Sleep and Aging

For older adults, some sleep problems can worsen age-related effects on the brain, heart, and metabolism.

U.S. News & World Report

Sleep changes as we age, and usually not for the better. Some sleep problems can worsen age-related effects on the brain, heart, and metabolism. By 2050, the population over 60 years of age worldwide will surpass 2 billion. Therefore, sleep issues will only increase, contributing to the existing public health crisis known as insufficient sleep.


But there is a silver lining (no pun intended). Treatment can slow down or reverse the physical and mental consequences of sleep disorders and lead to more years of healthier living. Here's how you may be affected.

How Aging Affects Sleep

People over age 60 commonly report sleep complaints. These range from poor quality slumber with frequent night awakenings to snoring, daytime sleepiness, restless legs and more. Sleeping during the daytime can perpetuate the cycle. Bedtimes and wake-up times advance (become earlier), leading to frustrations when sleep timing no longer matches that of the rest of the world.

Retirement can improve sleep quality after years of deprivation, but for some it may have the opposite effect as new retirees adapt to a new lifestyle. These changes can affect mood and increase loneliness.

Medical and psychiatric illness such as heart failure, chronic obstructive pulmonary disease, gastroesophageal reflux and pain, as well as medications, can also wreak havoc on getting a good night’s sleep. Beta blockers (used for high blood pressure and other types of heart disease) can cause nightmares, and diuretics (water pills) increase awakenings to urinate. Most medications have fatigue and daytime sleepiness on the list of common side effects. Steroids and thyroid hormone can cause insomnia.

According to the National Sleep Foundation, people 65 years of age and older should have at least seven or eight hours of sleep per night. Sleep serves many functions that renew and restore every cell in the human body.

In recent years, researchers have discovered one more critical role of sleep in older adults. The glymphatic system is a waste removal center of the central nervous system. During deep slumber, drainage of toxins that accumulate in the brain during the day increases. This cleaning system degrades with age, leaving toxins behind that can contribute to dementia. New research suggests that sleep disruption in middle-aged adults is a predictor of Alzheimer’s disease and related disorders when we age.

So where’s the silver lining, you ask?

Many sleep disorders that increase with age are treatable.

Sleep Disorders With Age

Insomnia affects one-third to nearly one-half of the elderly population. Chronic insomnia is defined as persistent difficulty initiating or maintaining sleep or early morning awakening with inability to return to sleep that leads to impaired daily functioning. It can be difficult to differentiate insomnia from normal age-related sleep changes; this may require consultation with a sleep specialist.

Recent studies found chronic sleep loss in older adults associated with an increased risk of depression and diabetes. Predisposing factors include being divorced or widowed, having a lower educational level, use of alcohol and smoking. Medical conditions, stress and some medications can perpetuate the cycle. Insomnia becomes chronic when we adopt behaviors and thoughts that make poor sleep a habit, such as spending excessive time in bed awake, napping during the day and having anxiety about going to sleep at night.

However, cognitive behavioral therapy for insomnia, or CBTi, is an effective treatment that can be done with a trained sleep psychologist or through a computerized program at home. This type of therapy is usually preferred over sleep medications.

Restless legs syndrome is a sleep-related movement disorder that increases markedly with age, affecting about one in five elderly adults. Most people with RLS know they have it. They experience an irresistible urge to move the legs at night that can be associated with unpleasant sensations like crawling, itching or pain. Symptoms occur when sedentary and are relieved with movements like stretching.

RLS is associated with a number of medical conditions and medications – most notably, iron deficiency anemia, renal disease, arthritis, Parkinson’s disease and some antidepressants.

Other common age-related symptoms such as edema and deep vein thrombosis (blood clots) can produce abnormal sensations in the legs and cramps at night that should be differentiated from RLS. A blood test for iron levels is generally required. Treatments include over-the-counter iron in deficient patients and prescription medications.

REM sleep behavior disorder is a lesser-known disorder affecting roughly 1% of adults, but with far greater consequences. RBD is a parasomnia – a sleep disorder characterized by unusual and undesirable physical events or experiences that disrupt sleep, like the non-REM parasomnia commonly known as sleepwalking – only from REM sleep.

Skeletal muscles are paralyzed during REM sleep (with the exception of those that control breathing and sphincters). This is a protective mechanism that prevents us from acting out vivid dreams and getting injured or injuring those around us at night. The brains of RBD patients facilitate muscle activation during REM sleep associated with active dreaming. When threatened by bad dreams, patients exhibit abnormal complex motor behavior, such as kicking, punching and screaming, often in reaction to being chased or attacked by people, animals or things.

What’s most important to know is that at least 80% of people with RBD will develop a neurodegenerative disorder like Parkinson’s disease within 14 years of RBD onset. Medications and safety measures are recommended when nighttime activity is frequent or injurious. Researchers worldwide are investigating how to prevent progression, in some cases enrolling people with RBD in clinical trials that monitor brain and muscle function over time.

Obstructive sleep apnea, or OSA, is one of the most common sleep disorders, and it also increases with age. Affected individuals usually snore, wake up frequently during the night and report daytime sleepiness, fatigue, morning headaches and waking unrefreshed, all due to abnormal loss of muscle tone of the upper airway muscles in sleep.

Bedpartners may recognize apnea – pauses in breathing during sleep. Among adults between 50 to 70 years, OSA affects 9% of women and 17% of men, both conservative estimates. Over 80% of people with OSA are undiagnosed, resulting in unnecessary cardiovascular events, brain disease (stroke, epilepsy, cognitive impairment) and metabolic disorders.

On the bright side, treatment can save lives and includes continuous positive airway pressure (CPAP), oral appliances, surgery and newer therapies like neurostimulation. CPAP can reduce epileptic seizures in people with epilepsy, recurrent stroke, headaches, hypertension, recurrent atrial fibrillation, high blood sugar and sudden death, to name a few.

How to Sleep Better

Follow these basic steps to a better night’s sleep:

  • Maintain a regular sleep routine.
  • Do not stay awake in bed more than 30 minutes.
  • Do not use electronics in bed.
  • Limit coffee, tea and other caffeinated beverages to before noon.
  • Avoid tobacco, alcohol and large meals at night.
  • Exercise daily, but avoid vigorous workouts close to bedtime.
  • Make sure your bedroom is comfortable and dark.

If your sleep problem persists despite these simple measures, talk with your doctor about how to get help. Sweet dreams!

A young woman laying in bed late at night awake suffering from insomnia, watching the alarm worrying about falling asleep