Gina Johnson
Sleep is essential for our health, and this doesn't change as we get older. In fact, it's a common misconception that older adults need less sleep. The truth is that older adults need the same amount of sleep as younger adults, between seven to nine hours each night. However, older adults often experience changes in their sleep patterns and sleep architecture, spending more time in the earlier, lighter stages of sleep and less time in the deeper, more restorative stages. This can lead to more frequent awakenings and a greater need for daytime napping. Additionally, older adults may face sleep barriers such as disabilities, chronic illnesses, and mental and physical health conditions that can further disrupt their sleep.
| Characteristics | Values |
|---|---|
| Amount of Sleep Needed | 7-9 hours |
| Sleep Quality | Poorer |
| Sleep Patterns | More fragmented |
| Sleep Architecture | Less time in deep sleep |
| Circadian Rhythm | Disrupted |
| Melatonin Production | Declines |
| Sleep Disorders | More prone |
| Risk of Cognitive Decline | Higher |
| Risk of Cardiometabolic Health Issues | Higher |
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What You'll Learn
Sleep patterns and duration
Older adults often experience changes in their sleep architecture, spending more time in the earlier, lighter stages of sleep and less time in the later, deeper stages. They also tend to go to bed and wake up earlier. This shift is called a phase advance.
The quality and duration of sleep can be affected by various factors, such as lifestyle changes, medical conditions, and sleep disorders. Lifestyle factors that can contribute to poor sleep include increased napping, caffeine consumption, and alcohol consumption. Medical conditions such as arthritis, chronic pain, and sleep disorders like insomnia and sleep apnea can also impact sleep quality and duration.
It is important to note that while older adults may get less sleep, it does not mean they need less sleep. Maintaining good sleep hygiene, such as consistent sleep schedules and a calming bedtime routine, can significantly improve sleep quality for older adults.
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Sleep disorders
Insomnia
The most common sleep disorder in older adults is insomnia, which affects 45% of those aged 65 to 79 years. Insomnia is characterised by difficulty falling asleep, staying asleep, or experiencing non-restorative sleep. It can be caused by various factors, including psychiatric or neurological disorders, medical conditions, medication side effects, substance use, environmental changes, and lifestyle factors such as retirement.
Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is a common sleep disorder in older adults, affecting 25-35% of people over 60 years. It is characterised by pauses in breathing during sleep due to a collapse of the upper airway. OSA can lead to fragmented sleep and poor sleep quality, and it is associated with cardiovascular disease, hypertension, and metabolic syndrome.
REM Sleep Behavior Disorder
REM sleep behavior disorder (RBD) is more common in older adults, typically appearing around age 50 or older. It is characterised by a lack of muscle paralysis during REM sleep, causing individuals to act out their dreams, sometimes violently. RBD is associated with poorer sleep quality and reduced quality of life.
Restless Legs Syndrome
Restless legs syndrome (RLS) is a neurological disorder causing an urge to move the legs while resting or sleeping. It can impair sleep and is more prevalent in older adults, affecting 9-20% of this population.
Circadian Rhythm Disorders
Age-related changes in the circadian rhythm can lead to disrupted sleep patterns in older adults. This includes a phase advance, where individuals experience earlier bedtimes and wake-up times. Older adults may also experience more fragmented sleep and a decreased proportion of deep sleep.
Other Sleep Disorders
Other sleep disorders that may be more common in older adults include periodic limb movement disorder, characterised by involuntary leg movements during sleep, and sleep-disordered breathing, which is associated with an increased risk of cognitive impairment and dementia.
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Sleep and brain health
Sleep is essential for brain health, and this remains true as we age. While sleep patterns and experiences change, older adults still require the same amount of sleep as younger people – that is, seven to nine hours each night. However, due to various factors, older adults may find it harder to fall asleep and tend to get lower quality sleep. This can lead to daytime napping, which further disrupts nighttime sleep.
Sleep Architecture
Older adults tend to spend less time in deep sleep, the most restorative stage. Their sleep becomes lighter and more fragmented, with more time spent in the earlier, lighter stages of sleep. This results in poorer quality sleep and less total sleep overall. The transition between sleep and waking up is often abrupt, and older people may feel like they are lighter sleepers than when they were younger.
Sleep Disorders
Age is a risk factor for sleep disorders such as REM Sleep Behavior Disorder and sleep apnea. Sleep apnea, a disorder where breathing stops temporarily during sleep, can cause severe problems and is recognised as the most common sleep-related breathing disorder. It leads to fragmented sleep and poor sleep quality, affecting oxygen levels in the body and causing headaches, daytime sleepiness, and difficulty thinking clearly.
Impact on Brain Health
Poor sleep in older adults is linked to an increased risk of cognitive decline, depression, and poorer cardiometabolic health. Research has found that older adults who get poor sleep are at a higher risk of dementia, with consistent sleep being a protective factor.
Additionally, sleep is integral to mental health as we age. It helps regulate mood, improve cognitive function, and enhance emotional resilience.
Tips for Improving Sleep
To improve sleep quality, older adults can maintain good sleep hygiene by following a consistent sleep schedule, creating a calming bedtime routine, and limiting caffeine and alcohol intake. Exercise also plays a vital role in improving sleep, with regular physical activity helping older adults fall asleep faster, sleep longer, and experience better sleep quality.
