Sleep Guide for Seniors
Our resources guide covers why older adults sleep less and how to sleep better as you age.
Sleep plays a vital role in maintaining your physical,4 9 emotional,3 17 and cognitive health.1 2 8 As you age, changes in sleep architecture, circadian rhythm, and overall health can make restful sleep more elusive — yet no less essential.5 In this guide, we’ll examine how sleep changes as you age, including the challenges that arise, who’s most at risk for sleep complications, and what you can do to get a good night’s rest.
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What is sleep architecture?
Before we delve into how aging impacts sleep quality, it’s important we go over the details of sleep architecture (or the phases of healthy sleep) since it’s often affected by age-related sleep changes.5
Sleep is a dynamic, cyclical process composed of multiple stages that repeat every 90 to 110 minutes. These stages fall into two main categories: non-REM (NREM) and REM (rapid eye movement) sleep, each serving distinct physiological and cognitive functions. The four stages include:16 18
- Stage 1 (NREM): The lightest stage of sleep, marking the transition from wakefulness. It’s easily disrupted.
- Stage 2 (NREM): A deeper light sleep stage where heart rate and body temperature begin to decrease. Early memory processing begins.
- Stage 3 (NREM or slow-wave sleep): The deepest and most restorative stage. It supports immune function, tissue repair, and physical recovery.
- REM Sleep: A phase marked by rapid eye movements, increased brain activity, and dreaming. REM is essential for emotional processing and the consolidation of procedural and emotional memories.
Why sleep matters more as you age
Sleep is essential at every age, but its impact on health becomes more pronounced as you grow older.6 7 8 9 Inadequate or fragmented sleep can impair memory consolidation,10 disrupt metabolic and immune function,11 and worsen chronic conditions like diabetes and cardiovascular disease.12 13 Older adults may be especially vulnerable due to age-related shifts in resilience,8 hormone balance,14 and brain function.17 Sleep is also closely tied to mental health.3 Insufficient rest can intensify anxiety and depression, which in turn can further disrupt sleep — creating a cycle that can undermine overall health and well-being.15 17
It’s a common myth that older adults need less sleep. In truth, adults over 65 still require about 7-8 hours of quality sleep per night — the same as people in their 20s. What changes with age is not the need for sleep, but the ability to get good quality sleep.9 16
Not all sleep is created equal. Quality sleep depends not just on duration, but also on depth, consistency, timing, and how we feel during the day. As we age, maintaining that quality can become more difficult: sleep often grows lighter and more fragmented, with less time spent in deep, restorative stages. As a result, older adults may feel unrefreshed even after a full night in bed.29
How aging affects sleep quality
Aging often brings lighter, more fragmented sleep and shifts in sleep timing. While these changes are normal, they can exacerbate other health issues if left unaddressed.29 Below, we break down some of the major changes that can affect sleep quality in seniors.
Older adults experience more frequent night awakenings and spend less time in deep and REM sleep.16 18 This age-related change in sleep architecture — known as sleep fragmentation — leads to reduced sleep efficiency and shorter total sleep time.
A meta-analysis of healthy individuals across their lifespan found that total sleep time decreases by approximately ten minutes per decade in adulthood, with this decline plateauing after age 60, and sleep efficiency decreasing by about 3% per decade starting from age 40.26 Fragmented sleep in later life has been linked to daytime fatigue, cognitive decline, and increased mortality risk.20
With age, the brain produces fewer slow-wave patterns that define deep, non-REM sleep.16 18 This decline contributes to impaired memory consolidation by weakening communication between the hippocampus and cortex during sleep.10 REM sleep also diminishes with age, both in duration and continuity, though precise reductions vary across individuals.18 Together, these changes contribute to the sleep-related cognitive decline observed in older adults.
As people age, the body’s internal clock — regulated by a part of the brain called the suprachiasmatic nucleus — becomes less sensitive to light and environmental cues. Light plays a key role in synchronizing the sleep-wake cycle, and reduced sensitivity can lead to advanced sleep phase syndrome (ASPS), where we feel sleepy earlier and wake around 3-5 a.m. Limited daylight exposure, especially in nursing homes, can worsen these shifts and further disrupt sleep.4 5
The production of melatonin (a natural hormone that helps manage your sleep-wake cycle) declines with age, disrupting circadian rhythms and making it harder to fall and stay asleep.30 Age-related retinal changes can reduce light sensitivity, further suppressing melatonin release and weakening circadian alignment. This contributes to fragmented sleep, daytime drowsiness, and irregular sleep patterns.21
Aging impairs the body’s ability to regulate core temperature — a key factor in falling and staying asleep. Normally, body temperature drops before bedtime to promote sleep, but in older adults, this response weakens, leading to disrupted sleep or early awakenings.22
Older adults often take longer to fall asleep — a delay known as increased sleep latency — and spend more of the night in lighter sleep stages, which can lead to fragmented rest. Many also nap during the day, creating a feedback loop that makes it harder to maintain consolidated sleep at night. As a result, sleep efficiency — the percentage of time in bed actually spent sleeping — often falls below the ideal 85%.16 18
Common sleep disorders in seniors
Age-related sleep changes, like lower melatonin production and circadian rhythm shifts, can also lead to seniors developing a host of various sleep disorders. In fact, according to a 2022 review, the rate of sleep disorders in older adults increases with age.31 Below, we’ll detail some of the most common sleep-related conditions experienced by seniors.
