Aging and Sleep

Sep 17, 2024

Fact Checked

Learn about the relationship between age and sleep to understand what’s normal—and what’s not.

Medical Reviewer: Chester Wu, MD

Reviewed by: Susan Stiles, PhD, Senior Director of Healthy Aging Innovations at NCOA

As we age, our sleep patterns change, but our ability to sleep shouldn’t. Your brain needs sleep to regulate your body, restore energy, and repair damage. Without a healthy amount of sleep, you’re left vulnerable to health conditions that accelerate aging and make it difficult to safely age in place.

Key Takeaways

Most older adults need at least seven hours of sleep every night.
Roughly 50% of older adults struggle to fall and stay asleep.
Studies report that anywhere from 20% to 60% of older adults take daytime naps.
An estimated 46% of older adults take five or more prescription medications, which may negatively influence sleep. ^[3] ^[4]
Regularly sleeping less than six hours per night may be linked to dementia and stroke-related brain changes as early as middle age. ^[2]

How does aging affect sleep?

Our sleep cycles and circadian rhythms are expected to change as we age. It’s normal for older adults to experience less total sleep time, sometimes caused by more disruptions during sleep.

You may also experience less time in stage three non-REM and REM sleep, influencing how the brain recovers, learns, and stores memories. Many older adults find that it takes longer to fall asleep initially, but getting back to sleep is usually not an issue. Research has found that the time it takes to return to sleep after waking is consistent for both older and younger adults. ^[9]

Do older people need more sleep?

It’s a common misconception that older adults sleep more than younger people. Adults of all ages need the same amount of sleep each night. But because older adults often experience poor sleep quality and continuity, they may need to spend more time in bed to achieve sufficient sleep duration overall and minimize the risk of daytime drowsiness.

The misconception that older adults need more sleep may be based on the prevalence of daytime drowsiness and excessive sleep. While not a normal part of aging, they are common. Excessive sleep is generally defined as ten or more hours of sleep per day or night. Research showed a 23% prevalence of excessive sleepiness among older adults (average age of 84), and many cases of daytime sleepiness are associated with frequent sleep disturbances during the night. Additionally, 20-60% of older adults report taking daytime naps, often to make up for sleep issues at night.

Unfortunately, too much sleep is linked to many of the same health conditions as too little sleep, like heart issues and increased falls risk. ^[25]Miner, Brienne, et al. The Epidemiology of Patient-Reported Hypersomnia in Persons with Advanced Age. Journal of the American Geriatrics Society. August 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898735/ rnrn

A 2021 study summarized research findings that link sleep deficiency with accelerated aging and disease onset, including heart issues and cancer.

As we age, our body tissues naturally experience damage. Our immune system has an inflammatory response to remove these damaged cells. This process occurs more as we age, but if we can’t remove the damage efficiently, it accumulates and promotes a chronic state of inflammation. The abnormal accumulation of damaged cells and inflammation as we age is called inflammageing. ^[1] ^[11]

Sleep regulates the immune system and its inflammatory response, which is important in removing damaged cells. Those with sleep deficiency have a higher risk of inflammageing. Adults who reported six hours or less of sleep nightly show more accumulation of tissue damage than those who got the recommended seven hours of sleep. ^[23] One study showed genetic damage in older adults after only one night of four-hour sleep, which remained despite the participants getting enough rest the following night. ^[22]

Do older people need less sleep?

No, older people don’t need less sleep. Seven hours of sleep is adequate for most older adults, but changes in sleep patterns can influence whether they get their recommended seven hours. ^[3]

Timing can shift in older adults as well. As you age, you’ll find that your circadian rhythm shifts forward in time. This phenomenon is called phase advance and causes older adults to feel awake earlier in the morning and drowsy earlier in the evening than younger adults. ^[3]

Sleep issues in older adults

Both old and newer research shows that many factors contribute to disordered sleep, and some are more common as we age. ^[15] ^[16] ^[17]
Some of the most frequent contributors to sleep concerns include:

Back, neck, or joint pain
Worry, anxiety, and depression
Neurodegenerative disorders, like dementia and Alzheimer’s
Sleep apnea or disordered breathing at night
Restless leg syndrome, or the urge to move your limbs often
Nocturia, or having to urinate at night
Stimulating medications or medication interactions
Decreased sunlight exposure
Decreased physical activity

Many of these factors are controllable. Kriebel-Gasparro highlighted multiple ways daytime habits can contribute to nocturia, for example. Taking diuretic medications or fluids before bedtime (alcohol, tea, coffee) can have you running to the bathroom throughout the night. Take diuretic medications first thing in the morning, not in the evening, unless otherwise prescribed. And be sure to limit fluid intake, especially diuretic beverages like the ones listed above, in the evening.

