Sleep and Aging

Fast Facts on Aging

• Older adults need the same amount of sleep each night as younger adults, which is 7 – 9 hours (1). Contrary to popular belief, healthy older adults do not need more or less sleep per day.
• Advanced age is a risk factor for sleep disorders like REM Sleep Behavior Disorder and sleep apnea. (2,3)
• Sleep patterns change with age, and it’s not uncommon for older adults to spend less time in deep sleep — the most restorative sleep stage. (4)
• Older adults may seem to sleep more because it’s harder for them to fall asleep (5), and they tend to get less or worse quality sleep, which may prompt daytime napping. (6)
• Poor sleep patterns in older adults are associated with diseases like Alzheimer’s (1), diabetes, and cardiovascular disease. (7)
• Drowsiness during the day can increase the likelihood of a fall and make it harder to do complex tasks. (8)
• As much as 50 percent of the older adult population has difficulty falling asleep, meaning twice as many older adults have sleep issues as younger adults in the U.S. (9)

One of the most interesting things about sleep is how dynamic it is. Day in and day out, it ebbs and flows in response to what’s happening in our lives. 

As we age over a lifetime, our requirements for sleep change as well. While everyone knows babies need the most sleep, one of the most common misconceptions about aging and sleep is that older adults need far less. The truth is that while older adults may get less sleep because sleep worsens as they age, the requirements remain the same as before. 

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t be taken as medical advice, and it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.

Sleep and Aging: What Changes as You Get Older?

A common misconception about sleep and aging is that older adults need less of it. The truth is The American Academy of Sleep Medicine recommends seven to nine hours of sleep each night for adults age 18 and over — and those recommendations don’t change with advanced age. (10) However, what does change is their sleep architecture (the organizational structure of normal sleep and how we move through sleep cycles) and sleep experience. (11) 

Sleep Patterns by Age

Different sources define aging, older adulthood, and the elderly a little differently. In general, changes to our sleeping patterns start to kick in around age 60, but may begin sooner or later for some people. Underlying medical conditions can also impact the age at which sleep disturbances start and how quickly they progress. 

While older adults need the same seven to nine hours as their 20-year-old self, the timing of their sleep will likely change as they advance in age. More specifically, older adults tend to go to sleep earlier and (as a result) wake up earlier than they did in their youth. (1)  Beyond the changes in timing, older adults tend to have more fragmented sleep, resulting in poorer quality sleep and less total sleep overall. (9). Moreover, older adults are more likely to nap during the day. (6)

Age-related sleep changes may include:

• Changes in sleep patterns, including earlier bedtime and wake times (9)
• Lower quality sleep (9)
• Frequent nighttime waking (9)
• Napping during the day (6)

Why Do Older Adults Seem to Sleep So Much?

While healthy older adults need the same amount of sleep as their younger counterparts, several age-related factors can impact how much they seem to sleep or how much they actually sleep.

Older adults tend to go to bed earlier than they did when they were younger, so it may seem as though they are sleeping more. (1) Peeking under the covers on this one, the truth is that older adults may feel the need to spend more time in bed in order to meet their daily requirements due to difficulties getting enough quality sleep.

Daytime napping can also add to this perception that older adults sleep more (6) — if they’re not getting their ideal amount of Zzz’s at night and tend to catch up during family movie night, it can appear that they’re sleeping more than they actually are. More on that below!

Napping, Daytime Drowsiness, and Older Adults

Napping is more prevalent with advancing age. (6) And while it may look like the elderly are sleeping all day, napping doesn’t necessarily mean that they are actually sleeping more or longer each day — it might just be their way of making up for lost sleep in the overnight hours. 

While napping may be a common lifestyle change accompanying aging, we’ll add here that excessive napping and long daytime naps may indicate an underlying medical condition like Alzheimer’s (12), diabetes, and cardiovascular disease (7). If you notice that you or a loved one are taking more than four naps in a 24-hour period, especially longer naps, it might be time to see your doctor. (6). 

