Aging And Sleep: Why Older Adults Sleep Poorly

As we age, our sleep patterns change and it is not uncommon for older adults to experience worse sleep quality. Older people tend to go to bed earlier and wake up earlier than when they were younger, and they spend less time in deep sleep—the most restorative sleep stage. This can be caused by a variety of factors, including changes in the body's internal clock, decreased exposure to daylight, and alterations in hormone production. Additionally, older adults are more likely to experience sleep disorders such as insomnia, sleep apnea, and restless leg syndrome. While it is a common misconception that older adults require less sleep, the truth is that they need the same amount of sleep as younger adults, which is 7 to 9 hours per night.

Circadian rhythms and internal clocks

Circadian rhythms change as people age, often leading to disrupted sleep patterns. The SCN deteriorates as people get older, disrupting circadian rhythms and influencing when people feel tired and alert. Older people also tend to spend less time outdoors, resulting in insufficient exposure to daylight, which is one of the most powerful cues for maintaining circadian rhythms. Changes in hormone production, such as the body secreting less melatonin, can also disrupt sleep in older adults. Melatonin is usually produced in response to darkness and helps promote sleep by coordinating circadian rhythms.

Research has shown that older adults tend to go to bed and wake up earlier than younger adults. They also experience more fragmented sleep, resulting in poorer quality sleep and less overall sleep. This can lead to an increase in daytime sleepiness, negatively affecting quality of life and exacerbating the risks of cognitive decline and falls.

Age-related changes in the circadian system may be influenced by a combination of biological and environmental factors. Certain clock genes may lose their rhythm and be replaced by others that act differently. Aging eyes may also play a role, as they may not let in as much light, particularly short-wave light, which is important for regulating the circadian rhythm.

To cope with changing circadian rhythms as we age, it is recommended to shift sleeping patterns earlier and to get more light during the day. Exposing oneself to light later in the day can help delay the release of melatonin and trick the body into delaying bedtime. Improving sleep hygiene and developing healthy habits can also encourage better sleep.

Hormone production

As we age, our bodies produce different hormones and in different quantities. This change in hormone production can have a significant impact on our sleep patterns and quality.

One key hormone that changes as we age is melatonin. Melatonin is often referred to as the "sleep hormone" as it is produced in response to darkness and helps promote sleep by coordinating our circadian rhythms. However, as people age, the body secretes less melatonin, which can lead to disrupted sleep patterns and make it harder to fall and stay asleep.

Another hormone that may play a role in sleep changes as we age is cortisol. Cortisol is a stress hormone, and while it is normal to have varying levels of cortisol throughout the day, with levels typically peaking in the morning and reducing at night, ageing can cause this rhythm to become disrupted. This can lead to elevated cortisol levels at night, making it more difficult to fall asleep and maintain a restful night's sleep.

Additionally, the ageing process can cause a decrease in the production of human growth hormone (HGH). HGH is important for muscle growth and repair, bone health, and metabolism. As levels of HGH decrease with age, it can impact the quality of sleep, as deep, restorative sleep is crucial for these processes.

Furthermore, changes in hormone production during menopause can also impact sleep. Decreasing levels of oestrogen during menopause have been associated with difficulty falling asleep, maintaining sleep, frequent awakenings, and overall poor sleep quality.

While hormone production changes are a natural part of ageing, understanding and addressing these changes can help improve sleep quality. This may include implementing healthy sleep habits, such as sticking to a regular sleep schedule, limiting screen time before bed, and creating a relaxing bedtime routine. Additionally, seeking medical advice to manage any underlying health conditions or sleep disorders is crucial for optimising sleep as we age.

Lifestyle factors

Napping

Older adults tend to nap more frequently than younger adults. While napping may be beneficial in some cases, excessive or late-day napping can disrupt nighttime sleep. Napping during the day can reduce the need for sleep at bedtime, leading to a disrupted sleep schedule. It is recommended to limit naps to 20-30 minutes and avoid napping after 3 pm to maintain a healthy sleep routine.

Caffeine and Alcohol Consumption

Caffeinated beverages can negatively impact sleep by reducing total sleep time and increasing the time it takes to fall asleep. Alcohol, on the other hand, may help one fall asleep initially but leads to fragmented and poorer-quality sleep once metabolized. It is advisable to limit caffeine and alcohol intake, especially later in the day, to improve sleep quality.

Fluid Intake

Drinking fewer fluids at night is recommended, as frequent trips to the bathroom can interrupt sleep. This is particularly important for older adults who experience nocturia, which is the medical term for waking up multiple times per night to urinate.

Exercise

Regular exercise can promote better sleep, but it is crucial to avoid rigorous physical activity close to bedtime. Exercising too close to bedtime can increase alertness and make it more challenging to fall asleep. Aim to finish any intense physical activity at least one to three hours before bedtime to optimize sleep.

Screen Time and Electronics

The light emitted by electronic devices such as televisions, smartphones, and tablets can interfere with sleep. It is recommended to avoid screen time in the bedroom and turn off electronic devices at least one hour before bed. Opt for relaxing activities that help you unwind, such as reading or listening to music.