“Other medications that can keep us awake include some antidepressants, like Prozac or Celexa, and cold medications, like Sudafed,” Kriebel-Gasparro said. “Of course, checking in with your health care provider, especially a geriatrician or geriatric nurse practitioner, to discuss any problems with sleep and strategies is essential for health.”

Sleep and chronic pain

Sleep and pain are connected by what is called a bidirectional relationship, which means they affect each other. As stated by Neuropsychopharmacology, chronic pain can make sleep issues worse, while it is also true that inadequate sleep can play a role in worsening chronic pain. Finding ways to address chronic pain with the help of your healthcare provider is one way older adults can improve their sleep and their overall well-being. Creating a comfortable sleep environment, including switching to the best mattress for back pain, may be a part of your plan for getting better sleep.

Sleep and depression

Sleep and depression have a two-way relationship. A review of relevant studies showed that sleep disturbance is a major symptom of depression. But disturbed sleep, particularly during your mood-balancing REM sleep, can also be the cause of depression. ^[12] Naturally occurring age-related changes to sleep patterns leave older adults vulnerable since they spend less time in REM sleep. ^[3]

Researchers have agreed on the relationship between sleep and depression, but there’s no consensus on how the two are linked or how to treat both issues best. There is some evidence specific to older adults, though. Research has found that older adults with depression and insomnia benefitted from cognitive behavioral therapy for insomnia (CBT-I) ⓘA type of talk therapy centered on making positive changes in both thinking and behavior., with significantly fewer symptoms at the 20-week follow-up visit. ^[13]

Sleep and dementia

“Disrupted sleep could increase the risk for neurodegenerative brain diseases,” warned Ann Kriebel-Gasparro, DNP, president-elect of the Gerontological Advanced Practice Nurses Association. Research has connected disturbed sleep and sleep-disordered breathing (like sleep apnea) with a higher risk for different types of dementia, a neurodegenerative condition that permanently impacts memory, thinking, and physical function. ^[14] Unfortunately, there is no cure for dementia, but there are disease management strategies.

Kriebel-Gasparro explained that sleep disturbance can increase beta-amyloid, a protein that accumulates in the brains of people with Alzheimer’s disease and other forms of dementia. Without adequate sleep, your body can’t keep up with beta-amyloid protein removal, triggering disease onset. Neurodegenerative damage can start young. Middle-aged adults who sleep less than six hours per night show changes in the brain that have been linked to declining brain health and medical conditions, like dementia or stroke. ^[2]

Like sleep and depression, sleep and dementia also have a two-way relationship. The same research series stated that altered sleep patterns are a hallmark sign of dementia, possibly due to changes in parts of the brain that control the circadian rhythm. This cyclical relationship is difficult to manage, but understanding it is the first step to developing the right treatment. ^[14]

Sleep tips: How older adults can get better sleep

If you notice negative changes in your sleep patterns, don’t wait to make changes until it impacts your daily life. Identify what triggers a bad night’s sleep and make small adjustments to your habits to prevent developing a sleep disorder.

Graphic describing strategies for better sleep

10 strategies to improve your sleep hygiene

Those who practice good sleep hygiene establish daily and nightly habits that promote quality sleep. In most cases of insomnia, addressing sleep hygiene is the first approach. ^[17] For some sleepers, this may look like choosing the best mattress for older adults to accommodate changing comfort needs. Discovering the ideal mattress includes finding an option suited for your preferred sleep position, such as the best mattress for side sleepers or a medium-firm mattress for sleeping on your back.

