Aging Gracefully and Living Comfortably in Your Later Years-Chapter Five-Sleep Hygiene

Key Takeaways: Sleep, Health and Aging 

• Sleep gets lighter and more disrupted with age. 
• Circadian rhythms and melatonin levels shift throughout our lifetime. 
• Chronic conditions and stress can interfere with sleep. 
• Poor sleep impacts heart, brain and mental health. 
• Small lifestyle changes can lead to better sleep and healthier aging. 

Sleep and Aging

Sleep is a critical component of healthy aging, and as we age, our sleep patterns can change significantly. Older adults often experience lighter, shorter, and more fragmented sleep, which can lead to a higher risk of chronic diseases and cognitive decline. Proper sleep is essential for maintaining physical vitality, mental sharpness, and emotional resilience.
To improve sleep quality in aging, it is recommended to:

• Establish a regular sleep schedule.
• Create a comfortable sleep environment.
• Practice relaxation techniques before bedtime.
• Limit caffeine and alcohol intake before sleep.
• Avoid napping during the day.
  Addressing sleep issues early can help prevent negative health outcomes and promote a better quality of life in older adults.

Why Does Aging Affect Sleep?

It is 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. Located in a part of the brain called the hypothalamus, this internal clock is made of around 20,000 cells that form the suprachiasmatic nucleus (SCN).

The SCN controls 24-hour daily cycles, called circadian rhythms. These circadian rhythms influence 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 and 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. Those with multiple health conditions are 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. The interactions of multiple medications may also cause unanticipated effects on sleep.

Lifestyle and Sleep 

Poor sleep quality in older adults can be related to the lifestyle changes that often come with aging. For example, retirement may lead to a less structured sleep-wake 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.
• 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 saving time or when experiencing jet lag.
• 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.

How Does Aging Affect Our Sleep Cycles? 

We spend about a third of our lives sleeping (or trying to fall asleep). Sleep isn’t just comforting; it’s essential for our health. Here’s what’s happening during our sleep cycles: 

• Stage 1: That hazy drifting-off moment 
• Stage 2: Light sleep — your body relaxes, but you’re still easily awakened 
• Stage 3: Deep, dreamless sleep — crucial for physical repair 
• REM sleep: Active dreaming and brain processing, marked by rapid eye movements (REM) 

Each of these stages cycles roughly every 90 minutes. So, when you jolt awake at 3 a.m. for no clear reason, you may simply be transitioning between cycles. 

In the early morning hours, your body’s cortisol — a stress hormone — naturally begins to rise, nudging your brain toward wakefulness. As we age, this hormonal shift becomes more noticeable. Combined with changes to our internal clock and a reduced capacity for deep sleep, we’re more likely to wake up and stay awake. 

Younger adults spend about 20% of their sleep in deep sleep, but this drops to 10–15% in older adults.  

Why Your Circadian Rhythm Shifts With Age 

Remember those weekends when you could clock ten hours of uninterrupted sleep after coming home from a late night out? Suddenly, that same routine started producing one yawn-riddled question the next day: “Why am I so tired?”  

Your circadian rhythm is your body’s internal clock. It controls when you feel alert and when you get sleepy. But it changes throughout life at three key stages: 

• Babies: No set rhythm yet. Newborns sleep in short bursts, sometimes up to 18 hours a day. 
• Teens: The clock shifts later, so night-owl adolescents usually stay up and sleep in. 
• Older adults: Sleep rhythms become less steady, making us feel tired earlier in the evening and wake earlier in the morning. 

This rhythm is regulated by the brain’s suprachiasmatic nucleus, which weakens over time. Paired with a decline in sleep-wake homeostasis — the internal system that builds up sleep pressure the longer we’re awake — we end up with more fragmented, lighter sleep. 

Melatonin: The Sleep Hormone 

As we age, our bodies produce less melatonin: the hormone that signals it’s time to sleep. This means we’re more likely to wake up from small disturbances, like needing to use the bathroom (nocturia), anxiety… even that creaky floorboard.  

Do Older People Need Less Sleep?

It is a common misconception that older adults require less sleep than younger individuals. Many older adults have a hard time getting the sleep they need, but that does not mean they need less sleep. In general, adults should aim to get at least seven hours of sleep each night.

Common Sleep Issues in Older Adults

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. There are several sleep issues that are especially common in older adults.

• 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. It is 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 and 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. 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 the upper airway collapsing or narrowing. Sleep apnea causes fragmented sleep and can affect oxygen levels in the body, leading to headaches, daytime sleepiness, and difficulty thinking clearly.
• Restless Legs Syndrome: Restless legs syndrome (RLS) affects 9% to 20% of older people , while periodic limb movement disorder (PLMD) affects 4% to 11%. RLS causes an urge to move the legs while resting or sleeping. PLMD causes involuntary movements in the lower limbs, most commonly in the feet.
• REM Sleep Behavior Disorder: REM sleep behavior disorder (RBD) primarily affects older people. While most people’s bodies do not move while they are dreaming, this disorder can cause people to physically act out their dreams, sometimes violently.
• Have falls or fainting spells. 