Moreover, excessive napping or failing to follow some napping best practices can interfere with sleep come nighttime, which may result in sleep deprivation or insomnia symptoms. (13)

Now, napping isn’t categorically bad. Napping is fine — as long as you optimize your naps so they don’t interfere with your sleep at night and abide by some napping best practices. 

Tips to optimize daytime napping: 

• Create a nap schedule and stick to it (this will make it easier to fall asleep during your nap and leave you feeling refreshed upon waking) (14)
• Limit naps to 20 to 30 minutes to avoid grogginess and boost your odds of feeling refreshed upon waking. (15)
• Don’t nap too late in the day. If you must nap, try to do so when your circadian rhythm causes a natural dip in alertness, typically before 3 p.m. (16)
• Sleep in a room that’s cool, quiet and dark. (14)

Senior Sleep Problems: Challenges Older Adults Face

Poor sleep is a common problem in the course of aging. While lifestyle or behavioral factors often play a role in how much sleep seniors need and how much they actually get, so too do medical issues and sleep disorders. (9) 

Lifestyle factors that contribute to poor sleep among older adults include:

• Higher prevalence of napping: Sleeping too late or too long during the day may reduce the need for sleep come bedtime. 
• Use of caffeinated beverages: Studies show that caffeine consumption can reduce total sleep time and increase the time it takes to fall asleep. (17) So, it might be wise to reconsider that cup of coffee with dessert.  
• Alcohol consumption:  While alcohol may help you fall asleep more quickly, it causes fragmented, poorer-quality sleep once it’s been metabolized. (18) 

Aside from lifestyle factors, many older adults face a host of medical conditions that can impact their ability to sleep.

Nocturia (Frequent Urination at Night)

Nocturia is the medical term for waking up multiple times per night to go to the bathroom. It’s estimated that 50 million people in the U.S. have nocturia, and as much as 24 percent of adults over age 65 will have two or more episodes of nocturia each night. (19) Beyond the nuisance of getting up to go to the bathroom, nocturia often leads to fragmented sleep, short sleep duration, and even sleep deprivation for older adults. (19)

Pain

Pain can have a profound effect on sleep quality. Arthritis and chronic pain, which increase in prevalence with older age, can make sleep almost impossible. (20, 21) The problem is further exacerbated by the fact that pain and poor sleep are bi-directional — that means pain leads to poor sleep, and poor sleep can exacerbate pain. (22)

Insomnia

Insomnia is the inability to initiate or maintain sleep. And while it can happen to anyone at any age, insomnia is the most common sleep disturbance reported among the elderly, affecting as much as  50–70 percent of all people aged 65. (23) If left untreated, insomnia can lead to sleep deprivation, which has been associated with more severe and chronic health issues like diabetes, heart disease, high blood pressure, stroke, and depression. (24)

Sleep Apnea

Characterized by pauses in breathing caused by a complete or partial airway collapse during sleep, obstructive sleep apnea (OSA) is recognized as the most common sleep-related breathing disorder among sleep disorders. For some people, those disruptions can occur hundreds of times per night, ultimately leading to fragmented sleep and poor sleep quality. (24) The most common risk factors for OSA in adults are obesity, sex (higher prevalence in men), and age. (26) Current estimates show that the prevalence of OSA in older adults may be as high as 70 percent in men and 56 percent in women. (9) 

Restless Legs Syndrome

Also known as Willis-Ekbom disease, Restless Legs Syndrome (RLS) is a neurological disorder that causes an aching, crawling, and creeping feeling in the legs that typically makes an appearance while the person is sleeping or resting. (2) The discomfort associated with RLS can usually only be temporarily relieved with movement, so it can and will impair sleep for those who suffer from it. RLS can begin at any age; however, its prevalence increases with advanced age, and women are twice as likely to be diagnosed with the disorder. (27) An estimated seven to 10 percent of Americans may have RLS; its prevalence jumps to 25 percent in those over age 65. (2) (28)

