Aging and Sleep:
Safe Sleeping Guide for Seniors and Caregivers

How Our Sleep Changes as We Age

The way we sleep changes and evolves as we age — right from the day we are born. The amount of sleep we need changes, as does our sleep cycle and the amount of time we spend in different sleep stages.

There are many common changes to our sleep that studies have shown are a result of aging.

These changes typically include:

• A decrease in total time spent asleep each night
• A delay in sleep latency, i.e., it takes longer to get to sleep once in bed
• An increase in the amount of time spent in the N1 and N2 stages of sleep
• A decrease in the amount of time spent in the N3 (deep) sleep stage
• A decrease in the amount of time spent in REM sleep
• More frequent nighttime awakening
• Fewer sleep cycles each night
• Decreased sleep efficiency
• Advancement of the circadian rhythm (i.e., earlier to bed and earlier to rise)
• An increase in the frequency of daytime napping

How Many Hours of Sleep Do Seniors Need?

There is a persistent and widespread assumption that older people do not need as much sleep as younger people. But this is nothing more than a myth. Adults aged 65 and over have the same sleep requirement as younger adults — between 7-9 hours per night.

So why the common belief that older adults do not need as much sleep?

A big part of it is likely because, in general, older people do in fact get less sleep — not because they actually need less, but because of natural changes to what is known as “sleep architecture” — which relates to the sleep cycle and the time spent in the different stages of sleep.

As we age, we also tend to suffer from more health conditions. These, along with the medications used to treat these conditions, are also common causes of reduced sleep in seniors.

Sleep Architecture in the Elderly

Generally, we see a decline in the quality of sleep we get as we age. This is due to changes in our sleep architecture, which simply refers to how our sleep is structured — the different stages and cycles of sleep we go through.

Older people tend to experience lower-quality sleep because they spend less time in the deep, restorative stage (N3) of non-REM sleep. More time spent in lighter sleep means they are more easily woken, and fragmented, interrupted sleep is common.

An analysis of multiple studies shows that there is a linear decrease in total sleep time with the age of around 10 minutes per decade. Time spent in both N3 (deep or slow-wave sleep) and REM sleep stages also decreases, plateauing after age 60. This increases the amount of time spent in the lighter N1 and N2 stages of sleep.

The overall efficiency and quality of sleep also decline due to the increased time to get to sleep (sleep latency) and fragmentation of sleep with increased arousals during the night.

Changes in the Circadian Rhythm

One of the major causes of the changes in the way we sleep as we age is our circadian rhythm. The circadian rhythm is the internal process that dictates when we sleep.

As people age, if they are not already there, they will often transition to what is known as a morning chronotype. Our chronotype is our propensity to sleep at a particular time during a 24-hour period.

In Layman’s terms, older people tend to be “morning people” — and a lot of this has to do with the change in circadian rhythm. According to studies, adults with a mean age of 68 reports preferred bedtimes 1 to 2 hours earlier than younger people. This is due to a shift in the body’s internal circadian rhythm and is why older people tend to go to bed earlier and rise earlier than younger people.

So, what is the cause of this change?

A University of Kent study shows that aging impairs the circadian clock’s ability to reset itself when exposed to light, which is a zeitgeber, or natural external cue that causes our internal biological rhythms to synchronize with the Earth’s light-dark, 12-month, and seasonal cycles.

This impairment is due to the reduction in sensitivity to light of the suprachiasmatic nucleus (SCN), which is a cluster of cells located within the hypothalamus in the brain that reacts to light signals and regulates the circadian rhythm.

Safe Sleeping Tips for Seniors

On the face of it, sleeping may seem like one of the least-dangerous activities we can undertake. Still, for many elderly, physical or cognitive decline, disability, illness, and medications can all create potential dangers during what is meant to be a peaceful and uneventful time of the night.

Safety is one thing that seniors, their families, and their carers should have at the front of their minds when it comes to sleeping.

