Aging and Sleep Guide -
Do Seniors Need Less Sleep and Other Questions
By Mark Mattei
Disclaimer – Nothing on this website is intended to be a substitute for professional medical advice, diagnosis, or treatment… Read More Here.
As one of the world leaders in sleep research, Matthew Walker, Ph.D., states “The shorter your sleep, the shorter your lifespan.” [1]
So does that mean that the opposite theory would hold true,
“The longer you sleep, the longer you live?”
“The longer you sleep, the longer you live?”
The answer to this is more complicated than a simple yes or no answer. The science behind both theories add up to one thing though — Sleep affects the way we age.
Many health enthusiasts talk about how diet and exercise can help prevent premature death and even forecast overall life expectancy, but what many people are forgetting to point out how sleep affects mortality rates.
The scary under-emphasized truth is that the quality and quantity of rest can be an excellent predictor of life satisfaction and it’s overall length.
While many of us refuse to admit that we’re getting older, aging is not just something the elderly do alone, according to an international team of researchers led by the University of Cambridge, it begins before we are even born. [2]
So, while aging your face 40 to 50 years on Faceapp might be fun to post on social media, in real life, getting older it is not quite as enjoyable. It involves a higher likelihood of getting sick, sleeping less, and eventually, kicking the bucket.
But before all that happens, what does the way we sleep now say about our future? And how do senior bedtime habits affect their health, and how much rest do they actually need?
“The old maxim “I’ll sleep when I’m dead” is therefore unfortunate. Adopt this mindset, and you will be dead sooner and the quality of that (shorter) life will be worse.” – Matthew Walker, Why We Sleep: The New Science of Sleep and Dreams [1]
Typical Changes To Sleep As We Age:
What’s Normal?
Things change as you get older. It’s a fact of life: hormones, cognitive function, physical abilities, and the way you look all begin to change — a lot. Included in this extensive list is our sleep physiology.
The quality of our rest may appear more subtly, than some of these other factors, like wrinkled skin, or short term memory loss, but behind closed eyelids the mind and body can begin to work against us, preventing those much needed Zzz’s from entering our unconscious dreamland.
Duration
One of the most noticeable ways that rest changes is in the amount of time your body rests in a 24 hour period. Newborns are known to snooze the day away, while older adults often get less shuteye than their younger peers.
The following statistics from the Centers for Disease Control and Prevention [3] are both recommendations and averages that identify the amount of rest people should get based on age.
| Age | Hours |
|---|---|
 Newborns (0-3 months) |
14-17 |
 Infants (4-11 months) |
12-16 |
 Toddlers (1-2 years) |
11-14 |
 Preschoolers (3-5 years) |
10-13 |
 School-age children (6-13 years) |
9-12 |
 Teenagers (14-17 years) |
8-10 |
 Young adults (18-25 years) |
7-9 |
 Adults (26-64 years) |
7-9 |
 Older adults (65+) |
7-8 |
While this chart recommends 1 to 2 hours less shuteye for the elderly, there are other professionals who would say that seniors need the same 7 to 9 hours as middle aged adults. [4] The trouble is that seniors get about a half hour below the minimum debated level, averaging at 6.51 hours each night. [5] While 1 to 2 hours less rest may not seem like a lot for one day, if you multiply that by each night of the year, by multiple years. That’s a lot of lost Zzz’s.
The amount of time spent sleeping is not the only thing that changes as you get older. For many adults, the quality of their rest also seems to get worse as they push into their late 50’s and beyond. This raises the long sought after question, “Do older adults simply need less shuteye, or rather, are they unable to generate the rest that they still need?” [6]
So, Do Older Adults Need Less Rest?
No, while older adults may be getting less shuteye: they do not need less. They need MORE. Doctor Sonia Ancoli-Israel from the University of California San Diego explains,
“The decrements seen in the sleep of the older adult are often due to a decrease in the ability to get needed sleep. However, the decreased ability is less a function of age and more a function of other factors that accompany aging, such as medical and psychiatric illness, increased medication use, advances in the endogenous circadian clock and a higher prevalence of specific sleep disorders.” [7]
Older adults simply have more health concerns, so when observed as a group, they are not sleeping as much. But healthy adults ages 65 and older actually report nighttime stats and habits that appear similar to their younger peers. [6]
This age demographic demonstrates the high correlation between health and sleep. Making up the minority are generally healthy older senior citizens who don’t struggle with this, while the majority is comprised of sick or otherwise unhealthy older adults who have trouble getting adequate rest. If this is how healthy versus unhealthy elderly adults compare, it stands to reason that sleep deprivation and general illness have a comorbid relationship.
