Aging and Sleep
As we get older, our bodies change, but our need for sleep does not. Like adults of all ages, older people need 7-9 hours of sleep per night. Getting that critical sleep, though, becomes harder and harder because of biological changes and the influence of prescription medications.
Lack of sleep with aging is a serious problem. Research estimates that somewhere between 30% and 50% of people over 65 suffer from insomnia, and this condition affects more women than men. Sleep deprivation among the elderly can complicate other health issues and cause daytime drowsiness that magnifies the risks of accidents and falls.
This guide takes a deeper look at aging and sleep to help understand the sleep-related challenges of getting older and specific strategies that can play a role in overcoming those challenges.
Why We Sleep Less As We Age
As we age, sleep gets harder for biological reasons. Alterations to circadian rhythms and a higher prevalence of sleep-disrupting medical conditions both get in the way of older people getting all the sleep that they need.
Age can also affect sleep because of the effect of medications. Many people increase their daily prescription list as they get older, and as those medications affect the body, they can interrupt sleep. Even sleep aids can have a negative effect on elderly people for achieving long-term, consistent sleep.
In this section, we’ll explore in greater details these two underlying causes for sleeping problems in older adults.
Does Sleep Change as a Natural Part of Aging?
It is natural to wonder why we sleep less as we grow older. Even though we may better recognize the benefits of sleep, actualizing those benefits can be complicated by the fact that getting a full night’s sleep gets increasingly more difficult.
Studies have demonstrated that sleep changes are a natural part of aging. This section reviews some of the factors that influence those changes.
Changes to Sleep Architecture
Fundamental changes to sleep architecture frequently occur with aging. This means that the typical cycle of sleep, including its timing and depth, becomes shifted, and these changes can pose powerful barriers to quality sleep.
Not all sleep is identical; instead, we proceed through stages of sleep. The average sleep cycle is around 90 minutes and made up of 4 stages. The first 3 stages are part of non-rapid eye movement (NREM) sleep, and the last stage is REM sleep. The early NREM stages are the lightest sleep while the late NREM stage is a slow-wave deep sleep.
Research indicates that older people tend to spend more time in the early, light sleep stages. This may deprive them of the recovery benefits of deep sleep and REM sleep. It is also easier to be awoken during light sleep, and those awakenings may feel more abrupt.
The timing of sleep commonly changes with aging as well. For many older people, sleepiness comes earlier in the evening, making it harder to sleep through the night and often leading to early awakenings. This Advanced Sleep Phase Syndrome (ASPS) is a type of Circadian Rhythm disorder that can result in reduced overall rest.
Another disruption in sleep architecture that can affect older people, especially men above 50, is REM sleep behavior disorder (RBD). During normal REM sleep, brain activity is high, but the body does not move. In RBD, a person begins to act out dreams physically, which can lead to personal harm and sleep disruption.
Co-Existing Health Conditions
A number of health issues can make it harder to get good sleep. While these conditions and problems can affect people of all ages, their prevalence increases with age.
How Can Prescription Medicine Change Our Sleep?
Another way that aging and sleep are related is through the influence of medications. While medications can alter our body’s functioning in ways that offer tremendous benefits, they can also have problematic secondary effects, including on sleep.
In older people, the effects of medication can become amplified by several factors. With older age, there is a higher propensity to take multiple medications, known as polypharmacy. In addition, aging affects the organs involved in metabolizing and clearing drugs, like the kidneys and liver, and this can create more unpredictable side effects, especially in the context of multiple medications.
Side effects of prescription drugs can vary from person to person, but some types of drugs are known to have the potential to impact sleep. For some patients, the biggest side effects may even occur from withdrawal after they have stopped taking the drug.
In general, prescription medications alter sleep in three ways: making it harder to fall asleep, altering sleep architecture, and fostering daytime sleepiness.
Prescription Medications and Insomnia
Various classes and types of drugs can contribute to sleep onset insomnia, meaning that they make it more difficult to fall asleep. Drugs that contain caffeine or an amphetamine, including over-the-counter medications, can have this effect even if they are taken many hours before bedtime. Other types of drugs that can contribute to insomnia include:
- Anti-inflammatory drugs, including many steroids
- Anti-seizure drugs
- Blood pressure medications (including beta blockers)
- Chemotherapy drugs
- Bronchodilators, which may be used for asthma or lung conditions
- Synthetic thyroid hormones
- Drugs to treat Parkinson’s Disease
It is important to remember that not every drug in these categories will cause insomnia. In addition, because side effects can be highly individualized, not all patients who take these drugs will experience sleep disruptions.
