Sleep And Ageing: Is Poor Sleep A Normal Part Of Getting Older

Quick Summary

• Sleep architecture does shift with age: deep sleep and REM sleep both decline, and sleep efficiency drops slightly. Total sleep time itself, however, stays fairly stable through the senior years.

• Over half of older adults report no sleep complaints at all. The ones who do struggle are disproportionately people managing depression, poor physical health, or a chronic illness, not simply people who have had more birthdays.

• Aging shifts the body’s internal clock earlier. This “phase advance” is why many older adults feel sleepy by early evening and find themselves wide awake at 3 or 4 in the morning.

• Specific, treatable conditions, including sleep apnea, restless legs syndrome, medication side effects, and mood disorders, explain most of the sleep complaints commonly blamed on “just getting older.”

Sleep In Older Adults

Ask most people why an 80-year-old sleeps worse than a 20-year-old, and the answer is simple: “that’s just what happens when you get old.”

This age-related decline assumption ranks among the most widely accepted ideas about aging. The research tells a more nuanced story.

Sleep does change with age, but the changes, and their underlying causes, turn out to be more specific and more treatable than “aging” suggests (Ancoli-Israel, 2009).

So what aspects of sleep change with age, and what doesn’t?

What Changes In Sleep Architecture With Age?

Sleep architecture, the pattern of sleep stages a person cycles through overnight, does change measurably with age. However, these changes in sleep architecture are smaller and level off earlier than most people expect.

A large analysis combining data from thousands of healthy sleepers found that slow-wave sleep (SWS), the deepest, most physically restorative stage, declines by about 2% per decade. This decline occurs mostly in young and middle-aged adults, and levels off after age 60 (Ohayon et al., 2004).

Sleep efficiency, the percentage of time in bed actually spent asleep, keeps declining gradually into the senior years too, though the drop is small, averaging around 3% per decade (Ohayon et al., 2004).

Total sleep time, however, doesn’t appear to change much. Despite the loss of deep sleep, adults over 55 report sleeping about as long as younger adults, roughly 7 hours on both weekdays and weekends. Younger adults, by comparison, average 6.7 hours on weekdays and 7.6 hours on weekends (National Sleep Foundation, 2003).

But while research shows the amount of sleep barely changes as we age, the timing of sleep does change.

To understand what changes about sleep timing and why, it’s useful to start with understanding what governs the timing of your sleep?

What Governs When You Feel Sleepy And When You Wake Up?

Two separate biological systems work together to influence sleep timing: a sleep drive that builds the longer a person stays awake, and an internal clock that runs on a roughly 24-hour cycle.

Sleep scientists call these Process S (sleep homeostasis, the biological “pressure” to sleep) and Process C, the circadian rhythm (Ancoli-Israel, 2009).

Process C is governed by the suprachiasmatic nucleus (SCN), a small cluster of brain cells often called the body’s master clock. The SCN synchronizes to the 24-hour day using external cues like the light-dark cycle.

It turns out that aging affects the circadian clock more than it affects the sleep drive system. And that matters for the sleep of older adults.

Why Does The Body Clock Shift Earlier With Age?

The body clock shifts earlier with age largely because the suprachiasmatic nucleus (SCN), the brain’s master clock, deteriorates somewhat over time. This deterioration results in the SCN producing a weaker, more easily disrupted circadian rhythm (Swaab et al., 1985) and a shift in melatonin timing.

The net result of these changes is that older adults tend to wake up while their melatonin levels are still relatively high, compared to younger adults (Duffy et al., 2002; Benarroch, 2008).

This shift in the timing of sleep, known as a phase advance, moves the whole sleep-wake cycle earlier. So feeling sleepy at 7 or 8pm and then waking spontaneously at 3 or 4am isn’t a “sleep disorder” as such. For many older adults, this pattern reflects a body clock that has simply moved forward. If you sleep 7 hours and you fall asleep at 8pm, naturally you’ll wake around 3am by simple mathematics.