Common Sleep Problems For the Elderly and Aging
“Approximately 50% of older adults complain of difficulty sleeping. Poor sleep results in increased risk of significant morbidity and mortality.” — Sonia Ancoli-Israel, Ph.D.[7]
There are a handful of disorders that affect older adults, causing them to experience restless nights. But these same problems also trouble a staggering number of younger adults as well. These issues often begin in early adulthood and are carried into the senior years, where the conditions can be exacerbated by the changes caused by lifestyle, aging, and disease.
Insomnia
Affects between 30-48% of older adults. [8]
NIH estimates that only about 10% of the general population have daytime impairment that corresponds to a diagnosis of insomnia. [9]
“Insomnia, defined as difficulty falling or staying asleep, is frequent in older people. In some patients, insomnia can be caused by an underlying medical condition or a medication side effect (secondary insomnia). In the absence of a causative factor, it is referred to as primary insomnia.” — Sleep Clinic, Mount Sinai Hospital Center & the Department of Medicine, McGill University [10]
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Sleep Apnea
Affects between 45% and 62% of adults 60+. [10]
Adults 30 to 60 years old are only affected at rates between 2% and 4%. [10]
“In this important respiratory disorder, the upper airway is repeatedly obstructed during sleep, which reduces airflow or stops it (apnea)… These episodes lead to interrupted, poor-quality sleep, nocturnal oxygen desaturation, and a notable reduction or even complete absence of REM sleep… This syndrome is even more frequent among older people, especially those who complain specifically of daytime fatigue.” — Sleep Clinic, Mount Sinai Hospital Center & the Department of Medicine, McGill University [10]
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Movement Disorders
“Movement disorders are especially prevalent in the elderly, and some are highly treatable. Because reduced agility and slowing of gait are associated with numerous movement disorders as well as with the normal aging process, the differential diagnosis of movement disorders in the elderly can be challenging. Many of these disorders share features of parkinsonism-hypokinesia, tremor, and muscular rigidity.” — Mark S. Baron, M.D. [14]
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Whatever your age, if you experience one of the following conditions or its symptoms, see your doctor to get help. They can help you rectify the problem, leading you to better rest and a healthier lifestyle.
Changing Patterns and Biology
Both the quantity and quality of rest ties back into the way we sleep. As we age, both conscious and unconscious patterns begin to change. These alterations in rest are often caused by a number of variables, that will be discussed shortly, and can be exacerbated by the disorders that were mentioned previously.
Older people have to deal with natural and unnatural changes that influence their circadian rhythm (the body’s internal timepiece). When compared with their younger peers, in a 9-hour block of time, older folks generally deal with more fragmented rest, less time spent in deep slumber, and earlier wake times in the morning. [6]
Source: “Sleep and Human Aging” — Science Direct [6]
So why does this happen?
How we snooze is affected by both our changing habits, shifting priorities, as well as our aging physiology. Adults 65 and older are less likely to go to bed late and more likely to wake up in the middle of the night for several reasons. Discounting nighttime disorders, here are a few of the most common and factors causing sleep fragmentation in the old.
01
Brain Activity
Let’s break down the science.
In the brain, there are three areas that help make up our internal “snooze button” and “wake up” alarm, also called a “flip-flop” switch. [6]
Your brain’s hypothalamus, located near the midbrain, has a preoptic area which produces a sleep inhibitor called neuropeptide galanin. The brainstem and midbrain help promote wakefulness — These two areas receive the neuropeptide galanin from the hypothalamus to promote sleepiness. [6]
As we age the number of galanin expressing neurons in the hypothalamus significantly decline, causing the midbrain and brainstem to stay more active and reducing “sleep pressure” on our brains and bodies. One report from the University of California, Berkeley explains, “The number of galanin-expressing neurons within the preoptic area of the hypothalamus significantly decline with age, and the severity of this cell loss at post-mortem examination predicts the severity of sleep fragmentation in older adults measured in the years prior.” [6]
Put more simply, in many adults as they get older, there is less pressure to “doze off” because certain parts of the brain are failing to send the necessary signals to induce sleepiness.
