Miya Pearson
Sleep patterns change as people age. Older adults tend to go to bed and wake up earlier than younger adults, and the quality of sleep decreases with age. Older people spend more time in the early, lighter stages of sleep and less time in the later, deeper stages of sleep. This shift in sleep architecture may cause older people to wake up more frequently during the night and experience more fragmented sleep. Sleep disorders, such as insomnia, sleep apnea, and restless leg syndrome, become more prevalent with age, further contributing to disrupted sleep.
| Characteristics | Values |
|---|---|
| Sleep architecture | Older adults spend more time in the earlier, lighter stages of sleep and less time in the later, deeper stages. |
| Sleep duration | Total sleep time stays the same or is slightly decreased (6.5 to 7 hours per night). |
| Sleep timing | Older adults tend to go to bed earlier and wake up earlier than younger adults. |
| Sleep efficiency | Older people wake up more often during the night and earlier in the morning. |
| Sleep disorders | Insomnia, sleep apnea, restless legs syndrome, REM sleep behavior disorder, and movement disorders become more common with age. |
| Sleep quality | Age-related changes in sleep architecture, circadian rhythms, and sleep-related hormones can lead to more fragmented and less restful sleep. |
| Sleep medications | Sleep medicines may help in the short term but carry risks and should not be used long-term. Antidepressants, antihistamines, melatonin supplements, and mild sleeping pills are some options that may be considered with medical advice. |
| Sleep improvement | Exercise, reducing bedroom distractions, improving sleep hygiene, and developing healthy sleep habits can help improve sleep quality. |
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What You'll Learn
Sleep stages and sleep architecture
Sleep is a complex process involving multiple parts of the brain working together to prepare the body for sleep. Sleep patterns tend to change as people age. Older adults tend to go to bed and wake up earlier than younger adults, and the amount of time spent in each type of sleep decreases. Sleep in older adults tends to be shorter and lighter, and they may wake up more often during the night. Older people also 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 having more fragmented, less restful sleep.
Healthy sleep consists of four stages, including one rapid eye movement (REM) sleep stage and three non-REM (NREM) sleep stages. These stages are determined by analysing brain activity during sleep, which shows distinct patterns that characterise each stage. The breakdown of sleep into various cycles and stages is known as sleep architecture. If someone undergoes a sleep study, their sleep architecture can be represented visually in a hypnogram or graph.
The first stage of NREM sleep, N1, occurs when a person first falls asleep and usually lasts one to seven minutes. During this stage, the body hasn't fully relaxed, though body and brain activities start to slow, with periods of brief movements. N2 is a slightly deeper stage of sleep, while N3, also called slow-wave sleep, is the deepest NREM sleep stage. REM sleep, often associated with dreaming, is thought to assist in brain development, especially early in life. As the night progresses, REM stages get longer, especially in the second half of the night. While the first REM stage may last only a few minutes, later stages can last for around an hour.
Older adults may experience changes in their sleep architecture due to various factors. These include underlying medical conditions such as arthritis, congestive heart failure, depression, and gastroesophageal reflux disorder. Respiratory disorders, such as sleep apnea, become more common with age and can cause multiple arousals during the night. Other issues, such as restless leg syndrome and periodic limb movements, can also disrupt sleep in older adults. Additionally, older adults are more likely to take medications and have medical conditions that affect their sleep.
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Sleep disorders and medication
Sleep disorders are a significant source of concern in older people, with insomnia being the most common sleep disorder in this demographic. Other sleep disorders prevalent among the elderly include sleep-disordered breathing and restless legs syndrome.
Insomnia in older adults is often characterised by difficulty falling or maintaining sleep, or non-restorative sleep, which can produce significant daytime symptoms such as difficulty concentrating and mood disturbances. It is important to note that insomnia in older adults is often underdiagnosed and undertreated, and non-pharmacological interventions are often underused.
Several factors can contribute to sleep disturbances in older adults, including retirement, health problems, the death of a spouse or family member, changes in the body's natural internal clock, chronic diseases, certain medications, herbs, supplements, and recreational drugs. Additionally, older adults are at a higher risk of medical and psychiatric conditions that can lead to insomnia symptoms.
When addressing sleep disorders in older adults, it is recommended to first consider non-pharmacological treatments such as cognitive behavioural therapy (CBT). CBT has been shown to improve sleep quality by targeting both the quality and quantity of sleep. Other non-pharmacological interventions include relaxation techniques, meditation-based mind-body interventions, and improving sleep hygiene. This includes creating a relaxing bedtime routine, sleeping in a quiet room that is not too hot or cold, and avoiding caffeine and alcohol before bed.
If pharmacological interventions are considered necessary, medications such as antidepressants, non-benzodiazepines, melatonin agonists, and herbals may be prescribed. However, it is important to exercise caution when prescribing these medications to older adults due to potential side effects and interactions with other medications. Benzodiazepines, for example, are not recommended for insomnia in older adults due to the increased risk of cognitive and psychomotor impairments, falls, and fractures. Additionally, barbiturates and chloral hydrate should be avoided in older adults due to the risk of overdose and physical dependence.
In summary, sleep disorders are a significant concern in older adults, with insomnia being the most prevalent. A comprehensive approach to managing sleep disorders in this population should include a combination of non-pharmacological interventions and, if necessary, carefully selected pharmacological treatments.
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Sleep duration and quality
The total sleep time, sleep efficiency, and deep sleep (slow-wave sleep) decrease with age, while the number of nocturnal awakenings and time spent awake during the night increase. Older adults may experience a shift in their sleep schedule, known as a "phase advance". They may feel tired earlier in the afternoon and wake up earlier in the morning. This shift is due to changes in the body's circadian rhythms, which regulate the timing of sleep. The window during which the internal clock enables sleep narrows with age, leading to earlier bedtimes and wake-up times.