What makes the shift worse?

Reduced daytime light exposure appears to make the shift worse. Older adults, particularly those in nursing homes, are typically exposed to far less bright light during the day than younger adults. Lower light exposure, in turn, is linked to more fragmented sleep at night (Espiritu et al., 1994; Shochat et al., 2000).

Can Waking Early Be A Problem For Older Adults?

Waking early can be a symptom of Advanced Sleep Phase Syndrome (ASPS). Advanced Sleep Phase Disorder describes a circadian pattern, common though not universal among older adults, in which the whole sleep period shifts earlier: sleepiness sets in around 7 to 9pm, and spontaneous waking happens around 3 to 5am (Ancoli-Israel, 2009).

Some older adults force themselves to stay awake until a more conventional 10 or 11pm bedtime, but still wake at 4am. This leaves too little time in bed, often prompting a nap the next afternoon. Others give in to the early sleepiness, napping unintentionally in front of the television. When night finally comes, these adults struggle with both sleep onset and early waking.

Schedule shifts, such as travel across time zones, are also harder to adjust to with this rigid, advanced rhythm (Ancoli-Israel, 2009).

Given all of these changes to sleep with aging, how many older adults are actually bothered by their sleep?

How Many Older Adults Actually Complain About Their Sleep?

Just over half of older adults report some difficulty sleeping, with the most common complaint, trouble falling or staying asleep, endorsed by 43% (Foley et al., 1995). The flip side often gets overlooked: roughly half of older adults report no sleep complaints at all.

Among those who do complain, complaints cluster heavily in people managing depression, breathing problems, poor overall health, or physical disability (Foley et al., 1999). Thus, disturbed sleep in later life tracks much more closely with illness than it does with age itself.

That pattern raises an obvious question: which conditions, specifically, are behind the most sleep complaints?

What Medical and Psychiatric Conditions Contribute To Insomnia in Older Adults?

Chronic pain, brain and nerve conditions, heart or lung problems, and mood disorders are the biggest drivers of insomnia complaints in older adults, far more than age on its own (Ancoli-Israel, 2009).

Arthritis, cancer, restless legs syndrome, Parkinson’s disease, stroke, lung disease, heart failure, and incontinence are all specifically linked to higher rates of insomnia. Mood disorders and generalized anxiety disorder also contribute: insomnia is a symptom used to diagnose both of these conditions.

A national survey found that older adults with heart disease, lung disease, stroke, or depression were much more likely than their healthier peers to sleep less than six hours a night, have insomnia, or feel excessively sleepy during the day. The more medical conditions a person carried, the more sleep complaints they reported (Foley et al., 2004).

Hormonal changes play a role too. Around menopause, the time it takes to fall asleep tends to increase by 8 to 12 minutes, and awakenings become more frequent. Hot flashes specifically increase nighttime arousals, brief awakenings, recorded on sleep studies (Purdie et al., 1995).

Illness aside, could the medications used to treat these conditions be part of the problem?

Can Medications Be Causing Your Sleep Problems?

Yes, many medications commonly prescribed to older adults can directly disrupt sleep, depending on when they’re taken.

Stimulating drugs taken late in the day, including certain antidepressants, antihistamines, beta-blockers, bronchodilators, decongestants, and thyroid hormones, can make it harder to fall asleep.

Sedating medications taken earlier in the day cause the opposite problem, contributing to daytime sleepiness, fatigue and napping that then worsens nighttime insomnia (Ancoli-Israel, 2009).

Alcohol, caffeine, and nicotine can interfere with sleep quality too, regardless of age.

Beyond illness and medication, several specific sleep disorders become far more common later in life.

So which sleep disorder shows up most often?

Is Sleep Apnea More Common In Older Adults?

Yes, obstructive sleep apnea (OSA), a condition in which the airway repeatedly narrows or collapses during sleep, is substantially more common in older adults than in younger ones.