02
Nocturia
The elderly experience a higher urge to wake up and use the restroom, a symptom that can lead to a condition called Nocturia, aka frequent nighttime urination. The National Institute on aging says,
“As you get older, the bladder changes. The elastic bladder tissue may toughen and become less stretchy. A less stretchy bladder cannot hold as much urine as before and might make you go to the bathroom more often. The bladder wall and pelvic floor muscles may weaken, making it harder to empty the bladder fully and causing urine to leak.” [15]
Long story short: make sure to take a restroom break before hitting the hay and watch how much liquid you drink.
04
Comorbid Conditions
It is commonly recommended that sleepers get between 7 and 8 hours of rest each night. Not getting enough shuteye can have serious side effects on your overall health.
When it comes to rest in general, there are a large number of correlating conditions that can affect both the quantity and quality of rest. It is often hard to distinguish the cause and effect relationship between comorbid conditions. For example, it can be difficult to tell if anxiety is robbing you of much-needed shuteye or if the lack of rest is causing anxiety.
These conditions can be even more common in the elderly, as they are generally more susceptible to illness and fatigue. People that have the following conditions; their complaints are most often a secondary to their comorbidity and not because by aging itself. [18]
Mental Health
“Risk factors for depression in older people include loss of a spouse, retirement, social isolation, comorbid disease, and onset of dementia.” — Sleep Clinic, Mount Sinai Hospital Center & the Department of Medicine, McGill University [10]
“Insomnia can be a symptom or harbinger (predecessor) of other psychiatric disorders. Insomnia can also be comorbid with other psychiatric disorders, thereby adding to the medical burden and increasing the risk of psychiatric relapse.” — Khurshid A. Khurshid, M.D. [19]
Heart/Blood Disease
A recent study found that heart attacks jumped by 25% the Monday after daylight savings, while they were reported as being 21% below average the Thursday after the clocks were turned back again. [20]
“Although the effects of sleep deprivation on our organs have been obscure, recent epidemiological studies have revealed relationships between sleep deprivation and hypertension, coronary heart disease, and diabetes mellitus.” — Kazuomi Kario, M.D., Ph.D. [21]
Cancer
Research has shown how longer rest duration during cancer is associated with survival. [22]
“Long-term sleep disruptions may raise the risk of some cancers. But sleep and cancer are intertwined in other ways as well. Getting a good night’s sleep is difficult during cancer treatment and can be a lifelong challenge for survivors.” — John Hopkins Medicine [23]
Gastroesophageal Reflux Disease (GERD)
“Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder encountered in the elderly patient. It is highly prevalent worldwide with a prevalence of 10%-20% in the western world. It is estimated that GERD affects 18.6 million people in the United States.” — Maxwell M. Chait, M.D. [24]
05
Physical Activity
06
Empty Nesters
The median age that parents kick that last child out to the curb so they can, yet again, experience life as free adults is 49 years old. [27] Typically, the elderly do not have their kids living at home, so they do not have to deal with putting young children to bed before being able to find time for themselves.
07
Retirement
According to the 2017 Federal Reserve report on the Economic Well-Being of U.S. Households, three-quarters of adults retire between the ages of 58 and 64, [28] meaning older adults are far less likely to be kept up worrying about work matters. One report found that 24% of adults bring work home during the week and spend an average of 2.9 hours working from home. [29]
Why Is Sleep Important as You Age?
How Is It Linked to Changes and Memory
Catching the right amount of Zzz’s at night can certainly facilitate the next day. Resting re-energizes the body and rejuvenates the mind, making it easier to crush that project at work, as well as giving you the confidence to ask out that brunette from the coffee shop.
On the other hand, getting too little shuteye can have the opposite effect. You drag yourself through the day, and not only do you feel weaker, but you are less sharp and stumble through a daze, forgetting all about the project you had to do, longing to rest your head on your pillow.
But what if sleeping soundly evaded you each and every night? Would that debt have long term effects?
Not only would you increase your risk for cardiovascular disease, cancer, a slew of mental health disorders, as well as another dozen possible conditions, not getting enough quality rest can significantly increase your chances of getting Alzheimer's disease (AD) later in life.