Sleep Environment

Creating a calm and comfortable sleep environment is essential. Keep the bedroom dark, quiet, comfortable, and at a cool temperature. Use low lighting in the evenings and before bed to signal to your body that bedtime is approaching.

Medical conditions

Older adults are more likely to experience fragmented sleep, resulting in poorer quality sleep and less total sleep overall. This is due to a variety of factors, including underlying medical conditions.

One of the most common sleep issues in older adults is insomnia, which affects up to 70% of people over 65. Insomnia is characterised by the inability to initiate or maintain sleep and can lead to sleep deprivation, which has been linked to more severe and chronic health issues such as diabetes, heart disease, high blood pressure, stroke, and depression.

Another common sleep disorder in older adults is sleep apnea, which is recognised as the most common sleep-related breathing disorder. It is characterised by pauses in breathing caused by a complete or partial airway collapse during sleep. These disruptions can occur hundreds of times per night, leading to fragmented sleep and poor sleep quality. Obstructive sleep apnea (OSA) is estimated to affect up to 70% of older men and 56% of older women.

Older adults are also more susceptible to restless legs syndrome (RLS), a neurological disorder that causes an aching, crawling, and creeping feeling in the legs that typically makes an appearance while the person is sleeping or resting. RLS can impair sleep and its prevalence increases with age, affecting 9-20% of older people.

REM sleep behaviour disorder primarily affects older adults and is characterised by a lack of muscle paralysis during REM sleep, causing sleepers to act out their dreams. This can include talking, shouting, and more violent reactions like thrashing limbs and punching. While relatively uncommon, affecting around 1% of the population, it is most prevalent among older adult males.

Age-related changes in the body's 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 normally helps promote sleep by coordinating circadian rhythms.

Additionally, older adults may experience frequent urination at night (nocturia), which can lead to fragmented sleep and sleep deprivation. This issue affects up to 80% of older adults and is caused by physical changes in the urinary system and other factors.

Pain and chronic illnesses can also interfere with sleep in older adults, creating a vicious cycle where less sleep leads to more pain. Conditions such as arthritis, chronic pain, and irritable bladder can make sleep difficult and should be addressed with a doctor.

Mental health conditions, such as anxiety and depression, can also impact sleep in older adults. It is important to seek help and treatment for these conditions, as they can contribute to sleep disturbances and negatively affect overall well-being.

Sleep disorders

Causes of Sleep Disorders in Older Adults

There are several factors that can contribute to sleep disorders in older adults:

• Age-related changes in sleep architecture: Older adults tend to experience a shift in their sleep patterns, known as a "phase advance". This results in them feeling tired earlier in the afternoon and waking up earlier in the morning. They also spend more time in the lighter stages of sleep and less time in the deeper, restorative stages of sleep.
• Circadian rhythm disruptions: The body's internal clock, known as the suprachiasmatic nucleus (SCN), deteriorates with age, disrupting circadian rhythms and affecting when people feel tired and alert.
• Hormonal changes: The body's production of melatonin, which promotes sleep, decreases with age.
• Lifestyle factors: Retirement, decreased social interaction, and less physical activity can contribute to sleep disorders.
• Medical conditions: Illnesses such as arthritis, sleep apnea, and restless leg syndrome can impact sleep quality.
• Medication side effects: Multiple medications and their interactions can also disrupt sleep.
• Pain and discomfort: Chronic pain and illnesses can make it difficult to get comfortable and fall asleep.
• Nocturia: Older adults often experience an increase in nighttime urination, which can interrupt sleep.

Several sleep disorders are commonly seen in older adults:

• Insomnia: Difficulty falling or staying asleep is a prevalent issue, with up to 70% of older adults affected.
• Sleep apnea: Obstructive sleep apnea, characterised by pauses in breathing during sleep, is the most common sleep-related breathing disorder in older adults.
• Restless legs syndrome: This neurological disorder causes an urge to move the legs while resting or sleeping and can impair sleep quality.
• REM sleep behaviour disorder: This disorder causes people to act out their dreams and is associated with poor sleep quality and reduced quality of life.

Tips for Improving Sleep in Older Adults

While sleep disorders can be challenging, there are strategies that can help improve sleep quality in older adults:

• Stick to a regular sleep schedule: Go to bed and wake up at the same time each day, even on weekends.
• Avoid daytime napping: Napping can disrupt nighttime sleep.
• Establish a bedtime routine: Engage in relaxing activities before bed, such as reading or listening to music.
• Optimise the bedroom environment: Make the bedroom a "sleep zone" by minimising light, noise, and electronic distractions.
• Exercise regularly: Exercise can improve sleep quality, but avoid strenuous activity close to bedtime.
• Limit caffeine and alcohol intake: These substances can disrupt sleep, especially when consumed close to bedtime.
• Treat medical conditions: Seek treatment for any medical conditions that may be impacting sleep, such as pain or irritable bladder.

Frequently asked questions