Insomnia is the most common sleep disorder in older adults, affecting up to 50% of people over 60. Symptoms include difficulty falling asleep, frequent awakenings, early rising, and unrefreshing sleep. In over 90% of cases, it’s linked to underlying issues such as chronic pain (e.g., arthritis), medications (e.g., diuretics, corticosteroids), anxiety, depression, or chronic illnesses like heart or neurodegenerative disease. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment and has stronger long-term efficacy than most medications.18 23
Obstructive sleep apnea (OSA) is common in older adults — especially in men, those with overweight or obesity, and individuals with dementia — but often goes undiagnosed, as symptoms like snoring or fatigue are mistaken for normal aging. OSA involves repeated breathing interruptions during sleep, leading to gasping, choking, and daytime sleepiness. Left untreated, it’s linked to cardiovascular disease,4 stroke,9 cognitive decline,16 and increased mortality.18 19 Studies estimate that OSA affects approximately 36% of older adults.24
Continuous positive airway pressure (CPAP) remains the standard treatment, with evidence of cognitive benefits even in patients with dementia.
Restless legs syndrome (RLS) is a neurological condition that becomes more common with age, affecting up to 20% of adults over 80 and an estimated 5–10% of older adults overall.25 It causes uncomfortable sensations — often described as crawling, tingling, or itching — in the legs, paired with an uncontrollable urge to move. Symptoms typically worsen at night, leading to fragmented sleep and reduced quality of life. RLS is associated with conditions such as iron deficiency, kidney disease, diabetes-related neuropathy, Parkinson’s disease, and the use of certain medications.25
Initial treatment often involves correcting low iron levels, if present. For ongoing symptoms, dopamine agonists, like pramipexole and ropinirole,9 16 are frequently prescribed.18 19
PLMD involves repetitive, involuntary leg movements during sleep — often every 20 to 40 seconds — that can fragment sleep without necessarily waking the person. While periodic limb movements during sleep (PLMS) are observed in up to 45% of adults over 65, PLMD is diagnosed only when these movements lead to significant sleep disruption or daytime impairment, affecting fewer than 5% of adults. PLMD often co-occurs with restless legs syndrome (RLS) or sleep apnea. Diagnosis typically requires a sleep study, and when treatment is needed, dopamine agonists such as pramipexole and ropinirole are commonly prescribed.9 16 18 19
REM sleep behavior disorder (RBD) is a parasomnia in which the normal muscle paralysis of REM sleep is lost, causing individuals to physically act out vivid and often violent dreams. It’s more common in older men, and symptoms may include shouting, punching, or falling out of bed.18 19
RBD is frequently associated with neurodegenerative diseases, especially Parkinson’s disease and Lewy body dementia, and may precede motor symptoms by several years. Treatment focuses on injury prevention, such as securing the sleep environment, and may include clonazepam, which is commonly used in clinical settings.18 19
Aging affects the body’s internal clock, often leading to advanced sleep phase syndrome (ASPS) — a condition in which individuals become sleepy in the early evening and wake up very early in the morning. These changes are worsened by declining melatonin production and limited exposure to natural light, especially in institutional settings.4 5 9 16 Circadian misalignment contributes to insomnia, excessive daytime sleepiness, and a reduced quality of life. Bright light therapy in the evening is considered the most effective treatment.18 19
Hypersomnia and EDS in older adults may stem from fragmented nighttime sleep, undiagnosed sleep apnea, or neurodegenerative conditions. It may also reflect underlying depression, hypothyroidism, or the sedating effects of multiple medications. While brief daytime naps can be restorative, excessive or habitual napping may indicate poor sleep quality at night. A thorough medical evaluation is important when hypersomnia begins to interfere with daily functioning.9 16 18 19
Sleep disruption is nearly universal in advanced dementia, often marked by nighttime wandering, frequent awakenings, and sundowning — a pattern of agitation and confusion that worsens in the evening. Patients with Alzheimer’s or Parkinson’s disease may also experience REM sleep behavior disorder, sleep apnea, or irregular sleep-wake cycles. In institutional settings, sleep efficiency is especially poor, with frequent transitions between drowsiness and brief wakefulness.9 16
Non-pharmacologic approaches — such as light therapy, structured sleep schedules, and environmental safety measures — are the preferred first-line interventions. Sedative medications should be used with caution due to the heightened risk of falls, delirium, and further cognitive impairment.18 19 20
Other causes of sleep disruption in seniors
Besides sleep disorders, sleep quality in older adults can also be detrimentally affected by other medical conditions or certain prescription medications. The following breakdown covers some of the most common concerns.
