Ageing & Sleep

Things you should know:

• Older people need about the same amount of sleep as younger adults.
• Age increases the risk of some sleep disorders.
• Medical conditions that arise with ageing can disrupt sleep.
• Sleeping tablets are best used only for short periods of time.
• Older people often take daytime naps as well as sleeping at night.
• Sleep/wake routines, daytime activity, and sunshine all help sleep.

How do older people sleep differently?

Certain sleep changes can be expected as we age. However, major changes in sleep are likely due to things that occur at all ages, such as stress and changes in lifestyle, or health changes that commonly co-occur with ageing. These include chronic pain, medication changes, and/or chronic illness: all of which we can do something about.

Most older adults require the same amount of sleep as all adults, around 7-8 hours a night. However, many older adults will fall asleep and wake earlier in the day. They tend to find falling asleep at night takes longer and wake more during the night than when they were younger, and, around 20-60% of older people have at least one 30-60-minute nap every day. Most people over the age of 80 nap for more than one hour each day.

Why does sleep change as we age?

Sleep changes as we age for two broad reasons: common and intrinsic age-related change, and; changes due to ill health or stress.

Common and intrinsic age-related changes to sleep. After middle age, our body clock gradually changes (see Body Clock). As we age, the hormones that help us sleep are released earlier in the day. As a result, some older adults may feel sleepy earlier than they used to and wake up in the early hours of the morning (see Advanced Sleep Phase Disorder). Melatonin is a hormone that is produced naturally in the body at night that promotes sleep. Older people make less melatonin so they may take longer to fall asleep.

Additionally, when we retire and/or our children have grown, we may become less active. After retirement, many people find it convenient to take a short nap during the day, which can reduce the need for sleep at night. Sleep problems tend to increase when there is not enough exercise or interesting activities during the day or people go to bed too early.

Change in sleep due to health or stress. Many health conditions can make it harder to sleep. Some that are common in older people are arthritis, osteoporosis, Parkinson’s, incontinence (see Nocturia), indigestion, heart disease, and lung diseases such as asthma or COPD. The drugs used to treat these conditions may also interfere with sleep. Anxiety and depression can both interfere with getting off to sleep and cause wakefulness during the night. Dementia or Alzheimer’s disease can make sleep worse (see Dementia and Sleep) and poor sleep is a risk-factor for dementia. Two-thirds of nursing home residents have problems with their sleep.

Other factors may interfere with sleep and cause awakenings during the night. These include hot flushes in postmenopausal women (see Menopause and Sleep) and the need to go to the toilet during the night. Pain may make it difficult to stay in one position for the whole night.

Furthermore, ageing is a time of transition, e.g., retirement, children grow and leave, loved ones pass away, we move homes due to health or downsizing, and finances can become stressful. While many are normal parts of ageing, these can bring about grief and/or stress that impacts sleep.

What sleep problems are common in older adults?

Approximately 22-54% of older people have sleep apnoea (see Sleep Apnoea), a further 4-11% have periodic limb movement disorder (see Periodic Limb Movements of Sleep), and 17 to 60% experience Insomnia for more than 3 months. These problems often disturb the sleep of the bed partner as well.

What can I do to improve my sleep?

No matter your concern about sleep, your first step can be monitoring your sleep using a sleep diary. A sleep diary can help you to isolate simple factors such as napping too long, drinking alcohol before bed, or pets waking you that you can change on your own.

You may be able to deal with many common and simple sleep ailments with some small changes. Simple things that can be done to improve sleep include keeping regular sleep hours by going to bed at about the same time every night and getting out of bed at about the same time every morning. An alarm clock can help with this as can aiming to spend only the time in bed that you need for sleep (e.g.,8 hours).  

If you happen to wake early and can’t get back to sleep, think about getting out of bed and starting your day. Regular sleep habits strengthen your Body Clock’s sleep-wake rhythm. Exposure to sunlight during the morning and late afternoon also help your body clock. Exercise during the day will help you to feel sleepier at night. See Sleep Hygiene: Good Sleep Habits. Take care with naps: an afternoon nap may help your energy levels but may also interfere with sleeping at night. Naps can be a problem if they are late in the afternoon or last longer than 15-20 minutes.

The best approach is to experiment to find what works for you. It is important to remember that sleep needs and sleep patterns change with age and different circumstances.

Where and when should you seek help?

Even If you have noticed changes in your sleep as you’ve grown older, if you’re feeling refreshed and have enough energy to complete activities throughout the day, don’t worry!

However, if you have persistent problems, believe your sleep issues may be due to poor health, your sleep problems are affecting your daytime wellbeing (see Insomnia),your mood or ability to concentrate (See Memory, Thinking and Sleep), or you are always feeling sleepy during the day (see Excessive Daytime Sleepiness), talk to your local doctor. None of these is a normal result of ageing. You should also seek help if your partner notices something wrong with your breathing during sleep. There are effective treatments for snoring, sleep apnoea and insomnia.

How are sleep disorders treated?

Treatment for a sleep problem depends on the cause, so the issue must be diagnosed before treatment commences. Talking to a doctor about sleep problems is important. You might need a referral to see a sleep specialist. There are a variety of effective treatments for snoring, sleep apnoea, restless legs, insomnia, and other common sleep problems. If you have insomnia, your doctor might recommend that you see a psychologist who specialises in Cognitive Behaviour Therapy for insomnia (CBT-i). Alternatively, your doctor may prescribe melatonin (a synthetic version of the hormone naturally produced by your body). Sleeping tablets, on the other hand, are effective for just a short time, and should not be used for longer than four weeks. You may find it difficult to stop taking them, and they may also make you drowsy the following day. Sleeping tablets also increase the risk of falls in some older people.

Can anything else cause symptoms of poor sleep?

Poor sleep may not simply be related to getting older. Stress, depression, anxiety, medications, pain and many other factors may all contribute. Remember that good sleep is vital for good health, and any concerns you have are best raised with your doctor.

Where can I find out more?

https://www.sleepfoundation.org/articles/aging-and-sleep

https://www.sleepfoundation.org/sleep-deprivation/lack-of-sleep-and-cognitive-impairment

Download a PDF of this Fact Sheet

Other useful links:

• Body Clock
• Melatonin
• Menopause and Sleep
• Common Sleep Disorders
• Advanced Sleep Phase Disorder (ASPD)
• Obstructive Sleep Apnoea (OSA)
• Periodic Limb Movements of Sleep (PLMS)
• Insomnia
• Cognitive Behavioural Therapy for Insomnia (CBT-I)
• Nocturia
• Anxiety and Sleep
• Depression and Sleep
• Mental Health and Sleep
• Dementia and Sleep
• Excessive Daytime Sleepiness
• Napping
• Snoring
• Restless Legs Syndrome (RLS)
• Sleeping tablets
• Pain and Sleep
• Sleep Study
• Sleep Hygiene: Good Sleep Habits