Prescription Medications and Sleep Architecture
Older adults are already at risk of problems from changing sleep architecture, but medications can further compound these issues. Some drugs can affect how well a person can progress through each stage of sleep. For example, some sedatives, including those in cough medicines, can affect sleep patterns. Other drugs, including some blood pressure medications and cholesterol medications, can interfere with sleep architecture.
In some cases, detailed studies about a medication’s effect on sleep stages may be limited or may have been conducted in younger patients whose experience is not a close parallel to older adults.
While not a prescription medication, alcohol is an example of another substance that can directly affect sleep architecture in complex and negative ways.
Prescription Medications and Daytime Sleepiness
Some medications -- including some used for colds, coughs, asthma, and pain -- can affect sleep by causing significant grogginess or drowsiness during the day. These drugs can make it challenging for a person to align their sleep-wake cycle with the day-night cycle where they live. They may encourage napping that can then make it harder to fall asleep or get a full night’s sleep.
Sleep Aids for Older Patients
Presented with these sleeping problems, some older people turn to over-the-counter sleep aids. Unfortunately, these can have side effects and are usually not recommended. These drugs can be habit-forming and can make falling asleep even harder once you’ve stopped taking them. They also may interact with other medications and lead to a grogginess after waking up that can increase the risk for falls or other accidents.
How to Get Better Sleep As You Age
Despite these challenges to getting great sleep, there are steps that older adults can take to boost their chances of solid nightly rest.
Talk to Your Doctor
Talking with your doctor can be a useful step in improving your sleep. If you’ve been struggling with insomnia or find that you’re not waking up feeling rested, it’s important for your doctor to know. Keeping a sleep journal in which you track your sleep patterns and how you feel the next day can offer useful information for your doctor to review.
Some conditions, like sleep apnea, are often undiagnosed in older people who may think that symptoms like drowsiness are not significant enough to bring up with their doctor. By making sure your doctor knows about your sleep problems, they can work with you to identify if there is an underlying cause.
If your sleep is being disrupted by pain or another physical ailment, the doctor can work with you on a strategy for managing that co-existing illness. They can also review your medications to see if there are any that could be disrupting your sleep.
A doctor can make a referral to a psychiatrist for help if you are anxious or depressed. Some psychiatrists have extra training to conduct cognitive behavioral therapy for insomnia (CBT-I) that can pair well with care for anxiety or mood disorders.
Step Up Your Sleep Hygiene
Because sleeping problems are multifaceted, there’s rarely a silver bullet to solve them. One important step, though, is to improve your sleep hygiene, which encompasses your sleep environment and your sleep-related habits and routines.
Enhance Your Sleep Environment
Having a great sleep environment means fostering comfort and relaxation while eliminating potential barriers to sleep.
Most people, including older adults, don’t have control over every aspect of their sleep environment. This is especially true for elderly people who live in assisted living or nursing facilities. Even if you can’t manage every single aspect of your sleep environment, there are usually ways to make an upgrade.
- Start with the mattress: a reliable mattress is a worthy investment. It can bring comfort and give your back the support it needs to reduce morning aches.
- Mind your head: along with your mattress, choose a supportive pillow so that you can rest your head and support your neck.
- Select quality bedding: opt for a sheet set and a comforter that fit your needs. Some bedding will offer a cooler night’s sleep while others will make for a warmer, cozier bed.
- Remove potential hazards: it is important to eliminate things that could cause you to trip and fall. Keep your main walkways clear and avoid using rugs in high-traffic areas.
- Limit light pollution: too much light can be distracting and can affect how well your body adjusts to the natural day-light cycle. Try to use only very low-light night lights, put up blackout curtains if you have lots of external light, and/or use an eye mask to keep your eyes shielded.
- Don’t use electronic devices: this goes along with light pollution. Cell phones and tablets produce blue light that can interfere with your ability to get good sleep. Try not to use them in your bedroom or for 30-60 minutes before you plan to go to bed.
- Choose your temperature: body temperature regulation can be more difficult for older people, so getting your bedroom temperature right is important. Normally a cooler bedroom is recommended, but this is subjective. Find the temperature that works for you and make sure your thermostat is set so that your bedroom is already at that temperature when bedtime arrives.
- Consider subtle scents: an essential oil can add a light scent to your bedroom, and some smells can enhance calm.
Enhance Your Sleep Routine
Part of what affects your ability to sleep well at night is how well you prepare yourself for sleep. This includes what you do during the day as well as in the immediate lead-up to bedtime.
- Eliminate or limit naps: napping can make it harder to sleep at night. If you need to nap, make sure it’s before 3 PM and keep it under an hour.
