The Impact of Aging on Sleep
More than half of older adults complain about sleeping difficulties, and over 20% may have sleep apnoea.
Age and the physiological changes that happen as we age have an impact on our sleep, but that doesn’t mean there are no effective ways to help support older adults in maintaining good sleep health. Here, we will explore the ways ageing affects sleep and review some approaches to supporting sleep in older adults.
The Relationship Between Sleep and Aging
Does it seem like your grandpa goes to bed at 6 pm? Older adults DO experience shifts in their sleep patterns. It is not just an observation many of us have had of our grandparents or parents – sleep patterns are different in older adults.
As we age, two sleep-related systems are impacted heavily by sleep: the circadian and sleep drive systems.
The circadian system regulates WHEN sleep happens, and sleep drive is responsible for creating sleepy feelings. Both of these systems are affected both directly and indirectly by the effects of ageing. These effects change the quality, amount and timing of sleep.
Changes in Sleep Timing
One of the most obvious changes we see in sleep in older adults is a shift to have more of a morning pattern – going to sleep earlier and waking earlier.
The brain’s melatonin production continues to decrease as we age, which can contribute to these changes in sleep timing. Additionally, eye conditions in older age can also decrease the amount of light hitting the back of the eye, so the brain can see the light fade ‘earlier’ than through a younger eye.
Combine this with not having a consistent morning time to ‘get going’ – which helps anchor the circadian rhythm – and you have a recipe for a shift in sleep timing seen very frequently in older people.
Differences between males and females in sleep timing also change as we age for other reasons. These differences in younger people may play an evolutionary/reproductive function, which is no longer necessary after we pass through our reproductive years.
Sleep Drive and Older Adults
Older people also may need longer periods of awakening to achieve quality sleep, resulting in less sleep and more wakefulness over 24 hours compared to their younger counterparts.
Reduced sleep drive and requiring more time to become sleepy enough to sleep can be caused by older adults being more sedentary and otherwise physically less active (which is a key component of sleep drive). Also, older adults tend to have a looser schedule and the ability to nap and sleep when they wish (which erodes sleep drive). This can result in a shorter window for sleep and less deeper sleep.
Other Sleep Disturbers
Older adults are more likely to be nutritionally deficient as compared to younger people, in part due to changes in the digestive system and reductions in excretions that metabolise important nutrients. Many older adults also experience dietary changes as a result of financial changes stemming from retirement. A reduction in diet quality and medications can result in both more fatigue and less physical activity and, therefore, less sleep pressure – all requiring more wake time to build up enough sleep drive to sleep.
Many older adults have health conditions which can directly affect sleep – or these conditions are treated with medications that can affect sleep. Examples include antidepressants, thyroid medications, parkinson medications, beta blockers and yes, even medications for sleep.
Sleep Architecture Changes
Most adults spend the majority of the night in lighter Stage 1 and Stage 2 sleep, but they have a regular and reliable proportion of the night that is spent in slow-wave/deep sleep and in rapid eye movement (REM ) sleep. As people age, they spend less time in REM sleep and in slow-wave sleep. This is not pathological – it is a normal change in sleep in older adults. The reasons are not completely clear.
Effective Management Strategies
Given the impact of ageing on sleep, it is crucial to incorporate evidence-based strategies to support healthy sleep in older adults.
Chronobiologists can provide guidance on the timing and dosage of light therapy for some individuals to help improve sleep quality. Excessive light can harm the eye, and poorly timed light therapy can actually make sleep timing worse.
Melatonin supplementation can support sleep timing. Dosage and timing are very important to avoid unfortunate and possibly dangerous side effects. Melatonin can cause nightmares but also morning drowsiness, which in older people can increase the risk of physical injury via falls.
Social aspects of a person’s life are a wonderful place to intervene to support sleep health. Maintaining regular routines, exercise and social contact can support cardiovascular health, circadian health and brain health – and improve sleep quality.
Recognising the impact of ageing on sleep can help normalise many people’s experiences and reduce sleep anxiety. Understanding the physical changes associated with ageing and supporting appropriate interventions can help all older adults with optimal sleep.
If you are an older adult with sleeping challenges or you love someone who is struggling, reach out to have a consultation.
The information contained above is provided for information purposes only. The contents of this post are not intended to amount to advice and you should not rely on any of the contents of this post. Professional advice should be obtained before taking or refraining from taking any action as a result of the contents of this post. Tracy Hannigan disclaims all liability and responsibility arising from any reliance placed on any of the contents of this post.