The number of older adults in the United States is expected to grow significantly over the next several decades. In fact, while people over 65 made up about 15% of the U.S. population in 2016, they’re expected to make up over 21% of the population by 2040. This trend is also playing out globally, as the United Nations estimates that the amount of people over 60 will double by 2050 and triple by 2100.
Aging is tied to numerous health concerns, including sleep difficulties. In fact, poor sleep can contribute to many of these problems, reducing quality of life in people over 65.
In order to address the unique needs of older adults, it’s more important than ever to understand the effects of aging on health. Since almost one third of our lives are spent sleeping, reviewing the relationship between aging and sleep is a fundamental part of promoting overall health in the elderly.
Why Does Aging Affect Sleep?
It’s common for older adults to experience changes in the quality and duration of their sleep. Many of these changes occur due to changes in the body’s internal clock. A master clock in a part of the brain called the hypothalamus is composed of about 20,000 cells that form the suprachiasmatic nucleus (SCN).
The SCN controls 24-hour daily cycles, called circadian rhythms. These circadian rhythms influence daily cycles, like when people get hungry, when the body releases certain hormones, and when a person feels sleepy or alert.
As people get older, their sleep changes due to effects of an aging SCN. Deterioration in the function of the SCN can disrupt circadian rhythms, directly influencing when people feel tired and alert.
The SCN receives information from the eyes, and light is one of the most powerful cues for maintaining circadian rhythms. Unfortunately, research shows that many older people have insufficient exposure to daylight, averaging around one hour each day. Daylight exposure may be even more restricted for people who live in nursing homes as well as those with Alzheimer’s disease.
Changes in production of hormones, such as melatonin and cortisol, may also play a role in disrupted sleep in older adults. As people age, the body secretes less melatonin, which is normally produced in response to darkness that helps promote sleep by coordinating circadian rhythms.
Health Conditions and Sleep
Mental and physical health conditions may also interfere with sleep. Conditions that commonly affect sleep in older people include depression, anxiety, heart disease, diabetes, and conditions that cause discomfort and pain, such as arthritis.
The relationship between physical health and sleep is complicated by the fact that many older adults are diagnosed with more than one health condition. In fact, the 2003 National Sleep Foundation Sleep in America Poll looked at 11 common health conditions and found that 24% of people between 65 and 84 years old reported being diagnosed with four or more health conditions. Those with multiple health conditions were more likely to report getting less than six hours of sleep, having poor sleep quality, and experiencing symptoms of a sleep disorder.
Sleep issues may also be related to the side effects of medications. Almost 40% of adults over the age of 65 take five or more medications. Many over-the-counter and prescription drugs can contribute to sleep issues. For example, antihistamines and opiates may cause daytime drowsiness, while medications such as antidepressants and corticosteroids may keep older people awake and contribute to the symptoms of insomnia. The interactions of multiple medications may cause unanticipated effects on sleep.
Lifestyle and Sleep
Poor sleep quality in seniors can be related to the lifestyle changes that often come with aging. For example, retirement leads to less working outside of the home and possibly more napping and less of a structured sleep schedule. Other significant life changes, such as loss of independence and social isolation, can increase stress and anxiety, which can also contribute to sleep issues.
How Does Aging Affect Sleep?
Aging affects people differently. While some older adults may have no significant disruptions in their sleep, others complain about getting less sleep and having worse sleep quality. Experts have found several common sleep disturbances in older adults:
- Shifting sleep schedule: As people age, the body’s circadian rhythms actually shift forward in time. This shift is called a phase advance. Many older adults experience this phase advance as getting tired earlier in the afternoon and waking up earlier in the morning.
- Waking up at night: Research has also shown that as people get older, they often experience changes in their sleep architecture. Sleep architecture refers to how people cycle through the different stages of sleep. Older adults spend more time in the earlier, lighter stages of sleep and less time in the later, deeper stages. These shifts may contribute to older people waking up more often during the night and having more fragmented, less restful sleep.
- Daytime napping: Research estimates that about 25% of older adults take naps, compared with around 8% of younger adults. While some experts suggest that a short daytime nap may be beneficial, many agree that extended napping and napping later in the day can make it harder to fall asleep at bedtime and create nighttime sleep disruptions.
- Longer recovery from changes in sleep schedule: Alterations in how the body regulates circadian rhythms make it more difficult for older people to adjust to sudden changes in their sleep schedules, like during daylight savings time or when experiencing jet lag.
Do Older People Need Less Sleep?