Joint pain, stiffness, and inflammation can make it difficult to fall or stay asleep.4 9 16 18 Comorbid conditions such as fibromyalgia or spinal osteoarthritis can further fragment sleep, leading to frequent awakenings and reduced sleep quality. Poor sleep and chronic pain reinforce each other, making both harder to manage.19 22 27
Diabetes may disrupt sleep. High blood sugar can lead to nocturia (frequent nighttime urination), while diabetic neuropathy causes burning or tingling sensations in the limbs, particularly at night. Both can fragment sleep. Additionally, fluctuating blood sugar levels can cause nighttime sweating, shakiness, and restlessness.4 12 18 19
Cardiovascular issues like heart failure, arrhythmias, and hypertension are all linked to impaired sleep. These conditions often coexist with obstructive sleep apnea (OSA), which is common in older adults but frequently underdiagnosed. OSA increases the risk of stroke, coronary artery disease, and cognitive decline.4 13 14 17 Some forms of cardiovascular disease, particularly heart failure, can also contribute to central sleep apnea — a condition in which the brain intermittently fails to signal the breathing muscles.18 19
These conditions have a bidirectional relationship with insomnia and other sleep issues. In older adults, grief, loneliness, and anxiety about illness or death can contribute to difficulty falling or staying asleep.18 19 Conversely, chronic insomnia increases the risk of developing or worsening depression. Common symptoms include early morning awakenings, fragmented sleep, or excessive daytime sleepiness.4 9 15 16
Sleep disruption is extremely common in individuals with dementia or Parkinson’s disease.2 3 4 5 Alzheimer’s patients may experience sundowning (worsening of symptoms in the evening), REM sleep behavior disorder, and circadian rhythm disturbances. Sleep issues often emerge before clinical symptoms of dementia and may accelerate cognitive decline.20 21 23 Disrupted sleep is also associated with impaired clearance of amyloid-beta, a protein linked to Alzheimer’s disease.21
Some medications can interfere with sleep or cause insomnia. Common culprits include corticosteroids, beta-blockers, decongestants, bronchodilators, diuretics, and certain antidepressants. Additionally, in nursing homes, sedatives are often overused to manage behavioral disturbances at night, despite evidence that they can worsen cognition and increase fall risk. As a rule, pharmacologic sleep aids should be used cautiously and only when non-drug interventions fail.4 18 19 22
Nocturia becomes more common with age due to reduced bladder capacity, prostate enlargement in men, diabetes, cardiovascular disease, and the use of diuretics or other medications taken later in the day.16 19 It is a major contributor to sleep fragmentation in older adults and increases the risk of nighttime falls.4 9 18
What healthy sleep looks like
For older adults, healthy sleep isn’t just about how long you sleep — it’s also about how well and how consistently you sleep. A good night of sleep typically means:
- Falling asleep within 20-30 minutes of going to bed
- Sleeping 7-8 hours total, though some older adults may feel rested with slightly less if sleep is uninterrupted
- Having few nighttime awakenings, or returning to sleep quickly if woken
- Waking up feeling alert, not groggy or irritable
On the other hand, some signs of poor sleep can include:
- Waking up feeling tired or unrefreshed
- Feeling drowsy during the day or needing frequent naps
- Trouble focusing or remembering things
- Frequent nighttime awakenings or waking too early in the morning
If you’re experiencing ongoing signs of poor sleep or other sleep-related concerns, it’s worth speaking to a healthcare provider. Many sleep disturbances in older adults are linked to treatable health issues, medication effects, or circadian disruptions that can be managed with support.16 18
Sleep hygiene for seniors
Creating a calming sleep environment and building consistent routines can significantly improve sleep quality, especially as age-related changes make deep rest harder to maintain.16 18 19 Some ways you can improve your sleep hygiene include:
- Create a restful bedroom: Avoid bright lights, persistent noise (like traffic or television shows), and high temperatures.4 22 19
- Establish a routine: Going to bed and waking up at the same time every day helps reinforce circadian rhythms.5 9 16 18
- Minimize sleep disruptors: Try to avoid screens, caffeine, and alcohol before bedtime.16 19 23
How seniors can get better sleep
Fortunately, there are many ways for seniors to improve their sleep and achieve quality rest, including lifestyle adjustments. Some of the most effective daily changes you can make include:
Daylight exposure helps regulate circadian rhythms, which control the sleep-wake cycle. This is especially important for those with limited sun exposure, such as residents of long-term care facilities.4 5 9 Morning sunlight or time near a bright window can help reinforce the body’s internal clock.16 18 19
If mild hunger keeps you up, a small snack may help. Tryptophan-rich foods (like oats or dairy) support melatonin production. Magnesium (found in almonds and bananas) may promote relaxation, while natural melatonin sources (like cherries and walnuts) can reinforce circadian rhythm.21
Wearable sleep trackers offer a convenient way to monitor sleep duration, quality, and disruptions. By tracking heart rate, movement, and oxygen levels, they can reveal patterns worth investigating. While not a replacement for clinical tools like polysomnography, they may support preliminary screening and ongoing sleep monitoring.28
Tracking your sleep for 1–2 weeks can help identify patterns and potential disruptors. Note when you go to bed, how long it takes to fall asleep, how often you wake, what time you wake up, and how rested you feel. This information can help your doctor pinpoint issues and recommend targeted solutions. Even minor sleep problems may reflect underlying factors worth addressing with professional guidance.