REM Sleep Behavior Disorder

Typically making its first appearance around age 50 or older, REM sleep behavior disorder primarily affects older adults. (29) The hallmark of REM Sleep Behavior Disorder (RBD) is a lack of muscle paralysis during REM sleep, which causes sleepers to act out their dreams. (29) Talking, shouting, and more violent reactions like thrashing limbs and punching are not uncommon. (9) As such, RBD has been associated with poorer subjective sleep quality and reduced quality of life. (29) Though RBD is relatively uncommon — it’s estimated that only about one percent of the population may have RBD — it’s most prevalent among older adult males. (29)

Perimenopause and Menopause

Perimenopause marks the start of a transitional stage for women. Essentially, their bodies begin moving toward the end of their reproductive years. During this time, they produce fewer hormones, and menstrual cycles become irregular. Menopause is the end of this transition, marked by 12 months without a period. (30)

Sleep issues among perimenopausal and menopausal women are extremely common (as much as 69 percent of midlife women have reported them), as decreasing estrogen levels are associated with difficulty falling asleep, maintaining sleep, frequent awakenings, and poor sleep quality overall. (31, 32) 

Sleep Tips For Aging Adults

Sleep is essential for optimal health and maintaining a good quality of life. So, to help you prevent the downstream effects of poor sleep quality and short sleep, Isabella Gordon, a sleep science coach and co-founder of Sleep Society, offers the following tips. 

Set A Consistent Bedtime Routine And Stick With It

A regular bedtime routine helps your body prepare for rest. If need be, incorporate practices like yoga or meditation to help yourself wind down.

Limit Caffeine Consumption

Too much caffeine can interfere with your natural sleep rhythms and prevent your body from entering deeper sleep. (33) So, as a best practice, avoid caffeinated beverages late in the day and opt for herbal teas to help promote relaxation at nighttime. (34)

Create A Calming Sleeping Environment 

Make sure your bedroom is dark, quiet, comfortable, and cool so that you can easily fall asleep each night. (14) Consider using blackout curtains or eye masks if outside lights are an issue, and use sound machines or fans to drown out any noise disturbances while you’re trying to drift off to dreamland.  

Exercise Regularly — But Not Right Before Bed

Daily exercise can promote better sleep, but it’s important to mind the timing. Rigorous physical activity too close to bedtime can be counterproductive to rest and relaxation as it increases alertness and makes falling asleep more difficult. (35) So, go ahead and exercise; just be sure to end your HITT session at least one hour before hitting the sack. 

Treat Outstanding Medical Conditions

Get treatment for any medical conditions that may be disturbing your sleep. Irritable bladder, pain, anxiety, depression, and tinnitus (ringing in the ears), are some of the symptoms that can interfere with sleep. You may experience substantially better sleep if you get treatment for your medical condition. (21, 36, 37, 38)

Keep A Journal

If you find yourself constantly lying in bed with your mind racing, consider writing down any thoughts or worries that come to mind in a journal and then put the notebook away until morning. This can help clear your head and allow you to relax before sleep. 

When to See a Doctor for Sleep Problems

Gordan suggests consulting your doctor if: 

• You’re having prolonged difficulty falling asleep or staying asleep
• Your sleep is significantly affecting your daily life
• You experience other symptoms such as extreme fatigue, vivid dreams, irregular breathing, snoring, or insomnia

Gordon cautions that beyond the issues directly linked with your sleep, other physical and cognitive issues, including “noticeable weight gain, poor concentration, daytime mood swings, increased irritability, and frequent headaches, may all warrant a visit to your doctor,” she says. “A doctor can help diagnose underlying conditions related to sleeping difficulties, such as thyroid disorder, diabetes, or depression, and can provide medical advice on improving your sleep quality. Similarly, a sleep specialist can help identify any underlying causes behind disturbed sleep patterns and suggest treatments accordingly.”

FAQs

The Last Word from Sleepopolis

As a general rule, healthy adults aged 18 – 60 typically require anywhere from seven to nine hours of sleep. While the requirements don’t change much through our adult lives, sleep typically worsens as we age due to a host of physiological, hormonal, and environmental changes. And while sleep quality and duration may take a hit, lifestyle changes and modifications to your sleep hygiene could prove helpful.

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Gordon, Isabella. Author Interview. August 13, 2023.