According to the National Institution on Aging, it is considered a myth that older adults require less sleep than younger individuals. Many older adults have a hard time getting the sleep they need, but that doesn’t mean they need less sleep. The amount of sleep that a person needs can decrease from infancy to adulthood, but this trend appears to stop around age 60. The National Sleep Foundation guidelines advise that people over 65 should get seven to eight hours of sleep each night.
Common Sleep Issues in Seniors
Researchers estimate that between 40% and 70% of older adults have chronic sleep issues and up to half of cases may be undiagnosed. Chronic sleep problems can significantly interfere with older adult’s daily activities and reduce their quality of life. Common sleep issues in older adults include:
- Pain: Discomfort and pain can lead to inadequate rest for some older adults. Pain and sleeplessness can become a vicious cycle, in which less sleep can lead to more pain, so it’s important to talk to a doctor if pain is interfering with sleep.
- Nighttime urination: Nighttime urination, also called nocturia, increases with age due to physical changes in the urinary system among other factors. This issue may affect up to 80% of older adults, contributing to increased sleep disruptions.
- Insomnia: Having persistent difficulty in falling or staying asleep is one of the most common sleep issues in older adults. Insomnia may be caused by a variety of overlapping factors but can get better with treatment.
- Daytime drowsiness: Many people believe that feeling tired during the day is a normal part of getting older, but this is not the case. Around 20% of older people experience excessive daytime sleepiness, which may be a sign of an underlying health condition rather than merely old age. Excessive daytime sleepiness in older adults may be a symptom of health issues like sleep apnea, cognitive impairment, or cardiovascular issues.
- Sleep Apnea: Obstructive sleep apnea can cause pauses in breathing during sleep. These pauses are related to a repeated collapse (apnea) or partial collapse (hypopnea) of the upper airway. Sleep apnea causes fragmented sleep and can affect oxygen levels in the body, leading to headaches, daytime sleepiness, and difficulty thinking clearly.
- Restless Leg Syndrome: Restless leg syndrome (RLS) affects 9% to 20% of older people, while periodic limb movements of sleep (PLMS) affects 4% to 11%. RLS causes an urge to move the legs while resting or sleeping. PLMS causes involuntary movements in the lower limbs, most commonly in the feet. Both disorders can significantly impact sleep and overall quality of life.
- REM sleep behavior disorder: REM sleep behavior disorder (RBD) primarily affects older people. While most people’s bodies are still while they’re dreaming, this disorder can cause people to act out their dreams, sometimes violently.
Sleep Tips for Seniors
Research has shown that older people can take steps to improve their sleep. These steps often involve focusing on improving sleep hygiene and developing habits that encourage quality sleep. Here are a few tips for getting a better night’s rest in your golden years:
- Exercise: Older people who exercise regularly fall asleep faster, sleep longer, and report better quality of sleep. Exercise is one of the best things older people can do for their health. The National Institute of Aging offers helpful tips for exercising safely as an older person.
- Reduce bedroom distractions: Televisions, cellphones, and bright lights can make it more challenging to fall asleep. Keep the television in another room and try not to fall asleep with it turned on. Move electronics out of the bedroom and reserve the bedroom for only sleeping and sex.
- Avoid substances that discourage sleep: Substances like alcohol, tobacco, caffeine, and even large meals late in the day can make sleep more challenging. Try quitting smoking, reducing caffeine intake, and eating dinner at least four hours before bedtime.
- Keep a regular sleep schedule: Remember that aging makes it more difficult to recover from lost sleep. Avoid sudden changes in sleep schedules. This means going to bed and waking up at the same time every day and being careful about napping too long.
- Develop a bedtime routine: Find activities that help you relax before bed. Many older people enjoy a bath, reading, or finding some quiet time before getting into bed.
Safe Sleeping for Seniors
Insufficient sleep in older adults can lead to a higher risk of falls and accidents. As people age, it’s helpful to make changes to the bedroom environment that reduce the risk of accidents and makes it easier to call for help when needed. Here are some steps to consider for a safer night’s sleep:
- Keep a telephone by the bed: It’s important to be able to call for help from bed. Put a phone on the nightstand and, even better, keep a list of important phone numbers nearby. Be careful about keeping a cell phone nearby particularly if it receives too many notifications during the night or if there’s too much temptation to look at the bright screen.
- Make sure a light is within reach: Having a light easily accessible reduces the need to stumble around in the dark when getting out of bed. This can reduce the risk of trips and falls when trying to find the lightswitch. Lights with motion sensors may be helpful in hallways or the bathroom.
- Reduce hazards in the bedroom: Never smoke in bed and be careful when placing objects in the bedroom that may become trip hazards, like rugs, cords, stools, and furniture.