- Get exercise: daily exercise can deliver many wellness benefits including promoting healthy sleep. It doesn’t have to be intense exercise; even walking or gardening can be beneficial.
- Take in some sun: getting some time outside and in daylight can help synchronize your body’s internal clock with your local day-night schedule.
- Have a set time for going to bed and waking up: a regular routine promotes consistency and makes it easier for your body to adjust. Stick to this schedule every day, even on holidays or weekends.
- Have a pre-bed routine: each night before you go to bed, go through the same set of steps to get yourself prepared. This sequence signals to your mind and body that bedtime is approaching. The steps can include things that make sleep easier like relaxation techniques (meditation, journaling, deep breathing) or having a warm cup of sleepytime tea.
- Restrict activities in bed: you want to associate your bed with sleep, and other activities like watching TV or eating can detract from that association. It’s fine to make an exception for sex, but try to limit any other activities in bed besides sleep and sex.
- Limit alcohol and caffeine: these can both interfere with sleep quantity and quality, so try to limit your intake, especially in the late afternoon and evening.
Learn More About Aging and Sleep
Health In Aging: This website, a service of the Health in Aging Foundation of the American Geriatrics Society, is a resource for science-based information on a diverse array of topics.
MedlinePlus: Older Adult Health: This is a useful portal to evidence-based websites curated by MedlinePlus, a service of the U.S. National Institutes of Health (NIH).
Mayo Clinic: Healthy Aging - What to Expect: This page from the Mayo Clinic describes some of the most common health challenges that seniors face, why they happen, and tips for managing them.
Biology of Aging
The Merck Manual for Consumers: Overview of Aging: This detailed resource describes how the aging process affects different systems of the body and the implications of those changes for overall wellness.
The State of Aging in America: Data Briefs: This research program from the U.S. Centers for Disease Control and Prevention (CDC) reviews known data about the impact of chronic disease in the older population.
U.S. National Institute on Aging (NIA): Safe Use of Medicines for Older Adults: This resource introduces critical tips to help older adults use medicines in a way that promotes both safety and effectiveness.
ACPA: Consumer Guide to Pain Medications and Treatments: This list of videos from the American Chronic Pain Association delves into medications to treat pain and the benefits and downsides that accompany their use.
Eldercare Locator: Eldercare Locator is a service of the U.S. Administration on Aging that is built to help connect older adults and their caregivers to vital local services in areas such as housing, transportation, legal rights, and more.
AARP: AARP is a leading organization representing older adults in the U.S. The group provides a huge range of services related to all aspects of senior living. AARP also advocates in government for policies that benefit older adults.
Harvard University: Sleep Health and Education: This page from Harvard’s Sleep Medicine program includes well-researched background information about critical sleep topics.
The National Sleep Foundation (NSF): This organization promotes better sleep through its website that has articles and links to various resources for further optimizing your sleep each night.
Psychology Today: Cognitive Behavioral Treatment for Insomnia (CBT-I) Defined: Allison Siebern Ph.D., a board-certified sleep psychologist and Assistant Professor at Stanford University, offers an introduction to CBT-I in this article published by Psychology Today.
Depression and Anxiety
Anxiety and Depression Association of America (ADAA): Support Groups: This page from ADAA contains links to organizations that provide support services to people affected by depression and anxiety. The page also has tips for starting up your own support group.
Restless Leg Syndrome
Restless Legs Syndrome Foundation (RLSF): The RLS Foundation is a nonprofit agency that strives to help people understand RLS, share information about treatment, and promote research to combat the condition.
American Sleep Apnea Association (ASAA): This organization focuses on improving health for people affected by sleep apnea. They promote research studies, share information, and have resources to help people who cannot afford medical equipment to combat sleep apnea.
NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center: The ADEAR Center has vital information for people with dementia as well as caregivers and doctors. Services are available by phone, mail, and e-mail.
The Parkinson’s Foundation: This nonprofit group shares information about Parkinson’s Disease, living with the condition, how to find excellent medical care, and new directions in disease research.
University of California Television: Sleep and Aging: This video about aging and sleep features an hour-long presentation by Dr. Jose Loredo, a doctor at UC San Diego who has a specialty in sleep medicine.
Harvard Medical School: the Art of Aging Well: This roughly 90-minute video features multiple experts from the Harvard Medical School reviewing different aspects of healthy aging and new avenues in aging research.
CDC: Healthy Aging - Promoting Well-being in Older Adults: This video comes from the CDC’s Public Health Grand Rounds series and delves into some of the most important health topics for the growing population of older adults in the United States.