There are dangers from the environment itself in the form of tripping, falling, and colliding with objects, confusion, disorientation, and wandering away from home (especially for people with Alzheimer’s or dementia).

The risk of suffering a fall or other accident that could result in an injury can be increased due to insomnia or lack of sleep due to another sleep disorder, on top of compounding the risk of developing diseases and other health issues.

Reducing Nighttime Risks for Seniors

1. Preventing Trips and Falls

Seniors are at the greatest risk when it comes to the consequences of tripping or falling in the home.

Physical frailty and vulnerability mean that a fall that may be inconsequential for a young-healthy person could have dire consequences for an elderly person. Falls in the home have the potential to cause traumatic injury, permanent disability, even death.

There are many potential hazards to be aware of, especially in the bedroom. The following are all potential trip hazards and should be removed or made safe:

• Rugs and carpets, especially the corners and edges
• Steps and stairs
• Electrical/phone cables
• Furniture items like bedside tables and chairs
• General clutter
• Clothing or shoes left on the floor
• Pets and pet beds

Takeaway

Think about any potential routes an elderly person may take if they get up in the night, for example, from the bedroom to the bathroom or the kitchen. Start in the bedroom and work your way through the house to identify, remove, or make safe any trip or fall hazards.

Consider investing in some movement-sensing nightlights that can turn themselves on and off to light the way and illuminate any potential hazards.

2. Seniors and Sleeping Pills

Sleeping pills are generally not recommended for seniors.

Firstly, they are intended for short-term use, not as long-term management for poor sleep. They don’t treat any underlying cause, and long-term use can cause dependence and addiction.

Seniors will often be on several other prescription medications, and sleeping pills can interact with these adversely. They can cause balance problems, confusion, delirium, and disorientation, increasing the risk of falls and accidents.

A doctor should always be consulted before using sleeping pills to ensure they are appropriate, and no risks are presented by any other medications being taken.

Takeaway

Natural remedies and talk or cognitive behavior therapy can be helpful alternatives to using sleeping pills. Cognitive-behavioral therapy (CBT) can address fears, thoughts, and behaviors that contribute to or cause problems sleeping.

In some cases, it can be more effective at treating chronic insomnia than medication, without any risks or harmful side effects.

3. Alzheimer’s Patients

Caring for an older person with Alzheimer’s is challenging, and extra precautions need to be taken to keep them safe at night.

Alzheimer’s can cause changes to the sleeping patterns of sufferers, including frequently waking during the night — which can lead to them wandering while in a disoriented state.

The same precautions in preventing trips and falls around the house should be taken for seniors with Alzheimer’s. Still, their wandering is not always restricted to within the home — they may leave the house and potentially travel some distance.

Seniors who wander will often be very confused and get lost. They can get themselves into trouble, often ending up in the most surprising, random, and dangerous places.

Seniors in this situation are at risk of injury and even death. Not being dressed adequately for being outside at night, especially in cold weather, poses a risk of exposure.

Takeaway

The risk of wandering can be reduced by ensuring good quality sleep at night — keeping patients occupied and active during the day helps.

But precautionary measures must still be taken — as well as ensuring trip and fall hazards are removed or minimized, extra measures should be taken. This includes securing and locking doors, windows, or any other method of egress, and using a personal medical alarm or GPS tracker.

4. Don’t Be Scared to Seek Assistance

Often, older people do not wish to be seen as “making a fuss” about things or seeming like a burden, so it can be hard to convince them to seek help.

However, if you yourself are an older person or you are a carer for an older person, there should be no hesitation to see a doctor or medical professional for any concerns around sleep, especially if there are changes to normal sleep behavior.

Takeaway

Changes in sleeping patterns or trouble getting enough good quality sleep can be signs of an underlying condition, or one beginning to develop. If nothing else, seeing a doctor can offer peace of mind and reassurance if your health is fine, and they can refer you to specialists like sleep doctors and therapists if needed.

