There is a common belief that we require less sleep as we get older and that insomnia is as inevitable as gray hair, wrinkles, and reading glasses. This is not true!
Although older people have more than their fair share of sleep problems, insomnia is not a normal part of aging. Plus, despite the myths, the number of hours of sleep we need each night doesn’t decline.
That said, changes in sleep cycles do occur as we get older—and along with an increase in health problems, they can make falling and staying asleep more challenging. Let’s look at how aging affects sleep and what you can do to get a better night’s sleep.
How Much Sleep Do You Really Need?
From birth through childhood, sleep requirements taper dramatically, from 14–17 hours for newborns to eight–10 hours for adolescents. From age 18 through old age, the recommended amount of sleep holds steady at seven to nine hours.
The experts who come up with these ranges acknowledge that requirements vary from person to person. Some healthy people sleep as few as four hours a night or as long as 10–11. However, the bulk of the research suggests that for adults of all ages, seven to eight hours a night is the sweet spot for optimal health.
Canadian researchers published a remarkably comprehensive analysis in October 2020 on the links between sleep duration and health outcomes. After reviewing studies that involved 4.4 million individuals from 30 countries, they found that, compared to the optimal seven to eight hours a night, both insufficient and excess sleep increased the risk of a number of medical problems.
Conditions linked with too little—or too much—sleep included obesity, diabetes, cardiovascular disease, depression, injuries, and neurological disorders such as dementia. Most revealing, they found that sleeping fewer than six hours a day was associated with a 12% increase in risk of death, but more than eight or nine hours increased risk by 39%!
Aging & Sleep Patterns
Why do so many older people have a hard time getting those seven to eight hours? One reason is subtle alterations in “sleep architecture”—the basic structure and organization of sleep.
Sleep consists of three gradually deepening stages of non-rapid eye movement (NREM) sleep plus a fourth stage of rapid eye movement (REM) sleep, when dreaming occurs. Each cycle lasts 90–120 minutes, and we generally cycle through these stages four or five times a night.
Researchers have identified several age-related sleep changes that correspond with common complaints:
- Melatonin: There is a gradual decline in the production of melatonin, the hormone that signals when it’s time to sleep.
- Circadian rhythms: A forward shift in circadian rhythms, the 24-hour fluctuations governed by our internal body clocks—related in part to the reduction in melatonin—may result in feeling sleepy earlier in the evening and awakening earlier in the morning.
- Sleep stages: Less time is spent in deep sleep (REM and late NREM sleep) and more time in the lighter stages of sleep. This is associated with more frequent awakenings and a harder time getting back to sleep.
Sleep Robbers
As you can see, the above changes, which are considered to be a normal part of aging, can make you more vulnerable to insomnia. However, the real contributors to older-age sleeping problems are anything but normal—and many of them are within your control.
- Chronic disease: 80% of older adults have at least one chronic disease, and 77% have two or more. Arthritis, diabetes, COPD, cancer, heart disease, and other chronic conditions are linked with poor sleep.
- Medications: 89% of people age 65 and older take at least one prescription drug, and 54% take four or more. Prescription and over-the-counter medications for asthma, hypertension, depression, high cholesterol, allergies, colds, and weight loss can interfere with sleep.
- Pain: Half of older individuals and 80% of those in assisted living report having persistent pain, a common cause of sleep loss.
- Sleep apnea: This sleep disorder, which causes frequent awakenings and prevents cycling into the deeper stages of sleep, is more prevalent in the older population.
- Restless leg syndrome: More common and more severe in people who are middle-aged or older, restless leg syndrome also disrupts sleep cycles.
- Nocturia: If you are a man who has to get up two or three times a night to heed the call of nature, you probably have benign prostatic hyperplasia (BPH), a common but treatable problem in older men. Uncontrolled diabetes and excessive fluids in the evening also cause frequent nighttime urination.
- Anxiety & depression: Thoughts and worries that you can’t shut off can make sleep elusive. Older people don’t have a monopoly on these problems, but nearly one in four women over age 65 takes an antidepressant.
- Excess alcohol: An estimated 15% of older Americans drink too much. Alcohol may make you feel sleepy, but in excess it interferes with the deepest stages of NREM and REM sleep—making you more likely to wake up during the night. It also worsens sleep apnea.
- Napping: Napping, especially 10-to-20-minute “power naps,” has multiple health benefits. Sleeping too long or too late in the day, however, can make for sleepless nights.
- Screen time: Older adults average four hours of TV daily. Watching stimulating shows before bedtime can make it harder to fall asleep—plus, blue light from all kinds of digital devices suppresses the release of melatonin.
“The Best Cure for Insomnia…”
If you go to sleep and wake up at a similar time most days, sleep through the night, have plenty of energy, and don’t get sleepy during the day, you’re getting enough sleep—no matter how many hours you put in.
If you need an alarm clock to wake you up, have to drag yourself out of bed, feel sleepy and unfocused during the day, take long naps, or sleep in later whenever you can, then you need more sleep.
The usual advice on how to get a good night’s sleep—which is really just common sense—pertains to people of all ages. But I want to emphasize a couple of points that are particularly important if you are in your 60s and older.
- Arrest sleep robbers: Get a handle on the sleep robbers listed above. Most of them can be treated—often with safe, natural therapies. This will make a tremendous difference not only in your sleep but in all aspects of your life.
- Take 3 mg of melatonin at bedtime: Other supplements such as L-theanine, GABA, and valerian help you relax and fall asleep, but melatonin is nature’s sleep aid, and production drops dramatically with age.
Finally, heed W.C. Fields’ sage advice: “The best cure for insomnia is to get a lot of sleep.”