We asked Kriebel-Gasparro about the advice she gives to her patients to improve their sleep. We also consulted the Journal of General and Family Medicine and the Sleep Hygiene Index (a clinical test that scores your sleep hygiene practices) to develop sleep hygiene tips to address common causes of sleep disturbance in older adults. ^[17] ^[18]

10 ways to improve your sleep hygiene are:

Establish a regular sleep schedule: Go to bed and wake up at the same time every day, and as soon as you wake up, get out of bed and start your day. Getting in and out of bed at different times daily can jumble your sleeping patterns.
Avoid alcohol at night: Alcohol can promote sleep for some people, but you’ll be likelier to wake at night to use the bathroom. Try not to drink alcohol within four hours of bedtime.
Avoid caffeine in the evening: Caffeine can make it difficult to fall asleep, as well as lead to more bathroom visits during the night. One study found that caffeine disrupts sleep even after six hours, so it’s best to avoid drinking coffee, tea, or soda after noon. ^[19]
Eat regular meals: Schedule three meals daily with light snacks if you feel hungry, but avoid eating heavy meals before bedtime.
Limit fluid intake before bed: If you need to use the bathroom often at night, avoid liquids before you sleep and prioritize water intake in the morning instead. If you have heart or circulation problems, talk to your doctor before starting this practice, as it can influence these conditions.
Stay away from electronics before bed: Watching the news or browsing social media can be stimulating, and sometimes upsetting, which will impact sleep quality. If you watch television or read during the day, avoid doing so in bed. Designate the bed for sleep, relaxing, and intimate activities only.
Make the bedroom a quiet, relaxing area: Sleep in a dark, quiet environment with a comfortable temperature of about 75 degrees Fahrenheit. If your bed is uncomfortable, consider upgrading your bed with a better mattress or an adjustable base.
Exercise regularly: Aerobic exercise in the morning, like walking and biking, improves the ability to fall asleep at night. But exercising to the point of sweating before bed may keep you awake.
Get more sunshine: Your brain regulates your sleep patterns using daylight, so step outside and open your blinds during the daytime.
Manage your worries: If your mind is racing before bed, list your to-dos to get them out of your head. You can address them in the morning when you’re well-rested. If you need more support for your racing thoughts, consider talking to a therapist who can offer solutions.

When to talk to your doctor

It’s time to talk to your doctor when your sleep habits worsen and you notice increased difficulty falling or staying asleep. It’s especially important to talk to your doctor if you notice daytime behavior changing due to poor sleep, like altered mood, mental fogginess, or feeling physically unsteady.

If you have a sleep diary or any sleep-tracking information, remember to take it with you when you see your doctor. Kriebel-Gasparro also recommended documenting any personal or family history of depression, anxiety, bipolar disorder, previous sleep disorder diagnoses, or history of brain trauma or concussion. “It is best to be honest with your provider, as they will be able to help you better if they know your history. Everything you share will be confidential,” she said.

Download our PDF sleep health packet below to track your sleep.

Final thoughts

Not sure where to start? Print our Sleep Packet and start keeping your sleep diary, documenting each day honestly and completely. “If you have concerns about your sleep, be sure to speak to your provider for recommendations on lifestyle changes, medications, or supplements that can help you get quality sleep and improve your brain health,” said Kriebel-Gasparro.

Have questions about this review? Email us at reviewsteam@ncoa.org.