Among older adults living at home, 25% have five or more breathing pauses per hour of sleep, and 62% have ten or more apneas and hypopneas, partial breathing pauses, combined per hour (Ancoli-Israel et al., 1991a).

The Sleep Heart Health Study, a large study that followed adults aged 40 to 98, found that around 20% of people 60 and older met criteria for at least moderate sleep apnea, compared to about 10% of those around 45 (Young et al., 2002). This rise is partly explained by weaker respiratory muscles, reduced airflow, and age-related changes in the shape and length of the airway (Ancoli-Israel, 2009).

Sleep apnea can also look different in older adults, showing up as nighttime bathroom trips, changes in memory or thinking, or repeated falls rather than the loud snoring typical in younger patients (Launois et al., 2007). Because of these symptoms, treatment is generally recommended for older adults with sleep apnea alongside heart disease, high blood pressure, nighttime urination, memory or thinking problems, or more severe breathing disruption (Ancoli-Israel, 2007).

Sleep apnea often comes with other conditions. What happens when it shows up alongside insomnia, which is one of the most common sleep complaints in this age group?

Can Insomnia and Sleep Apnea Occur Together in Older Adults?

Yes, insomnia and obstructive sleep apnea frequently occur together in older adults, and treating only one condition can leave the other undermining sleep. One study following older adults with insomnia found that 45% also had moderate-to-severe obstructive sleep apnea (Alessi et al., 2016).

This insomnia-and-apnea overlap matters for treatment choices: Cognitive Behavioral Therapy for Insomnia (CBT-I), the first-line non-drug treatment for chronic insomnia, works just as well in people with mild-to-moderate sleep apnea as it does in people without it (Fung et al., 2016).

The reverse relationship holds too. Untreated insomnia is a known risk factor for abandoning positive airway pressure (PAP) therapy, the standard sleep apnea treatment, partway through (Wickwire et al., 2010). Because of this two-way relationship, older adults with both conditions generally need treatment for both at the same time, not one after the other.

And what about the legs, rather than the airway?

Are Restless Legs and Periodic Limb Movements More Common With Age?

Yes, restless legs syndrome (RLS), a condition causing an uncomfortable “creepy-crawly” sensation in the legs that worsens at rest, becomes significantly more common with age (Phillips et al., 2000; Berger et al., 2004).

Periodic limb movements in sleep (PLMS), repetitive leg jerks during sleep, follow a similar pattern: an estimated 45% of older adults experience them, compared to just 5-6% of younger adults (Ancoli-Israel et al., 1991b).

Age appears to be a real risk factor for RLS specifically, but not necessarily for PLMS (Ohayon & Roth, 2002).

Sleep Pattern or Disorder	Younger Adults	Older Adults
Moderate-or-greater sleep apnea (AHI ≥ 15)	~10% (around age 45)	~20% (age 60+)
Any significant breathing pauses (AHI ≥ 10)	Not reported in this data	62%
Periodic limb movements in sleep (PLMS)	5-6%	~45%
Difficulty falling or staying asleep (complaint)	Not reported in this data (typically 10-20%)	43%

AHI stands for apnea-hypopnea index, the number of breathing pauses per hour of sleep.

The RLS and PLMS numbers above aren’t purely academic statistics. In one documented case, a man in his seventies had struggled to fall and stay asleep for over 20 years.

An overnight sleep study found a periodic limb movement index of 94.5, a very high result. Once his RLS and PLMS were treated directly, alongside basic behavioral strategies for insomnia, his sleep improved markedly within a few weeks (Ancoli-Israel, 2009).

RLS and PLMS are more common in older adults. But there’s one more movement-related condition worth knowing about, particularly for older men.

What Is REM Sleep Behavior Disorder?

REM sleep behavior disorder (RBD) is a condition in which the muscle paralysis that normally accompanies REM sleep, the dream stage, fails to occur. This failure allows people to physically act out their dreams.