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Sleep and physical health
Sleep is vital for the physical health of older adults. While older adults need the same amount of sleep as younger adults (7-9 hours), their sleep patterns change with age. Older adults tend to go to bed earlier and wake up earlier, and their sleep often becomes lighter and more fragmented. This can be due to various factors, including changes in their body's internal clock, certain medications, or health conditions like arthritis or sleep apnea.
Poor sleep in older adults is associated with an increased risk of physical health issues such as:
- Cardiometabolic health issues: Sleep plays a role in heart health, and insufficient sleep can increase the risk of cardiovascular problems.
- Diabetes: Disrupted sleep patterns and poor sleep quality have been linked to diabetes in older adults.
- Obesity: There is a link between inadequate sleep and obesity, as sleep plays a role in metabolism and can affect eating habits.
- High blood pressure: Sleep deprivation can contribute to high blood pressure and other cardiovascular issues.
- Breathing disorders: Conditions like sleep apnea can cause breathing disruptions during sleep, further affecting sleep quality.
- Pain and discomfort: Arthritis and other chronic pain conditions can make it difficult for older adults to get a good night's sleep.
- Frequent urination: Nocturia, or nighttime urination, becomes more common with age and can disrupt sleep patterns.
To maintain physical health, older adults should aim for consistent sleep schedules, calming bedtime routines, and limited caffeine and alcohol intake. Exercise can also promote better sleep and improve overall physical health. It is important for older adults to prioritize sleep and address any underlying health conditions that may be impacting their sleep quality.
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Sleep and mental health
Sleep is closely connected to mental and emotional health and has demonstrated links to depression, anxiety, bipolar disorder, and other conditions. Research is ongoing to better understand the bidirectional relationship between mental health and sleep. Both are complex issues influenced by a multitude of factors. However, given their close association, there is a strong reason to believe that improving sleep can positively impact mental health and be a component of treating many psychiatric disorders.
Brain activity fluctuates during sleep, increasing and decreasing during different sleep stages that make up the sleep cycle. Each stage plays a role in brain health, allowing activity in different parts of the brain to ramp up or down and enabling better thinking, learning, and memory. Research has also shown that brain activity during sleep has profound effects on emotional and mental health.
Sufficient sleep, especially rapid eye movement (REM) sleep, helps the brain process emotional information. During sleep, the brain evaluates and remembers thoughts and memories, and a lack of sleep is particularly detrimental to the consolidation of positive emotional content. This can influence mood and emotional reactivity and is linked to mental health disorders and their severity, including the risk of suicidal ideation.
The traditional view that sleep problems were a symptom of mental health disorders is increasingly being questioned. Instead, it is becoming clear that there is a bidirectional relationship between sleep and mental health, where sleeping problems may be both a cause and a consequence of mental health issues. Further research is needed to identify the diverse connections between sleep and mental health and how their multifaceted relationship can be influenced by various factors.
Obstructive sleep apnea (OSA) is another aspect of sleep that has been linked to mental health. OSA, which involves pauses in breathing and reduced oxygen levels during sleep, occurs more frequently in people with psychiatric conditions and may detract from their physical health and heighten their risk of serious mental distress.
Depression, a type of mood disorder marked by feelings of sadness or hopelessness, is estimated to affect over 300 million people worldwide. Around 75% of depressed people exhibit insomnia symptoms, and many also suffer from excessive daytime sleepiness and hypersomnia (sleeping too much). While sleeping problems were once seen as a consequence of depression, growing evidence suggests that poor sleep may induce or exacerbate depression. The difficulty in identifying clear cause-and-effect reflects a bidirectional relationship where sleep problems and depressive symptoms are mutually reinforcing.
Anxiety disorders, which affect an estimated 20% of adults and 25% of teenagers in America, also have a strong association with sleeping problems. Worry and fear contribute to a state of hyperarousal, and hyperarousal is considered a central contributor to insomnia. Sleep problems may become an added source of worry, creating anticipatory anxiety at bedtime that makes falling asleep more difficult.
Bipolar disorder involves episodes of extreme moods that can be both high (mania) and low (depression). During manic periods, individuals with bipolar disorder usually feel less need for sleep, but during depressed periods, they may sleep excessively. There is evidence that sleeping problems induce or worsen manic and depressive periods, and because of the bidirectional relationship between bipolar disorder and sleep, treating insomnia can reduce the impact of bipolar disorder.
Schizophrenia is a mental health disorder characterised by a difficulty in differentiating between what is and is not real. People with schizophrenia are more likely to experience insomnia and circadian rhythm disorders, which may be exacerbated by medications used to treat the condition. Poor sleep and schizophrenia symptoms may be mutually reinforcing, so there are potential benefits to stabilising and normalising sleep patterns.
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that involves a reduced attention span and increased impulsiveness. Sleeping problems are common in people with ADHD, who may have difficulty falling asleep, experience frequent awakenings, and feel excessive daytime sleepiness. There is evidence of a bidirectional relationship between sleep and ADHD. In addition to being a consequence of ADHD, sleep problems may aggravate symptoms such as reduced attention span or behaviour issues.
Autism Spectrum Disorder (ASD) is an umbrella term for several neurodevelopmental conditions affecting communication and social interaction. Children and adolescents with ASD have a higher prevalence of sleep problems, including insomnia and sleep-disordered breathing, which tend to be more persistent than sleeping problems in children without ASD. Addressing insomnia and other sleep disturbances is an important component of care, as it may decrease excessive daytime sleepiness and other health and behaviour problems in people with ASD.
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