Sources

Carroll, Judith E. and Prather, Aric A. Sleep and Biological Aging: A Short Review. Current Opinion in Endocrine and Metabolic Research. June 2021. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658028.
Yaffe, Kristine, et al. Sleep Duration and White Matter Quality in Middle-Aged Adults. Sleep. September 2016. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989263.
Miner, Brienne and Kryger, Meir H. Sleep in the Aging Population. Sleep Medicine Clinics. March 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300306.
Delara, Mahin, et al. Prevalence and Factors Associated with Polypharmacy: A Systematic Review and Meta-Analysis. BMC Geriatrics. July 2022. Found on the internet at https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03279-x.
Brain Basics: Understanding Sleep. National Institute of Neurological Disorders and Stroke. Found on the internet at https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep.
Zisapel, Nava. New Perspectives on the Role of Melatonin in Human Sleep, Circadian Rhythms, and Their Regulation. British Journal of Pharmacology. August 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057895.
What Happens During Sleep? National Institute of Child Health and Human Development. Found on the internet at https://www.nichd.nih.gov/health/topics/sleep/conditioninfo/what-happens.
Eugene, Andy R. and Masiak, Jolanta. The Neuroprotective Aspects of Sleep. MEDtube Science. November 2015. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651462.
Klerman, Elizabeth B, et al. Older People Awaken More Frequently But Fall Back Asleep at the Same Rate as Younger People. Sleep. June 2004. Found on the internet at https://academic.oup.com/sleep/article/27/4/793/2696955.
Li, Xiaoyu, et al. Association Between Sleep Disordered Breathing and Epigenetic Age Acceleration: Evidence from the Multi-Ethnic Study of Atherosclerosis. eBioMedicine. December 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6921369.
Ferrucci, Luigi and Fabbri, Elisa. Inflammageing: Chronic Inflammation in Ageing, Cardiovascular Disease, and Frailty. Nature Reviews Cardiology. September 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146930.
Fang, Hong, et al. Depression in Sleep Disturbance: A Review on a Bidirectional Relationship, Mechanisms and Treatment. Journal of Cellular and Molecular Medicine. February 2019. Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1111/jcmm.14170.
Sadler, Paul, et al. Cognitive Behavior Therapy for Older Adults with Insomnia and Depression: A Randomized Controlled Trial in Community Mental Health Services. Sleep Research Society. August 2018. Found on the internet at https://academic.oup.com/sleep/article/41/8/zsy104/5003056?login=false.
Ward, Stephanie A. and Pase, Matthew P. Advances in Pathophysiology and Neuroimaging: Implications for Sleep and Dementia. Respirology. November 2019. Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13728.
Gulia, Kamalesh K. and Kumar, Velayudhan Mohan. Sleep Disorders in the Elderly: A Growing Challenge. Psychogeriatrics. May 2018. Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1111/psyg.12319.
Burns, Angus C., et al. Time Spent in Outdoor Light is Associated With Mood, Sleep, and Circadian Rhythm-Related Outcomes: A Cross-Sectional and Longitudinal Study in Over 400,000 UK Biobank Participants. Journal of Affective Disorders. December 2021. Found on the internet at https://www.sciencedirect.com/science/article/abs/pii/S0165032721008612.
Suzuki, Keisuke, et al. Sleep Disorders in the Elderly: Diagnosis and Management. Journal of General and Family Medicine. April 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689397.
Mastin, David F., et al. Assessment of Sleep Hygiene Using the Sleep Hygiene Index. Journal of Behavioral Medicine. July 2006. Found on the internet at https://www.researchgate.net/publication/7222661_Assessment_of_Sleep_Hygiene_Using_the_Sleep_Hygiene_Index.
Drake, Christopher, et al. Caffeine Effects on Sleep Taken 0, 3, or 6 Hours before Going to Bed. Journal of Clinical Sleep Medicine. November 2013. Found on the internet at https://jcsm.aasm.org/doi/10.5664/jcsm.3170.
Moreland, Briana L., et al. A Descriptive Analysis of Location of Older Adult Falls That Resulted in Emergency Department Visits in the United States, 2015. American Journal of Lifestyle Medicine. November 2021. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8669898.
ADA National Network. Accessible Lodging. February 2017. Found on the internet at https://adata.org/factsheet/accessible-lodging.
Miaskowski, Christine, et al. A Biopsychosocial Model of Chronic Pain for Older Adults. Pain Medicine. September 2020. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/31846035.
Carroll, Judith E., et al. Partial Sleep Deprivation Activates the DNA Damage Response (DDR) and the Senescence-Associated Secretory Phenotype (SASP) in Aged Adult Humans. Brain, Behavior, Immunity. January 2016. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679552.
Liang, Geyu, et al. Associations Between Rotating Night Shifts, Sleep Duration, and Telomere Length in Women. PLOS One. August 2011. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154494.
Miner, Brienne, et al. The Epidemiology of Patient-Reported Hypersomnia in Persons with Advanced Age. Journal of the American Geriatrics Society. August 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898735.
Sewerynek, Ewa. Melatonin and the Cardiovascular System. Neuroendocrinology Letters. April 2022. Found on the internet at https://www.nel.edu/userfiles/articlesnew/NEL230702R10.pdf.

Nicole Hernandez is a writer and physical therapist who empowers people to make informed decisions about their health as a writer and clinician. She has written for NCOA, AginginPlace.org, and physical therapy clinics to educate readers on fall and injury prevention, rehabilitation, home modifications, and other clinical themes including hearing aids and medical alert systems.

Dr. Chester Wu is board certified in Psychiatry and Sleep Medicine, training at Baylor College of Medicine and Stanford University School of Medicine, respectively. He has since established his own private practice in Houston, TX where he provides psychiatric and sleep medicine services.

Was this helpful?

Thank you for your feedback!