5. Creating a Healthy, Comfortable Sleep Environment for Seniors

• Get rid of trip hazards and make sure the floor is clear of clutter and objects that pose a danger.
• Use non-slip rugs and make sure edges and corners are secured and in place.
• Ensure plenty of clearance around furniture, especially hard or sharp corners.
• Be sure paths are adequately lit. Consider using movement sensing or remotely controlled lights and night lights in hallways.
• Install rails in the bedroom, bathroom, and anywhere there are steps to be navigated.
• Use stair gates to prevent falls.
• Be sure potential hazards such as medications, poisons, firearms, etc. are locked away.

Sleep Disorders in Seniors

There are a number of sleep disorders common in older people, and there are several factors that older people are affected by that can cause insomnia or other sleep problems.

These include:

• Being sedentary a lot of the time, and lack of exercise
• Medications
• Poor sleep hygiene
• Poor sleep environment
• Menopause and postmenopause
• Lack of natural sunlight
• Social isolation
• Stress and anxiety
• Medical conditions
• Pain or discomfort

Both older people, as well as family and carers, need to be aware of the possible effects of lack of good quality sleep, as chronic problems can have a significant impact on both an older person’s general physical and mental health, as well as their overall quality of life.

Chronic sleep problems can lead to persistent daytime tiredness, which can have knock-on effects in the form of needing to nap during the day, decreased activity levels, increased social isolation, and depression.

We’ll now take a look at some of the common causes of disrupted or poor-quality sleep in seniors, and how older people and their carers can overcome these and promote better sleep.

1. Insomnia

The most common and widespread sleep problem in the older population, Insomnia is more prevalent in older people than young people. As many as 50% of older adults suffer from difficulties in getting to or maintaining sleep.

The signs of insomnia are:

• Difficulty getting to sleep (increase sleep latency)
• Difficulty maintaining sleep (frequent waking during the night)
• Waking too early and not being able to return to sleep
• Reduced overall sleep time
• Excessive daytime tiredness

It is common for seniors who have insomnia to “catch up” on sleep with daytime naps, but this can just compound the problem if it then causes further delays in getting to sleep at night.

Medications and prescribed or over-the-counter sleep aids can help. Still, they are not a desirable long-term solution, and as we will touch on further in this guide, sleeping medications should be treated with caution when it comes to seniors’ use.

Takeaway

There are many alternative ways aside from relying on sleeping pills to counter insomnia and a lack of good-quality sleep, including lifestyle changes and alternatives to prescribed medications, which we’ll cover in detail in another section of this guide.

2. Snoring

While snoring is generally more of a threat to the undisturbed sleep of the partner we share our bed with, it can have more serious implications for the one doing the snoring if left unaddressed.

Snoring is more prevalent in older people due to the weakening and loss of the airway muscles’ tone as we age. This can cause the soft tissue surrounding the airway to collapse, resulting in snoring.

Takeaway

Snoring is not dangerous in itself, but chronic snoring can signify a serious underlying condition such as obstructive sleep apnea, which can raise the risk of diseases like diabetes, hypertension, stroke, and cardiovascular problems.

3. Sleep Apnea

Sleep apnea, which is characterized by periods where breathing stops altogether, is more prevalent in older adults than younger ones. This is due to the same weakening of airway muscles that causes snoring.

While snoring is not a problem as serious as sleep apnea, it can be a sign of it. Obstructive sleep apnea is when the same soft tissue that collapses around the airway completely obstructs it, resulting in periods where breathing stops completely despite the respiratory effort.

Central sleep apnea is caused not by a physical blockage of the airway, but by the brain not signaling the muscles to breathe. Central sleep apnea is not as common as obstructive sleep apnea and can be a sign of an underlying, potentially serious illness.

Sleep apnea can have similar consequences as insomnia, with excessive tiredness during the day. Medical advice should always be sought if sleep apnea is suspected.

