Ashwin Lewis
Sleep patterns change as we age. Older people find it harder to fall asleep, wake up more often during the night, and wake up earlier in the morning. Total sleep time stays the same or is slightly decreased (6.5 to 7 hours per night). Older people spend less time in deep, dreamless sleep and more time in REM sleep. The transition between sleep and waking up is often abrupt, making older people feel like they are lighter sleepers than when they were younger.
Research suggests that the functional relationship between age and REM sleep is nonlinear. One study found that the percentage of REM sleep decreased by about 0.6% per decade until the mid-70s, after which there was a small increase in REM sleep. Another study found that the percentage of REM sleep decreased until age 60, after which it stabilised.
| Characteristics | Values |
|---|---|
| Total sleep time | Decreases with age, but remains the same or is slightly decreased (6.5 to 7 hours per night) |
| Sleep latency | Increases with age |
| Sleep efficiency | Decreases with age |
| Sleep maintenance | Decreases with age |
| Sleep stages | Older people spend less time in deep, dreamless sleep and REM sleep |
| Self-reported sleep quality | Older people are less likely to report sleep problems |
What You'll Learn
Total sleep time
According to one study, TST decreases by about 8 minutes per decade in males and 10 minutes per decade in females. Another study found that TST decreased by 10-12 minutes per decade in the adult population, with this association being stronger in women than men.
The decline in TST is likely due to a combination of physiological changes in sleep, changes in sleep-related habits, and increased rates of sleep disorders. Older people also tend to spend more time in bed, which can contribute to the development and maintenance of insomnia.
It is important to note that the decline in TST may not be noticeable to older people themselves, as they may feel deprived of sleep even when their total sleep time has not changed. This is because older people sleep more lightly and wake up more often, which can give the perception of reduced sleep.
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Sleep latency
Tests that measure sleep latency include the multiple sleep latency test (MSLT), the maintenance of wakefulness test (MWT), and polysomnography. These tests are often used to help diagnose sleep disorders or assess excessive daytime sleepiness.
In summary, sleep latency is an important indicator of sleep quality and overall sleepiness. While the average sleep latency for healthy individuals is between 10 and 20 minutes, this can vary depending on age and other factors.
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Sleep efficiency
Other factors that influence sleep efficiency include:
- Pain
- Nocturia (needing to wake up to use the bathroom)
- Sleep medication use
- Bad dreams
- Marital status
- Anxiety disorders
- Mood disorders
- Illness, particularly painful illnesses such as arthritis or rheumatism
- Income and education level
- Caffeine consumption after 6 pm
- Napping during the day
- Exercise before bedtime
Some of these factors have a stronger influence on sleep efficiency than others, and their influence can vary between men and women, as well as between younger and older elderly persons. For example, anxiety disorders and being aged 75 or older are associated with higher odds of poor sleep efficiency in women but not in men. On the other hand, being single and having a painful illness are risk factors for men only.
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Sleep stages
Sleep is divided into three non-rapid eye movement (NREM) stages and one rapid eye movement (REM) stage. A typical night's sleep consists of four to six sleep cycles, with each cycle lasting about 90 minutes. The first sleep cycle is often the shortest, ranging from 70 to 100 minutes, while later cycles tend to fall between 90 and 120 minutes.
Stage 1 (N1)
Stage 1 is the lightest stage of sleep, usually lasting just one to seven minutes and accounting for about 5% of total sleep time. During this stage, the body and brain activities start to slow down, with periods of brief movements and light changes in brain activity.
Stage 2 (N2)
Stage 2 is still light sleep, but the body enters a more subdued state. The heart rate and body temperature drop, and eye movement stops. Brain activity slows down, but there are short bursts of activity that are believed to help resist being woken up by external stimuli. Stage 2 accounts for about 45% of total sleep time, with each successive cycle becoming longer.
Stage 3 (N3)
Stage 3 is the deepest stage of NREM sleep, making up about 25% of total sleep time in adults. During this stage, the brain produces slow and strong brain waves known as delta waves. The body takes advantage of this deep sleep stage to repair injuries and strengthen the immune system. It is hard to wake someone up during this stage, and if they do wake up, they will likely experience sleep inertia, a state of confusion or "mental fog" that can last about 30 minutes.
REM Sleep
REM sleep is associated with dreaming and is believed to be essential for cognitive functions like memory, learning, and creativity. During this stage, the brain activity picks up, nearing levels seen when a person is awake. The body experiences atonia, a temporary paralysis of the muscles, except for the eyes and the muscles that control breathing. The first REM cycle is typically the shortest, around 10 minutes, while later cycles can last up to an hour. REM sleep makes up about 25% of total sleep time in adults.
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Self-reported sleep quality
Sleep duration is the natural candidate to provide an objective estimate of sleep quality. However, it should be noted that a habitual sleep duration of 7.5 hours is rarely achieved in modern society, with most individuals sleeping for less than 6 hours per night. This chronic sleep restriction can have a profound impact on sleep quality. Sleep efficiency, the relationship between total sleep time and time in bed, is another measurable parameter that can provide an objective estimate of sleep quality.
Subjective estimates of sleep quality are influenced by factors such as sleep latency, sleep duration, the presence of insomnia, the use of sleeping drugs, and daytime functioning. However, these measures do not always align with objective indicators of sleep quality. For example, older adults may be less likely to report sleep problems and tend to accept noticeable sleep changes as a part of normal aging.
Polysomnography (PSG) is the gold standard for objectively evaluating sleep. It measures sleep latency, sleep duration, sleep efficiency, sleep stages, and sleep pattern characteristics, providing insights into sleep regulation and the functions of different sleep stages. PSG analysis has revealed that short total sleep duration and decreased sleep efficiency are consistently associated with low sleep quality.
REM sleep, in particular, has been implicated as a critical factor in determining sleep quality. It is controlled by the circadian clock and can provide a window-like mechanism that defines the termination of the sleep period. An adequate amount of REM sleep appears necessary to guarantee sleep continuity and prepare the brain for wakefulness.
Age-related changes in sleep architecture, including REM sleep, occur throughout adulthood. Total sleep time, sleep efficiency, and slow-wave sleep decrease with age, while the number of nocturnal awakenings and time spent awake increase. However, these changes tend to stabilise after the age of 60, and healthy older adults are less likely to report sleep problems.
In summary, self-reported sleep quality is influenced by various factors, including sleep duration, sleep efficiency, and sleep disturbances. Polysomnography analysis suggests that short sleep duration and decreased sleep efficiency are consistently associated with low sleep quality. REM sleep, in particular, plays a critical role in sleep continuity and wakefulness preparation, making it an important indicator of sleep quality.
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Frequently asked questions
REM stands for rapid eye movement sleep. It is the stage of sleep where most dreams occur.
Sleep patterns tend to change as you age. Most people find that aging causes them to have a harder time falling asleep. They wake up more often during the night and earlier in the morning.
The percentage of REM sleep decreases with age.
There is a negative correlation between age and REM sleep, meaning that as age increases, the percentage of REM sleep decreases.
Older people can improve their sleep quality by avoiding stimulants such as caffeine, exercising regularly, and maintaining a consistent sleep schedule.
