefit from daytime leisure activities, which can contribute to a daily routine and their overall wellness.
Sleep and Cognitive Impairment in Seniors
Cognitive changes are normal as people age, but some older adults and their loved ones have to cope with more complicated cognitive impairment, including dementia. Maintaining quality sleep is a challenge for many people with dementia, which can significantly affect quality of life for themselves and their loved ones and caregivers.
Dementia is a serious concern for older adults and their loved ones. Unlike some of the normal signs of aging like slower memory recall and thought processing, dementia is a neurodegenerative disease characterized by the progressive loss of brain cells and cognitive functioning that interferes with a person’s ability to care for themself. There are different stages and types of dementia, with Alzheimer’s disease being the most common.
People with dementia frequently experience sleep disturbances. This can occur as a result of dementia’s effects on the brain, and people with dementia are also more likely to have certain sleep disorders like obstructive sleep apnea, irregular circadian rhythms, insomnia, and REM sleep behavior disorder.
Disrupted sleep can worsen the symptoms and severity of dementia. Identifying sleep problems in individuals with dementia can help deliver interventions that improve their quality of life, and evidence suggests that better sleep may also help slow the rate of cognitive decline.
It is important for people with dementia to work with a doctor who can identify any sleep disorders or other causes of poor sleep and tailor treatment for that individual. Understanding the scope of sleep problems in people with dementia and working with a health care team may contribute to better overall health for people with dementia.
Impacts of Poor Sleep for Seniors
Quality sleep is important for people of all ages. For older adults in particular, poor sleep can diminish quality of life and lead to an array of other health problems.
- Memory challenges: There is strong evidence that deep sleep, or slow wave sleep, is important for helping people build memories and support cognitive function. Older adults spend less time in deep sleep, which in turn can make memory recall more challenging.
- Impaired complex thinking: Sleep also supports thinking by enabling concentration and analysis. Sleep deprivation can make it harder to focus, stay motivated, and problem solve.
- Heart health: Both not getting enough sleep and oversleeping have been linked to an increase in cardiovascular problems like heart disease.
- Anxiety and depression: Not getting sufficient sleep at night is associated with a higher incidence of several mental health conditions, including depression and anxiety.
- Irritability: Healthy sleep can improve mood. Poor sleep quality is also associated with more aggressive behavior.
- Impulsive behavior: Sleep loss can negatively impact decision-making by increasing impulsive and risk-seeking behavior. It is also associated with lowered moral awareness, which may affect relationships with others.
- Higher risk of falls: Daytime drowsiness and impaired physical function can increase the risk of accidents and falls in older adults. For older adults who drive, insufficient sleep may heighten the risk of auto accidents.
- Cognitive decline: In addition to short-term effects on brain function, sleep loss may contribute to a higher risk of developing dementia.
Tips for Better Sleep for Seniors
Some of the challenges older adults face with sleep can be managed with lifestyle changes. Better daily habits around sleep hygiene may improve sleep quality.
In many cases, these lifestyle changes are straightforward and easy-to-implement. Talking with a doctor can help review how to apply these tips for any specific individual.
- Steady schedule: Have a consistent bedtime schedule that includes going to bed and waking up at the same time each night.
- Caution with caffeine: Avoid drinking caffeine and other stimulants in the afternoon. Coffee can disrupt sleep even if it is consumed six hours before bedtime.
- Moderation of alcohol: Limit alcohol consumption, especially close to bedtime, because it can reduce sleep quality.
- Limiting screen time: Try to reduce how much you watch TV or look at phone or computer screens before bedtime, since blue light may disrupt the body’s circadian rhythm.
- Careful napping: Limit long naps, which can contribute to oversleeping and may make it harder to fall asleep easily at night.
- Avoiding tossing and turning: Don’t lay in bed if you can’t fall asleep. Instead, try to do a safe, quiet, and relaxing activity for 20 to 30 minutes before trying to sleep again.
- Exercising regularly: Physical activity can improve sleep quality and promote other aspects of overall health. Talk with a health professional about the best type of activity before starting a new exercise regimen.
- Monitoring evening fluid intake: Restrict fluid consumption close to bedtime to avoid having to wake up multiple times in the night from having a full bladder.
- Relaxing before bed: Try to wind down before bed through meditation, deep breathing, reading, or another relaxing bedtime routine.
- Staying active: Look for ways to increase daytime activity that can establish a regular schedule and routine, create connections with others, and keep you engaged during the day.
- Talking with a doctor: Speak with a doctor about any persistent sleep problems, significant daytime drowsiness, or any other symptoms that are affecting your day-to-day quality of life.
Safe Sleep for Seniors
Inadequate sleep can increase the risk of falls and related injuries in older adults. Keeping a safe sleep environment can help reduce the risk of bedroom accidents. Some elements of creating a safe sleep setting include:
- Lighting: Motion-sensor night lights in bedrooms, bathrooms, and hallways are an energy-efficient way to light a path at night without needing to reach for a switch.
- Eliminating hazards: Clearing out potentially dangerous items like glass can help reduce the risk of accidents. Decluttering the bedroom, including getting rid of loose cords and wires, can decrease tripping hazards.
- Proper bed height: Ensure that the bed’s mattress and frame are low enough for your individual comfort while also making it easier to get in and out of bed.
- Staying in contact: Keeping a telephone or smartphone nearby provides a quick and effective way to contact emergency services and family members during urgent moments.
Frequently Asked Questions About Aging and Sleep
Do Older People Sleep More?
It’s a myth that older people sleep more than other adults. In fact, many sleeping problems become more common in older adults.
Expert recommendations reflect the fact that older adults do not need to sleep more than other adults. Recommendations from the National Sleep Foundation (NSF) suggest that older adults sleep seven to eight hours per day and that other adults sleep seven to nine hours per day.
In adults of any age, too much sleep may be a sign of an underlying health problem.
Do Older People Need Less Sleep?
All adults are recommended by the National Sleep Foundation to get no less than seven hours of sleep each day. For older adults, the NSF does not recommend more than eight total hours of daily sleep.
It is important to note that every person’s sleep needs can vary, and some older adults may need more or less sleep to feel well rested. Any individual with questions about how much sleep they need should talk with their doctor for specific guidance.
Why Is It Harder to Sleep When You Get Older?
Sleeping can be more challenging for older adults because of many biological and lifestyle factors related to aging. For example, normal sleep patterns may be interrupted for various reasons including changes to the body’s internal clock, effects of other health conditions, and difficulty adapting to new routines in retirement.
However, not all older adults experience sleep problems. Practicing healthy sleep hygiene can make it easier to get quality sleep, and working with a doctor can identify underlying problems that may be interfering with nightly rest.
Resources for Seniors and Caregivers
- Your Guide to Healthy Sleep: This resource from the National Institutes of Health provides a step-by-step guide to improving sleep hygiene for better quality sleep.
- Caregiving Support: This webpage prepared by the federal government’s USA.gov service includes a list of resources to support caregivers, including those who provide help to older adults.
- Alzheimer’s Association Virtual Support Groups: For people affected by Alzheimer’s disease, this page from the Alzheimer’s Association includes details about support groups for both caregivers and individuals with dementia.
- Social Isolation and Loneliness Outreach Toolkit: The National Institute on Aging developed this resource to help spread awareness about maintaining personal connections and reducing social isolation in older adults.
- Exercise and Physical Activity: This resource from the National Institute on Aging offers practical advice for older adults about ways to start and maintain an active lifestyle.
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