What normal sleep changes
can be expected as you age?
cognitive and emotional health. Did you know that unsatisfactory sleep is NOT a hallmark of aging?
Five ways to maintain sound sleep as you age:
1. Make your sleep a health priority. If you have sleep concerns, talk about them and take action!
- Discuss your dissatisfaction or what others are saying about your sleep (snoring, moving, etc) with your doctor or a healthcare provider who understands sleep.
- If you take medication, discuss its potential sleep-related side effects with your pharmacist or physician.
- If you are a woman discuss, the menopausal symptoms that interfere with your sleep (e.g., night sweats and hot flashes).
2. Adopt a regular sleep-wake cycle that results in restfulness.
3. Create an optimal environment for sleep.
This can include:
- A quiet and dark room set at a comfortable ambient temperature.
- If necessary, do not hesitate to sleep in a separate bed or room to protect your sleep quality and that of your bed partner.
4. Maintain healthy sleep hygiene – Good health and good sleep go hand in hand.
- Stay active, eat well and get exposed to daylight and lighting as much as you can.
- Don’t overeat or exercise intensely near bedtime.
- Limit or avoid alcohol, caffeine and nicotine. Refrain as much as possible from using substances (alcohol, sleeping pills, etc.) too close to bedtime or to induce sleep.
- Diminish stress and worries before bedtime as much as you can. Use relaxation techniques, perform relaxing activities (e.g., mandalas, knitting, etc.), or make a “to do list” to empty your mind.
- Try to avoid night-work or night shifts if possible.
- If you experience jetlag, allow yourself some time to adjust to your new time zone.
5. Don’t over-stress about sleep!
Age-related sleep changes are to be expected and normal. However, you should seek advice from a sleep expert if they are drastic, cause excessive sleepiness and/or negatively impact your daily activities.
What normal sleep changes can be expected as you age?
Regardless of your age, it is not normal to sleep poorly and not feel rested upon awakening. If you are not satisfied with your sleep and you constantly feel sleepy or you do not feel like your best self during the day, you should consider making lifestyle changes and seek medical advice. Sleep should never be overlooked at any age, because poor sleep can mask the symptoms of an underlying medical condition that requires your attention.
Poor sleep is not inevitable.
There are solutions that can help you sleep and feel better.
As time passes, the normal aging process brings on physical changes as well as alterations in your sleep patterns. Even if you do not suffer from specific sleep disorders, medical issues or psychological problems, sleep will change as you age, just as gray hair will appear or your skin will wrinkle. Sleep modifications are part of normal aging and may or may not impact your daily activities.
It is a common misconception that we need much less sleep as we age and sleep is automatically less satisfying among older individuals. It is true that sleep becomes more fragile as we get older and that even if some elderly individuals may need less sleep than their younger selves, the actual decrease is relatively small. Most of the time, an aging individual’s sleep needs remain the same in terms of its duration, but changes are seen in “how ” and “when” sleep occurs. Compared to younger adults, older individuals may or may not sleep less during a 24-hour period, but clear differences are seen in their sleep quality and schedule.
For example, someone older than 60 years old may experience the following:
- Bedtimes and wake-up times are earlier than when they were in their 40s.
- Less sleep is needed during the night.
- Increased sleep needs during the day, which are fulfilled by restful napping.
- Lighter sleep, which is often reflected by more frequent disruptions (i.e., awakenings) and less time spent in the deep sleep stage.
- Difficulty remaining asleep, especially in the second half of the night close to morning awakening.
Please note that excessive sleepiness is always suspicious; at any age, you should make sure it is not signalling a sleep trouble (e.g., insomnia, apnea, narcolepsy, etc) or a medical or psychological condition. However, when associated with the normal aging process, napping when feeling sleepy efficiently compensates for shorter sleep at night.
Ultimately, your aging body adapts, the need to sleep balances itself and your total sleep duration in a 24-hour period approximates that of your younger adult self. These age-related differences in sleep patterns are just as normal as the sleep changes you experienced as you grew from a baby to a child, and then an adolescent. However, now (as then) you must consider and adapt to these changes so you can continue to feel satisfied with your sleep and rested during the day.
Time to sleep: the impact of an aging biological clock
A lot of people are not aware of the biological forces that regulate their sleep-wake cycle. One innate mechanism is the biological clock, which is situated in our brain and control the urge to go to sleep at night and be active during the day. This internal timekeeper is responsible for the sleep-wake cycle and, as we age, it starts to exhibit a weaker and earlier timing that affects our sleep schedule and sleep quality. This partly explains the above-described age-related changes in sleep (earlier bedtimes, earlier awakenings, more napping and shallower sleep).