Takeaway

There are some treatment options available for sleep apnea, including:

• Using a continuous positive airway pressure (CPAP) device, which provides constant airflow through a mask that is worn while sleeping to keep the airway open.
• Lifestyle changes. Some of the most effective treatments for sleep apnea are things such as losing weight, quitting smoking, avoiding alcohol late in the day, and changing sleeping positions.
• Wearing a dental device to alter the positioning of the jaw and tongue to promote unrestricted airflow.

4. Restless Leg Syndrome (RLS)

Restless leg syndrome is a condition that can be extremely uncomfortable and can cause severely disrupted sleep.

It is characterized by sensations such as tingling, burning, crawling, or pins and needles in one or both legs. It can cause an uncontrollable urge to move the legs to find relief from the sensations, which is often worse at night when lying in bed or when sitting for long periods.

In many cases, the cause of RLS is unknown, but research has shown there appears to be three factors that can cause it: genes, concentrations of iron, and dopamine in the brain.

Antidepressants, anti-nausea medications, and allergy medications are also known to contribute to RLS development. Symptoms can be worsened by caffeine, nicotine, and alcohol.

Takeaway

Iron supplements, dopamine-boosting medications, muscle relaxants, sleep aids, and even opioids are used to treat RLS. Still, lifestyle changes and activities that promote relaxation before bedtime, such as meditation or yoga, can help, as can massage, warm baths, and warm or cold packs applied to the leg muscles.

5. Periodic Limb Movement Disorder (PLMD)

Periodic limb movement disorder is another movement disorder like restless leg syndrome, but PLMD is characterized by involuntary and uncontrollable jerking movements of the arms and legs during sleep.

Onset early in the night can prevent sufferers from falling asleep and can cause nighttime waking. It is a potentially dangerous condition, especially for seniors, as the jerking movements can sometimes be violent enough to cause the sufferer to fall out of bed.

Takeaway

Like restless leg syndrome, periodic limb movement disorder can be eased or treated through exercise, relaxation, and warm baths. Medication can also be prescribed to treat the condition.

6. Gastroesophageal Reflux Disease (GERD)

As we get older, heartburn often increases in both frequency and intensity. If heartburn happens more than twice a week, it is diagnosed as gastroesophageal reflux disease or GERD. As anybody who has tried to sleep with a particularly bad reflux case knows, it can be severely disruptive and uncomfortable.

Reasons for GERD becoming more common as we age include:

• Weakening of the esophageal sphincter, which controls the opening between the esophagus and stomach. Instead of only opening to allow food into the stomach, it can sometimes allow stomach acid to escape up into the esophagus.
• Weight gain can also contribute to a weakening of the esophageal sphincter. Overweight people are at higher risk of severe GERD.
• When the upper part of the stomach bulges up through the diaphragm into the chest cavity, this is known as a Hiatal hernia. Very common in over-60’s, Hiatal hernias will often have no symptoms but do put sufferers at a higher risk of GERD.
• Medications commonly taken by older adults, such as blood pressure medications, opiates, and antidepressants, can cause GERD.

Men over 50, especially Caucasian, overweight, and former or current smokers, are at higher risk of esophageal cancer if prolonged GERD is left untreated. Weight loss and adjusting medications can help alleviate GERD and heartburn.

Takeaway

The biggest tip for sufferers for immediate relief when trying to sleep? Sleep on your left side, with your head raised if you can. This orientates your body so that the esophageal sphincter is above the stomach contents, making it harder for reflux to escape.

Summary

Aging presents a host of challenges both for those experiencing it and those caring for the aged. A larger focus tends to go on our health, as more and more issues tend to arise as we get older.

Sleep has a significant bearing on our overall physical and mental health, and can be adversely affected by medical conditions, medications, and simply as a natural consequence of aging.

Whether you are a senior yourself or a carer for someone who is, we hope this guide gives you the knowledge and confidence to not accept poor sleep as just a fact of life for older people and that promoting good-quality sleep in a healthy, comfortable and safe environment is a worthwhile investment in the overall wellbeing of our elders.