Older adults, and older men in particular, face a higher risk of developing RBD, a disorder that can involve vigorous movement and, occasionally, aggressive behavior toward a bed partner during sleep (Abad & Guilleminault, 2004).

RBD deserves attention beyond the disrupted sleep itself: the condition has been linked to several neurodegenerative diseases, conditions where brain cells progressively break down, including Parkinson’s disease and dementia with Lewy bodies (Ferman et al., 2002).

Is Regular Napping A Problem For Older Adults?

Regular daytime napping is common among older adults, but whether napping helps or hurts remain unclear in the research. Napping is linked to factors like nighttime sleep fragmentation, long-acting sedating medications, and dementia (Foley et al., 2007).

Several large studies have also found an association between frequent napping and worse outcomes, including depression, pain, and even mortality risk (Stone et al., 2009).

Whether napping causes these outcomes, or simply travels alongside the same health problems that disrupt nighttime sleep, isn’t yet clear. Either way, a pattern of frequent, unplanned napping is worth mentioning to a sleep specialist rather than dismissing as harmless.

Zooming out from napping specifically, why does disturbed sleep matter beyond feeling sleepy or fatigued?

How Does Disturbed Sleep Affect Health and Daily Life In Older Adults?

Poor sleep in older adults carries consequences well beyond fatigue, with links to reduced physical functioning, more problems with memory and thinking, a higher risk of falls, and increased mortality risk (Stone et al., 2008).

Daytime sleepiness itself causes real difficulty too: reduced alertness, slower reaction times, and concentration problems that can sometimes be mistaken for early dementia (Ancoli-Israel, 2000).

For people living with dementia specifically, disturbed sleep is extremely common and tends to track with how advanced the dementia is. This pattern is often driven by the same combination of pain, medication effects, circadian changes, and specific sleep disorders discussed throughout this article (Pat-Horenczyk et al., 1998).

Given how often dementia and disturbed sleep occur together, what does that overlap actually look like?

How Does Sleep Change for Older Adults Living With Dementia?

Sleep disturbance is markedly more common in people living with dementia than in the general older adult population, and the pattern of disruption differs by the type of dementia involved. Nearly 60% of people with dementia experience sleep-disordered breathing, and about half report insomnia (Lavoie et al., 2018).

The overlap is even higher for two specific conditions: roughly 90% of people diagnosed with Lewy body dementia or Parkinson’s disease experience a sleep disturbance, most often REM sleep behavior disorder or insomnia (Guarnieri et al., 2012; Dauvilliers, 2007).

Sleep-disordered breathing shows up most often in vascular dementia, while people with Alzheimer’s disease more typically report insomnia alongside increased daytime napping (Zhou et al., 2012).

A distinct pattern called Irregular Sleep-Wake Rhythm Disorder (ISWRD) also appears across dementia types. ISWRD occurs when the body’s internal clock loses its synchronization with the sleep-wake cycle altogether, so a person may still get a normal total number of hours of sleep, but scattered across short, fragmented episodes throughout both day and night rather than consolidated overnight (Lavoie et al., 2018).

Medications prescribed for dementia can add to the disruption. Acetylcholinesterase inhibitors, drugs used to slow cognitive decline in Alzheimer’s disease, can increase nighttime arousal and nightmares (Dauvilliers, 2007), and Parkinson’s medications can worsen daytime sleepiness, nighttime waking, and hallucinations (Adler & Thorpy, 2005). Certain antidepressants can also trigger or worsen REM sleep behavior disorder, though bupropion, an antidepressant with a different mechanism of action, doesn’t share this effect and is generally preferred for depressed patients who also have REM sleep behavior disorder (Trotti, 2010).

Given how tangled these factors can get, what actually helps?

What Helps Improve Sleep for People With Dementia or in Long-Term Care?