The glymphatic system is the brains waste removal resource. When the body is asleep, especially during non-REM (rapid eye movement) stages, it removes toxic proteins called tau and beta-amyloid. These same proteins have been linked to Alzheimer’s disease and the excessive buildup of these plaques are now being associated with inadequate rest.
Some studies have shown that gray matter loss in the brain could be caused by sleep deprivation [30] and it has also been observed that this might be one of the earliest cerebral areas to be disrupted in Alzheimer's disease. [31]
When people fail to get enough slow-wave, aka deep sleep, these toxins are not cleaned out and the risk of Alzheimer's is likely to increase. [32] Like many conditions associated with sleep health the causality remains unclear: is it the deprivation causing the buildup of brain toxins, or are the excess tau and beta-amyloid proteins causing patients to not get proper rest?
This research on this is still ongoing, but evidence suggests that its tie to memory is not only a day to day occurrence, but stands to greatly affect our future. For more info on Alzheimer’s disease and sleep, click here.
Men & Women -
Does their Sleep Age Differently?
Age is not the only factor affecting your nighttime slumber. Gender also plays a leading role in determining how you rest as you get older.
Elderly men, in general, take a heavier toll than women. They experience greater levels, by up to 50%, of impairment in their non-REM compared to younger adult males. [6] This non-REM deprivation takes a heavy toll on gray matter loss in the brain and reduced metabolism. [6]
As for the woman, they were virtually unaffected in non-REM stages when compared to their younger female peers. But they did not go completely unscathed, both elderly men and women experience a drop in REM as they get older. So while both take a hit, men take on the brunt of the dilemma.
Could this be why women live six to eight years longer than men? [33]
We don’t know, but it is fun to think about!
Sleep Better Tonight -
Tips for Senior Rest
So, now that you know all about slumber and aging, you are probably wanting to know what you can do about it. Here are a few useful tips that you can start doing today!
Cut Down on Screentime
Watching TV or playing games on your phone causes you to take in a ton of “sleep inhibitory” blue light. Turn it off and pick up a book instead.
“Watching television seemed to be the most important time cue for the beginning of the sleep period, rather than hours past sunset or other more biological factors. So, in fact, TV may make people stay up late, while alarm clocks make them get up early, potentially reducing sleep time below what is physiologically needed.” — The University of Pennsylvania School of Medicine [34]
Exercise
More
Getting some exercise is a great way to wear your body out. Be careful though, exercising too late in the day could amp you up with energy-boosting hormones, so best to keep your workout to the early morning or midday in order to get peak results for bedtime.
“Given their importance to healthy aging, it is not surprising that ample research has examined associations between sleep quality and physical activity among older adults. In particular, research examining physical activity as a predictor of sleep quality has demonstrated that as physical activity levels increase, both subjective and objective sleep quality tends to improve.” — Journal of Applied Gerontology [35]
Watch the Napping
Napping is a great tool but only when used appropriately. If you nap too long or do it too late in the day, it can impede on your bedtime and cause you to stay up. Plan naps accordingly, leaving them for the early afternoon hours.
“10% of adults ages 55–64, and 25% ages 75–84, report the occurrence of daytime naps. Across these older age groups, roughly half of these naps are unplanned.” — Sleep and Neuroimaging Laboratory, Department of Psychology, University of California, Berkeley [6]
Careful with Caffeine
It doesn’t really need to be said but we’ll say it anyway. A shot of espresso before bed is a good way to not get an ounce of shuteye. If you’ve got to have caffeine, leave it for the morning.
“Results show that 400 mg of caffeine (about 2-3 cups of coffee) taken at bedtime, three and even six hours prior to bedtime significantly disrupts sleep. Even when caffeine was consumed six hours before going to bed, objectively measured total sleep time was dramatically reduced (more than one hour). However, subjective reports suggest that participants were unaware of this sleep disturbance.” — American Academy of Sleep Medicine [36]
Easy on the Alcohol
A quick drink before bed might help you fall asleep, but it will also make you more likely to wake up in the middle of the night. Take some water instead, it’s better for you.
“This sleep disruption may lead to daytime fatigue and sleepiness. The elderly are at particular risk because they achieve higher levels of alcohol in the blood and brain than do younger persons after consuming an equivalent dose. Bedtime alcohol consumption among older persons may lead to unsteadiness if walking is attempted during the night, with increased risk of falls and injuries.” — National Institute on Alcohol Abuse and Alcoholism [37]
Conclusion
The correlation between sleep loss, memory loss, and general health decline can be alarming to many. Here is a word of advice and hope to those panicking individuals now counting how many hours they slept last night. There is time.