Additionally, older adults are more likely to experience medical conditions and take medications that can impact their sleep. Factors such as illness, medications, mental health issues, and pain can make it challenging for older adults to get a good night's sleep. Sleep disorders, such as insomnia, sleep apnea, and movement disorders like restless leg syndrome, become more prevalent with age. Insomnia is the most common sleep problem in adults aged 60 and older, characterised by difficulty falling or staying asleep at least three nights a week. Short-term insomnia can result from stress or changes in routine, while chronic insomnia lasts longer than three months and cannot be fully explained by another medical cause.
To improve sleep duration and quality in older adults, it is recommended to practice good sleep habits and address any underlying sleep disorders or health conditions. Maintaining a consistent sleep schedule, exposing oneself to natural daylight, and creating a comfortable sleep environment can all contribute to better sleep. In some cases, cognitive behavioural therapy or short-term use of certain medications may be recommended to improve sleep. However, it is important to consult a doctor before taking any sleep medications, as older adults may respond differently to these drugs.
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Sleep patterns and habits
One common sleep problem in older adults is insomnia, characterised by difficulty falling or staying asleep at least three nights a week. Short-term insomnia can result from stress or changes in routine, while chronic insomnia lasts longer than three months without a clear medical cause. Sleep apnea, a condition where breathing pauses during sleep, also becomes more prevalent with age. This can be treated with a continuous positive airway pressure (CPAP) device, specific sleeping positions, or dental devices. Other sleep issues include restless leg syndrome and periodic limb movements, which can disrupt sleep quality.
To improve sleep habits, older adults can focus on sleep hygiene and develop healthy bedtime routines. Regular exercise helps older people fall asleep faster, sleep longer, and experience better sleep quality. Reducing distractions in the bedroom, such as removing televisions and smartphones, can also aid sleep. Additionally, maintaining a consistent sleep schedule, exposing oneself to natural daylight, and creating a comfortable sleep environment are beneficial.
While sleep patterns evolve with age, it is important to address sleep problems and not attribute them solely to ageing. Consulting a doctor or seeking treatments like cognitive behavioural therapy can help manage sleep disturbances. Keeping a sleep diary can also aid in identifying patterns and discussing them with a healthcare provider.
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Sleep environment and distractions
Sleep is a vital part of a person's physical and emotional health. As people age, their sleep patterns change, and they may experience difficulty falling asleep or staying asleep. Older adults need seven to nine hours of sleep each night, but many struggle to get enough sleep. To improve sleep quality, it is essential to create a peaceful sleep environment that minimises distractions and promotes comfort.
Minimising Distractions
Reducing distractions in the bedroom is crucial for improving sleep quality. Televisions, smartphones, and bright lights can disrupt sleep. It is advisable to keep the bedroom screen-free and reserve it solely for sleeping and sex. Screens engage the mind, delay REM sleep, increase anxiety, and emit blue light that suppresses melatonin production. Additionally, a cluttered bedroom can contribute to disordered sleep. A well-organised and peaceful environment is more conducive to restful sleep.
Optimising the Sleep Environment
Creating a comfortable sleep environment involves maintaining a suitable temperature, usually between 16°C and 19°C, and ensuring the room is dark and quiet. Earplugs or white noise can be helpful in blocking out noise. A comfortable mattress and pillow suited to one's preferred sleep position are also essential. For older adults, it is important to keep a phone nearby for emergencies, but notifications and bright screens can be disruptive, so it's best to keep them on silent or do-not-disturb mode.
Addressing Medical Conditions and Medication
Medical conditions and medications can significantly impact sleep in older adults. Conditions such as frequent urination, pain, arthritis, asthma, diabetes, osteoporosis, heartburn, and Alzheimer's disease can interfere with sleep. Additionally, medications and their side effects can impair sleep. It is important to address these issues with a healthcare professional to find solutions that improve sleep quality.
Healthy Daytime Habits
Improving daytime habits, such as diet and exercise, can positively impact sleep. Avoiding substances like caffeine, nicotine, and alcohol can enhance sleep quality. Caffeine and nicotine are stimulants that can disrupt sleep, and while alcohol may initiate sleep, it often leads to disrupted sleep and middle-of-the-night waking. A light snack before bed, such as low-sugar cereal, yogurt, or warm milk, can help satisfy hunger without disrupting sleep. Regular exercise helps older adults fall asleep faster, sleep longer, and experience better sleep quality.
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Frequently asked questions
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. This may contribute to older people waking up more often at night and having fragmented sleep.
There are four phases of sleep: one for rapid eye movement (REM) sleep and three that form non-REM (NREM) sleep. NREM sleep is broken down into three distinct stages: N1 (light sleep), N2 (slightly deeper sleep), and N3, also called slow-wave sleep, the deepest NREM sleep stage. REM sleep, often associated with dreaming, usually occurs about 90 minutes after falling asleep.
Total sleep time decreases with age, along with sleep efficiency and deep sleep. Meanwhile, the number of nocturnal awakenings and time spent awake during the night increase. Older adults tend to go to bed and wake up earlier, and their sleep tends to be shorter and lighter.
Insomnia is the most common sleep problem in adults aged 60 and older, characterized by trouble falling or staying asleep. Other disorders include sleep apnea, restless legs syndrome, and REM sleep behavior disorder, where people may act out their dreams physically.
Older adults can improve their sleep hygiene by reducing bedroom distractions, exercising regularly, and establishing a consistent sleep schedule. They should also address any underlying medical conditions or pain that may interfere with sleep.