Behavioral strategies, not medication, are the recommended first-line approach for improving sleep in people with dementia, and they tend to work best when started early in the disease course (Dauvilliers, 2007). Three approaches carry real benefit with little downside.

Bright light therapy also has a track record here, increasing sleep efficiency and total sleep time in people with dementia (Zhou et al., 2012; Sloane et al., 2007). Installing the lighting on walls and ceilings, rather than relying on a traditional light box, tends to be better tolerated. The American Academy of Sleep Medicine recommends light therapy specifically for ISWRD (Auger et al., 2015). The same guideline advises strongly against sleep-promoting medications, including melatonin, for people with dementia.

Long-term care facilities bring their own sleep challenges. Nighttime noise, room-sharing, rotating staff, and less exposure to outdoor daylight than someone living at home all disrupt sleep further. Poor sleep and low daytime activity also feed into each other in a reciprocal cycle: each one worsens the other (Garms-Homolova et al., 2010). The same facilities, though, are often well positioned to help. Structured programs that combine outdoor light exposure, regular exercise, social activity, consistent bedtime routines, and reduced nighttime noise and light have reduced nighttime awakenings and strengthened residents’ daily activity rhythms (Alessi et al., 2005; Martin et al., 2007). Sleep apnea remains treatable in long-term care too: positive airway pressure therapy hasn’t been studied as thoroughly in institutional settings as in the community, but people with dementia can achieve reasonable adherence with a caregiver’s support (Ayalon et al., 2006).

So where does all of this leave someone who recognizes their own sleep, or a loved one’s, in these patterns?

Where To From Here?

If you’re an older adult whose sleep no longer feels like it used to, the research here should offer reassurance: your experience is common, well studied, and in most cases, not simply the unavoidable result of getting older.

Deep sleep does decline somewhat with age, and the body’s internal clock does shift earlier. But the sleep complaints that actually disrupt daily life often trace back to something identifiable, and treatable: a mood disorder, a medication, sleep apnea, restless legs, or a shifted circadian rhythm. And a Behavioral Sleep Medicine specialist is trained to untangle these kinds of combinations.

Rather than offering generic advice, a specialist can build a structured, individualized plan around your medical history, medications, and sleep patterns, targeting the real mechanism behind your sleep problem rather than treating “old age” as the diagnosis.

Frequently Asked Questions About Sleep And Ageing

Q1: Is it normal for older adults to sleep less than younger adults?

A1: Total sleep time actually stays fairly stable with age, contrary to popular belief. Adults over 55 report sleeping close to 7 hours a night, not far off younger adults’ 6.7 to 7.6 hours (National Sleep Foundation, 2003). What does decline with age is the depth of sleep: slow-wave sleep, the deepest stage, drops by about 2% per decade before leveling off after 60 (Ohayon et al., 2004).

Q2: Why do older adults wake up so early in the morning?

A2: Older adults tend to wake up early because the body’s internal clock shifts earlier with age, a pattern called a phase advance. This shift happens largely because the suprachiasmatic nucleus (SCN), the brain’s master clock, weakens over time (Swaab et al., 1985). The result is a sleep-wake cycle that runs on an earlier schedule: sleepy by 7 to 9pm, awake by 3 to 5am, sometimes called Advanced Sleep Phase Syndrome (Ancoli-Israel, 2009).

Q3: Is insomnia a normal part of getting older?

A3:  No, insomnia is not simply a normal part of getting older. Roughly half of older adults report no sleep complaints at all, and the ones who do complain are disproportionately people managing depression, poor physical health, or a chronic illness rather than age itself (Foley et al., 1999). Persistent insomnia in later life is usually a sign that something specific, and treatable, is going on.

Q4: What medical conditions commonly cause insomnia in older adults?