How Chronic Conditions and Lifestyle Affect Sleep 

If you’ve ever forgotten where you’ve left your keys, felt unusually negative or gotten overwhelmed by simple daily tasks, there might be a simple answer. Sleep deprivation and stress can be destructive to our bodies and minds, causing physical and mental deterioration. These issues get worse the older we get. 

Research shows that poor sleep increases the risk of conditions like: 

• Heart disease 
• Diabetes 
• High blood pressure 
• Mental health issues 

Sleep Tips for Older Adults

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. 

• 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. 
• Reduce bedroom distractions: Televisions, smartphones, 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. Consider quitting smoking, reducing caffeine intake, and eating dinner at least four hours before bedtime.
• Keep a regular sleep schedule: Aging can make 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 or too close to bedtime.
• Develop a bedtime routine: Find activities that help you relax before bed. Many older people enjoy taking a warm bath, reading, or finding some quiet time before getting into bed.
• Talk to your doctor if you suspect a sleep disorder, medication interference or symptoms of sleep apnea. 

Safe Sleeping for Older Adults 

As people age, it is helpful to make changes to the bedroom environment that reduce the risk of falls and accidents and makes it easier to call for help when needed. There are several steps that older adults can take for a safer night’s sleep.

• Keep a phone by the bed: It is important to be able to call for help from bed. Put a phone on the nightstand and keep a list of important phone numbers nearby. But be careful about keeping a smartphone nearby, particularly if it receives too many notifications during the night or if there is too much temptation to look at the bright screen.
• Make sure a light is within reach: Having a light easily accessible reduces the risk of stumbling, tripping, or falling in the dark when getting out of bed. 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. It is safest to have a clear path from the bed to the door.

Can you have quality sleep as you age?

Difficulty sleeping is not a normal part of aging.

As we age, our circadian rhythms do change, but poor sleep practices can heavily impact both the ability to fall asleep and the quality of sleep. Building healthy routines is important at any age.

The National Institute on Aging explains that the lack of sleep can contribute to high blood pressure, heart disease, diabetes, memory issues, mental health concerns and an increased risk of falls. It is more than just feeling tired; there can be real health concerns.

The team at Sanford Center for Aging offers the Sanford Assessment, a free, community-based health and wellness review for those over the age of 60. In that assessment, the team reviews sleep as part of the full health review. Leslie Baker, Pharm.D., BCGP, director of geriatric pharmacy services; and Shelby Greene, LCSW, MSW, coordinator of clinical social services will ask you:

1. Can you fall asleep?
2. Can you stay asleep?
3. Can you go back to sleep after waking up?
4. Do you wake feeling rested?
5. Do you nap throughout the day?

The answers to these questions can help determine what could be impacting sleep and any health concerns that either contribute to or could be a symptom of exhaustion.

“Being proactive with sleep is better than being reactive,” said Greene. “Any work you do to preemptively build a solid sleep routine will help tenfold compared to trying to salvage poor sleep.”

There are many quick fixes on the market, but do they work? Supplements and medications commonly used to help with sleep include:

• Magnesium: However, there is no good data to support whether magnesium supplements can help with sleep. Magnesium typically relaxes muscles, which is why some think it can help get you to sleep, but excessive magnesium can lead to cardiovascular complications and neurological disorders according to the National Library of Medicine.
• Melatonin: The American Academy of Sleep Medicine (AASM) does not recognize melatonin for sleep therapy. More is not better when it comes to melatonin supplements. Melatonin occurs naturally in the body, but too much melatonin, can negatively impact sleep quality.
• Xanax, Ambien and Benadryl: These may help an individual go to sleep, but the long-term use of these medications to aid in rest can disrupt brain rhythms critical for memory leading to cognitive health decline and a higher risk of dementia according to Harvard Medical School.

“People take sleep for granted and want a quick fix, which is why medications and supplements have gained popularity,” said Baker. “Medical conditions such as sleep apnea can affect sleep. If after following healthy sleep practices you still have difficulty sleeping, it is important to have a conversation with your medical provider.”

The Sanford Assessment team suggests the following steps to better sleep:

1. Build a routine: Going to sleep at the same time and winding down away from technology before going to sleep can greatly improve sleep quality.
2. Reduce caffeine: Caffeine is a stimulant that blocks sleep-inducing chemicals. Older adults clear caffeine from their system at a slower rate than younger persons, which can lead to increased side effects. The amount of caffeine consumed when a person is younger, may not be suitable for an older person.
3. Be recreational-substance smart: Although alcohol may help someone fall asleep, it will not help to stay asleep. As the National Council on Aging points out, alcohol can disrupt the sleep cycle, preventing the deep sleep needed.
4. Cognitive behavioral therapy (CBT): Unlike sleep aids, CBT can help overcome the causes of common sleep issues by re-training the body with skills to relax. There is a lot of evidence-based data to support the success of CBT, but it can be difficult to find clinicians providing this option.

“Ultimately it is important to speak with your primary care physician,” said Greene. “You don’t know what you don’t know – it could be a missing puzzle piece that is representing as poor sleep but could be pain, fatigue, moodiness, weight gain or something else. Ask your doctor questions and include all the things you may be experiencing; don’t dismiss your intuition. You know your body best and together you may find the root cause of your lack of sleep.”

Better sleep means sharper thinking, better moods, fewer health risks, healthier aging — and a more vibrant, independent life.