What NIA and NHLBI Say About Sleep in Older Adults
As people age, how they sleep changes, the National Institute on Aging (NIA) says. Many older people don’t sleep well, the agency says.
NIA says older adults need about the same amount of sleep as all adults, seven to nine hours each night. They tend to go to bed and wake up earlier than younger adults, and the time spent in each type of sleep decreases. Sleep disorders become more common with age.
How Much Sleep Older Adults Need
NIA puts the need at seven to nine hours each night, about the same for older adults as for all adults.
Timing is what moves. Older people tend to go to sleep earlier and get up earlier than they did when they were younger, NIA says. Getting enough sleep helps people stay healthy and alert.
NIA also describes what a good night’s sleep depends on: sleeping when the body is prepared, sleeping seven to nine hours, and getting enough of each type of sleep.
How Sleep Changes in Later Life
A person spends about one-third of their life sleeping or trying to sleep, by NIA’s reckoning. Though it may seem simple, sleep is a complex process. Multiple parts of the brain work together to produce signals that prepare the body for sleep.
The circadian rhythm — what NIA calls “the body’s clock” — provides the timing for sleep. Sleep-wake homeostasis is a state of balance: the body’s drive to sleep, which increases the longer a person is awake.
Certain signals in the body lead to sleep. Melatonin is a hormone the body releases when it gets dark, and it makes a person feel sleepy. Adenosine builds up in the brain while a person is awake and gets broken down while they are asleep.
NIA names two major types of sleep, rapid eye movement (REM) and non-REM, and they occur in cycles — usually three to five each night.
Non-REM sleep happens when brain wave activity slows down, which NIA calls deep sleep. Deep sleep is needed to feel refreshed in the morning. REM sleep is when dreaming usually happens, and brain wave activity is closest to what it is when a person is awake.
Older adults tend to go to bed earlier and wake up earlier than younger adults, and the amount of time spent in each type of sleep decreases. Sleep tends to be shorter and lighter. A person may wake up more often during the night.
Older adults are also more likely to take medications and have medical conditions that affect sleep, NIA says. Factors such as illness, medications, mental health, and pain can make a good night’s sleep hard to get.
Sleep Disorders That Become More Common With Age
Sleep disorders become more common with age. NIA’s list includes insomnia (trouble falling or staying asleep), sleep apnea (pauses in breathing during sleep), and movement disorders such as restless legs syndrome.
Insomnia is the most common sleep problem in adults age 60 and older, according to NIA. People with this condition have trouble falling asleep or staying asleep at least three nights a week.
Short term insomnia can be caused by stress or changes to routine. Chronic, or long-term, insomnia lasts more than three months and can’t be fully explained by another medical cause.
Sleep apnea causes a person to stop breathing for a few seconds repeatedly during sleep. Throat muscles relax during sleep, and in people with sleep apnea that relaxation blocks their airway.
Snoring can be a sign — but not everyone who snores has sleep apnea, NIA says. Undiagnosed or untreated sleep apnea can lead to serious health problems, including heart attack.
Source: National Institute on Aging
| Condition | How NIA describes it | Treatment NIA describes |
|---|---|---|
| Insomnia | Trouble falling asleep or staying asleep at least three nights a week | Healthy habits at bedtime may help prevent or manage insomnia, and cognitive behavioral therapy (a type of counseling) can help |
| Sleep apnea | Causes a person to stop breathing for a few seconds repeatedly during sleep | A continuous-positive-airway-pressure (CPAP) device may be used while sleeping |
| Restless legs syndrome | Feels like there is tingling, crawling, or pins and needles in one or both legs | Treatment with iron supplementation or medications is usually helpful |
| Periodic limb movement disorder | Causes people to jerk and kick their legs every 20 to 40 seconds during sleep | Medication, warm baths, exercise, and relaxation can help |
| REM sleep behavior disorder | People can move their muscles and act out their dreams | A safe environment to prevent injuries while sleeping, and medication or melatonin supplements |
What Poor Sleep Is Linked To
Not getting enough sleep can cause harm to the body, NIA says. Waking up tired, feeling easily annoyed, trouble falling asleep, or trouble staying asleep may be signs of not getting a good night’s sleep.
Lack of quality of sleep can lead to problems with memory and negative feelings. It can also lead to more stress in relationships, and an increased risk of falls or accidents.
The National Heart, Lung, and Blood Institute (NHLBI) says sleep deficiency can cause a person to feel very tired during the day. The person may not feel refreshed and alert when they wake up.
Sleep deficiency can cause problems with learning, focusing, and reacting, NHLBI says. Ongoing sleep deficiency can raise the risk of some chronic health problems. It results in a higher-than-normal blood sugar level, which may raise the risk of diabetes.
People who are sleep deficient are less productive at work and school, per NHLBI. They take longer to finish tasks, have a slower reaction time, and make more mistakes.
Lack of sleep also may lead to microsleep — brief moments of sleep that happen when a person is normally awake. A person can’t control microsleep, and might not be aware of it.
Treatments the Agencies Describe
For insomnia, NIA says healthy habits at bedtime may help prevent or manage it, and cognitive behavioral therapy (a type of counseling) can help. Sleep medicines may help in the short term, but they carry risks and should not be used long term.
NHLBI describes cognitive behavioral therapy for insomnia (CBT-I) as a 6- to 8-week treatment plan to help people learn how to fall asleep faster and stay asleep longer. It is usually recommended as the first treatment option for long-term insomnia and can be very effective. A doctor, nurse, or therapist can deliver it in person, by telephone, or online.
Some prescription medicines used to treat other health conditions can also increase the risk of insomnia, NHLBI notes.
Benzodiazepines may be prescribed if other treatments and medicines have not worked, according to NHLBI. They can also interact dangerously with other medicines.
Over-the-counter products that contain antihistamines are sold as sleep aids. Antihistamines can be unsafe for some people, NHLBI says.
Melatonin supplements are versions of the sleep hormone melatonin made in a lab, in NHLBI’s description. Research has not proven that melatonin is an effective treatment for insomnia.
Side effects of melatonin may include daytime sleepiness, headaches, upset stomach, and worsening depression. It can also affect the body’s control of blood pressure, causing high or low blood pressure.
The FDA does not currently review dietary supplement products for safety and effectiveness before they are marketed, NHLBI says.
NIA says it may be time to talk with a doctor when a person is always sleepy or finds it hard to get enough sleep at night.
Sleep and Alzheimer’s Disease
Alzheimer’s disease often affects a person’s sleeping habits, NIA says.
When a person with Alzheimer’s has sleep problems, it can also affect the sleep their caregiver gets. Both need restful sleep, NIA says.
A person with Alzheimer’s may have a medical condition or take a medication that causes sleep problems, NIA says. In other cases, Alzheimer’s itself may be causing changes to the brain that disrupt sleep.
A health care provider may recommend medication or nonmedication strategies to help the person sleep well, according to NIA.
For older adults, NIA’s range stays at about the same seven to nine hours as for all adults. The changes it describes include a tendency toward earlier bedtimes and wake times, less time in each type of sleep, and more common sleep disorders.
This article is general information, not professional advice. For decisions about your money or health, consult a qualified professional.