Together, these adjustments can improve sleep quality, often without the need for medication.
When to talk to your doctor
Not all sleep changes with age are cause for concern, but some may signal an underlying disorder or medical issue. If sleep problems persist for more than a few weeks, interfere with daily functioning, or worsen other health concerns, it may be worth speaking with your healthcare provider.
Here are some signs that professional support may be needed:
- You consistently wake feeling unrefreshed, even after a full night’s sleep.
- You fall asleep unintentionally during the day or feel excessive daytime drowsiness. This may reflect poor nighttime sleep quality, even if you’re unaware of disruptions.
- You snore loudly, stop breathing, or gasp for air during sleep. These are hallmark symptoms of obstructive sleep apnea, which is common in older adults and can increase the risk of heart disease, stroke, and cognitive decline.
- You feel uncomfortable sensations in your legs at night, or an urge to move them when resting. This may suggest restless legs syndrome (RLS), a neurological condition that makes falling asleep difficult.
- You thrash, kick, shout, or act out dreams during sleep. These behaviors may point to REM sleep behavior disorder (RBD).
- You routinely take more than 30 minutes to fall asleep, or wake up repeatedly and struggle to return to sleep. This pattern could indicate chronic insomnia.
In these cases, other methods to improve sleep — like supplements or medication — may be ideal.
Medications, supplements, and other medical interventions
If lifestyle changes aren’t enough, you may do well with a medication, supplement, or other approach to improve your sleep quality. Some of these options include:
- Cognitive Behavioral Therapy for Insomnia (CBT-I) is the first-line treatment for chronic insomnia. It works by addressing unhelpful thoughts and behaviors around sleep and has been shown to be as effective as medication, with longer-lasting results.
- Melatonin may help regulate sleep cycles, especially for those with circadian rhythm issues. It should be used under medical supervision, as the right dose varies by individual.
- Magnesium may support relaxation and reduce nighttime restlessness, particularly in people with a deficiency.
- Herbal options like chamomile tea or valerian root may promote calm, though scientific evidence is limited.
- For those with obstructive sleep apnea, continuous positive airway pressure (CPAP) therapy is the standard treatment. It can significantly improve sleep quality, daytime alertness, and cardiovascular outcomes.
- Sleep medications should be used cautiously and only when necessary, as they can increase the risk of falls, confusion, or dependence in older adults. Short-term options like zolpidem, eszopiclone, and ramelteon are generally safer. Benzodiazepines, such as temazepam or lorazepam, are more sedating and typically not recommended for long-term use.
- Specific conditions may require tailored treatments, such as dopamine agonists for restless legs syndrome, clonazepam or melatonin for REM sleep behavior disorder, and light therapy to reset disrupted circadian rhythms.
Resources
The following links offer additional information on sleep concerns, how aging impacts sleep, and additional ways you can improve your sleep quality.
- National Institute on Aging – Sleep and Older Adults: Offers science-based tips on sleep problems in older adults and ways to improve sleep health.
- American Academy of Sleep Medicine – Sleep Education: Comprehensive guides on sleep disorders, treatment options, and age-related changes in sleep.
- CDC – Sleep and Health: Authoritative data and resources on sleep hygiene, health impacts of poor sleep, and aging.
- Cleveland Clinic – Sleep Disorders Center: A comprehensive program from the Cleveland Clinic’s Sleep Disorders Center focused on diagnosing and managing common sleep challenges in older adults.
- Alzheimer’s Society – Sleep and the Risk of Dementia: Details the connection between sleep disturbances and Alzheimer’s in older adults.
- Preventing Falls at Home: Room by Room: A guide from the National Institute on Aging detailing how to prevent falls in your home, including in the bedroom.
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Innerbody uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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