The weakening of sleep means that as we age we become more sensitive to challenges imposed upon our sleep-wake cycle. For example, into our forties we often adapt more slowly to jetlag or shift work, and we have more difficulty or take longer to recover from sleep deprivation. You may also suffer from other age-related conditions that challenge sleep, such as nocturia (the need to urinate at night). Thus, the older we are, the more sleep weakens, the more we must take extra care to keep a regular sleep schedule.
To nap or not to nap, that is the question!
Sleeping during the day typically has a negative effect on nighttime sleep, as it diminishes the pressure to go to sleep at night and may cause insomnia symptoms. However, because of the age-related changes in our biological clock, napping does not necessarily have this negative effect in older people. An extreme need to sleep every day might signal an underlying problem, even later in life, and thus warrants a trip to your doctor. If you are otherwise healthy, however, you should enjoy, with no guilt or fear, the recharging benefits provided by a short nap (about 20 to 45 minutes) when the need arises or as a regular sleep habit.
Is it age or a sleep disorder?
Certain conditions that affect our sleep or occur while we sleep are called “sleep disorders”. It has been well established that older individuals have a higher proportion of sleep disorders compared to young adults linked to aging or health matters. Nonetheless, solutions do exist and talking about it with a health provider could change your nights and days!
Here is brief list of sleep disorders seen more frequently as we aged:
Repeated pauses in breathing during sleep accompanied by decreases in oxygen saturation and sleep quality
Repetitive movements of limbs, often the legs, that occur while falling asleep (most often) or during sleep; may or may not disrupt sleep
Overwhelming urge to move the legs, usually caused by uncomfortable or unpleasant sensations in the legs; occurs usually when attempting to fall asleep or while resting
Presence of abnormal muscle tone during a period of sleep called REM sleep, resulting in apparent acting out of dream content
Sleep disorders can be symptoms of illness or responses to life events.
The interrelationship between health and sleep is very important for older individuals. For example, those newly identified as having a significant illness are more likely to have a new complaint of chronic insomnia within the next few years compared to older individuals who do not have a medical disease. Cardiovascular disease, pulmonary disease, chronic pain conditions, and dementia are all associated with poor sleep quality and/or excessive daytime sleepiness* SLEEPINESS VERSUS FEELING FATIGUE Sleepiness is the urge or need, difficult to repress, to sleep during the day. Not to be confused with fatigue, which is a feeling of exhaustion that requires one to rest, but that does not translate into involuntary sleep or an excessive need for it. Tired people can fight sleep without difficulty during the day. Sleepy people, on the other hand, are consumed by sleep. They can fall asleep easily in class, at work or while driving, for example. Sleepiness is not a normal state because it is related to either an acute (sleep deprivation) or chronic sleep loss or poor sleep quality. Severe sleepiness is often a critical symptom of sleep disorders, but also of certain medical or psychological problems. Don’t sleep on it!
Beyond medical conditions, elderly individuals frequently take medications that can affect their sleep and/or suffer from psychiatric disorders whose acute symptoms might contribute to sleep difficulties (e.g., depression and insomnia).
In terms of major life changes and stress, aging leads to menopause, retirement, the loss of a loved one, reduced social contact, etc., all of which can impact health and affect us as we age.
If you suspect that you have a specific sleep disorder, you should consult your physician or any other healthcare provider who is knowledgeable about sleep.
Menopause and sleep
If you have ever discussed menopause with your friends, you may have realized that there are as many menopause experiences as there are women. For most women, this natural transition is a smooth one with no major issues. Even then about half of menopausal women report sleep disturbances. Compared to pre-menopausal women, menopausal women are twice as inclined to use sleeping pills, as some sleep less or have insomnia symptoms.
Very few sleep studies have evaluated the effect of menopause on objective sleep parameters in the laboratory, and the reported results have not yet provided satisfying answers. More studies have investigated how sleep is affected by various menopause-related symptoms, such as night sweats and hot flashes, which often prompt women to seek medical attention. Without a doubt, these menopausal symptoms and associated treatments seem to play a role in whether or not women are satisfied with their sleep. However, we still don’t know how these symptoms and treatments impact the recuperative function of sleep.
* SLEEPINESS VS FEELING FATIGUE
Sleepiness is the urge or need, difficult to repress, to sleep during the day. Not to be confused with fatigue, which is a feeling of exhaustion that requires one to rest, but that does not translate into involuntary sleep or an excessive need for it. Tired people can fight sleep without difficulty during the day. Sleepy people, on the other hand, are consumed by sleep. They can fall asleep easily in class, at work or while driving, for example. Sleepiness is not a normal state because it is related to either an acute (sleep deprivation) or chronic sleep loss or poor sleep quality. Severe sleepiness is often a critical symptom of sleep disorders, but also of certain medical or psychological problems. Don’t sleep on it!
Credit: The Canadian Sleep and Circadian Network (CSCN), Reut Gruber from the Canadian Sleep Society (CSS) and Immerscience