A4: Chronic pain, conditions affecting the brain and nerves, heart or lung problems, and mood disorders are the medical conditions most strongly linked to insomnia in older adults. Arthritis, restless legs syndrome, Parkinson’s disease, stroke, heart failure, and incontinence all carry this link, and so do depression and generalized anxiety disorder (Ancoli-Israel, 2009). Older adults managing several of these conditions at once tend to report the most sleep complaints (Foley et al., 2004).

Q5: Is sleep apnea more common in older adults?

A5: Yes, obstructive sleep apnea becomes substantially more common with age. About 25% of older adults living at home have five or more breathing pauses per hour of sleep, and the Sleep Heart Health Study found that roughly 20% of adults 60 and older have at least moderate sleep apnea, compared to about 10% of those around 45 (Young et al., 2002). Sleep apnea can also look different in older adults, showing up as nighttime bathroom trips or memory problems rather than the loud snoring typical in younger patients (Launois et al., 2007).

Q6: Can insomnia and sleep apnea happen at the same time?

A6: Yes, insomnia and obstructive sleep apnea frequently occur together in older adults. One study found that 45% of older adults with insomnia also had moderate-to-severe sleep apnea (Alessi et al., 2016). Because untreated insomnia can also make it harder to stick with sleep apnea treatment (Wickwire et al., 2010), both conditions generally need to be treated together rather than one after the other.

Q7: What is restless legs syndrome, and does it get worse with age?

A7: Restless legs syndrome (RLS), a condition that causes an uncomfortable “creepy-crawly” sensation in the legs that worsens at rest, does become significantly more common with age (Phillips et al., 2000; Berger et al., 2004). Periodic limb movements in sleep, repetitive leg jerks during sleep, follow a similar pattern, affecting an estimated 45% of older adults compared to just 5-6% of younger adults (Ancoli-Israel et al., 1991b).

Q8: What is REM sleep behavior disorder?

A8: REM sleep behavior disorder (RBD) is a condition in which the muscle paralysis that normally accompanies REM sleep fails to occur, allowing people to physically act out their dreams. Older adults, particularly older men, face a higher risk of developing RBD (Abad & Guilleminault, 2004). The condition is also worth flagging to a doctor: RBD has been linked to neurodegenerative diseases such as Parkinson’s disease and dementia with Lewy bodies (Ferman et al., 2002).

Q9: Is napping bad for older adults?

A9: Whether napping is harmful for older adults remains unsettled in the research. Napping is linked to factors like nighttime sleep fragmentation and sedating medications (Foley et al., 2007), and several large studies have also found an association between frequent napping and worse outcomes, including depression, pain, and mortality risk (Stone et al., 2009). A pattern of frequent, unplanned napping is worth mentioning to a sleep specialist rather than dismissing it as harmless.

Q10: How does dementia affect sleep, and can dementia related sleep problems be treated?

A10: Dementia substantially increases the rate of sleep disturbance. The pattern differs by dementia type: nearly 60% of people with dementia have sleep-disordered breathing and about half have insomnia. Roughly 90% of people with Lewy body dementia or Parkinson’s disease experience a sleep disturbance, most often REM sleep behavior disorder or insomnia (Lavoie et al., 2018; Guarnieri et al., 2012; Dauvilliers, 2007). Behavioral approaches, including a consistent routine and bright light therapy, are the recommended first-line treatment and tend to work best when started early (Dauvilliers, 2007; Auger et al., 2015).

Q11: When should an older adult see a sleep specialist?

A11: An older adult should see a sleep specialist when sleep complaints are disrupting daily life, rather than assuming poor sleep is simply an unavoidable part of aging. The sleep complaints that actually interfere with daily functioning almost always trace back to something identifiable and treatable: a mood disorder, a medication, sleep apnea, restless legs, or a shifted circadian rhythm. A Behavioral Sleep Medicine specialist can build a structured, individualized plan around a person’s specific medical history and sleep patterns, rather than treating “old age” as the diagnosis.

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Written By Dan Ford, DBSM, Sleep Psychologist

Published By The Better Sleep Clinic