The more scientists and doctors begin to understand how this affects the aging process, the more they know how to fight this nighttime epidemic that so heavily affects our modern society.
Precious Zzz’s are being robbed from behind closed eyelids and sleepers don’t even realize it, and the worst part is, they don’t even recognize how much they need it.
In a world where burning the midnight oil used to be a sign of progression and “can do it” attitude, it is time to turn the focus to getting more shuteye, rather than less. After all, our lives could very well depend on it.
Explore our top picks for the best mattresses for seniors.
[1] Matthew Walker, Ph.D., “Why We Sleep: The New Science of Sleep and Dreams”
[2] Old Before Your Time: Study Suggests that Ageing Begins in the Womb, University of Cambridge
[3] How much sleep do I need?, CDC
[4] A Good Night's Sleep, National Institute of Aging
[5] Older Adults Need Less Sleep, Live Science
[6] Sleep and Human Aging, Science Direct
[7] Sleep Disorders in the Older Adult – A Mini-Review, National Center for Biotechnology Information
[8] Insomnia in the Elderly: A Review, Journal of Clinical Sleep Medicine
[10] Sleep and Aging: 1. Sleep disorders Commonly Found in Older People, National Center for Biotechnology Information
[11] Prevalence of Movement Disorders in an Elderly Nursing Home Population., National Center for Biotechnology Information
[12] Functional Movement Disorders, UpToDate
[13] U.S. and World Population Clock, Census
[14] Movement Disorders in the Older Patient: Differential Diagnosis and General Management., National Center for Biotechnology Information
[15] Bladder Health for Older Adults, National Institute of Aging
[16] Human Melatonin Production Decreases with Age., National Center for Biotechnology Information
[17] Do Plasma Melatonin Concentrations Decline with Age?, The American Journal of Medicine
[18] Sleep Disturbances and Chronic Disease in Older Adults: Results of the 2003 National Sleep Foundation Sleep in America Survey, Science Direct
[19] Comorbid Insomnia and Psychiatric Disorders, National Center for Biotechnology Information
[20] Daylight Saving Impacts the Timing of Heart Attacks, American College of Cardiology
[21] Sleep Duration as a Risk Factor for Cardiovascular Disease- a Review of the Recent Literature, National Center for Biotechnology Information
[22] Sleep Duration is Associated with Survival in Advanced Cancer Patients, National Center for Biotechnology Information
[23] Lack of Sleep and Cancer: Is There a Connection?, Johns Hopkins Medicine
[24] Gastroesophageal Reflux Disease: Important Considerations for the Older Patients, National Center for Biotechnology Information
[25] Exercise and Sleep in Community-Dwelling Older Adults, National Center for Biotechnology Information
[26] Aerobic Exercise Improves Self-reported Sleep and Quality of Life in Older Adults with Insomnia, National Center for Biotechnology Information
[27] Tapestry™ Segmentation, Esri
[28] Report on the Economic Well-Being of U.S. Households in 2017 – May 2018, Federal Reserve System
[29] American Time Use Survey Summary, United States Department of Labor
[30] Long-term Total Sleep Deprivation Reduces Thalamic Gray Matter Volume in Healthy Men., National Center for Biotechnology Information
[31] The Role of Grey Matter in Alzheimer’s Disease, Alzheimers
[32] Mayo Clinic Study: Sleep Apnea May Be Tied to Increased Alzheimer's Biomarker in Brain, Eurek Alert
[33] Female Life Expectancy, World Health Organization
[34] Television Watching Before Bedtime Can Lead to Sleep Debt, American Academy of Sleep Medicine
[35] A Longitudinal Examination of Sleep Quality and Physical Activity in Older Adults, Journal of Applied Gerontology
[36] Late afternoon and early evening caffeine can disrupt sleep at night, American Academy of Sleep Medicine
[37] Alcohol and Sleep, National Institute on Alcohol Abuse and Alcoholism
Mark Mattei
Mark sleeps like it's his job, and we often have to remind him that it’s not. He likes to study sleep health, writing content, and producing videos on his findings. When he’s not, he’s likely writing the great American screenplay, growing out his beard, or spending time with his family.
