In this article, we look at some of the sleep problems we may experience as we get older, why they affect us, and what we can do to minimise or manage them:
- How big a problem is this?
- What are the consequences of not getting enough sleep?
- Managing sleep problems as we get older
- What about the use of sleeping tablets?
- What about complementary therapies?
How big a problem is this?
Sleep patterns tend to change as we get older. It is estimated that 40–70% of older adults complain of sleeping problems. These include difficulties in getting to sleep, waking up at different times during the night, and waking up too early in the morning. Older people wake up more often (on average three to four times a night) because they spend less time in deep, dreamless sleep.
It is a myth that older adults need less sleep than younger people. Older adults still need between seven hours and nine hours per night to stay healthy.
US National Institution on Aging
Napping during the day is more common in older people: an estimated 25% of older adults take a nap during the day, compared to 8% of younger adults. While a short day-time nap may be considered beneficial, it is generally accepted that longer naps and napping later in the day can contribute to sleep disruption.
What are the consequences of not getting enough sleep?
Without adequate sleep – and most particularly quality restorative sleep – we may increase the risk of developing health problems. These problems include:
- Irritability, inability to concentrate, poor mental reasoning and memory recall, coupled with daytime sleepiness and napping.
- An increased risk of falls and of hip and other bone fractures.
- An increased risk of traffic accidents due to lapses in concentration while driving.
What are the causes of sleep problems in later life?
There are several causes of sleep disruption. Here are some of the more common ones we may experience in later life:
- Biological changes in our body, in particular changes in our body clock and declining levels of the sleep hormone melatonin.
Our circadian rhythm (part of our body clock) is a 24-hour daily cycle which influences, among other things, when we feel sleepy or alert. Age-induced deterioration of the specific area of the brain that controls our circadian rhythm – known as the ‘central master clock’ – results in disruptions of sleep patterns.
In addition, as we age, the body secretes less melatonin (a hormone), which is normally produced in response to darkness and helps promote sleep by coordinating circadian rhythms.
- Pain and discomfort due to physical illnesses, including night-time bladder problems (for instance, nocturia), which may affect up to 80% of older adults.
- The side effects of medications we might be taking to treat these specific conditions or to treat other health/medical conditions.
Read the label and stickers on prescription bottles or boxes. They may have information about possible side effects, including how the medication might affect sleep.
- Disturbance to our sleep patterns due to neurological disorders (such as Alzheimer’s) or mental illness (such as anxiety and depression).
What can we do if we experience sleep problems as we get older?
To get a good night’s sleep, we need to identify, tackle and manage the underlying cause of the problem. Below are some suggestions that might help:
- Managing the biological changes in our body
- Managing pain and discomfort due to physical illness
- Managing neurological disorders and mental illness
- Managing nocturia
- Managing restless leg syndrome
- Managing night cramps
- Managing sleep hypopnea and apnoea
Managing biological changes in our body
We can reinforce our body’s natural clock by:
- Getting exposure to bright light during the day, if possible.
- Avoiding ‘blue light’ (from lap tops, tablets and computers) just before we go to bed and while we’re in bed.
- Investing in black-out curtains and avoiding background lights while in bed at night.
Avoiding blue light when you are in bed is important. That’s because photoreceptors in the eye are particularly sensitive to blue light, and this stops the formation of the all-important sleep hormone melatonin. A 2021 review of 24 studies focusing on sleep showed substantial evidence for the effectiveness of wearing ‘blue-blocking’ glasses (also known as ‘amber glasses’) in the evening for reducing the time taken to fall asleep in people with sleep disorders.
Managing pain and discomfort due to physical illness
Pain may often be from age-related diseases such as osteoarthritis, gastrointestinal problems and night-time bladder issues.
The best way to deal with poor sleep resulting from these problems is to see your doctor and get medication to treat the underlying cause. To be effective, any medication should ensure adequate night-long relief.
Managing neurological disorders and mental illness
Neurological disorders and diseases such as anxiety, depression, Alzheimer's and Parkinson's Disease can result in major disturbances in sleep patterns.
Again, the best way to deal with this is to seek treatment from your doctor for the underlying disorder or disease.
‘Nocturia’ means getting up to go to the bathroom two or more times during the night. This could be due to drinking too much before you go to bed (in particular drinks with a diuretic effect, like coffee or alcohol). If this is the case, drinking less in the evening may help. Pelvic floor-muscle exercise-based therapy may also be considered. Early evidence suggests that this type of behavioural treatment is as beneficial as the most frequently used drug therapies.
If you think you might be suffering from diabetes, polyuria or an enlarged prostate, seek medical advice.
Managing restless leg syndrome (RLS)
This condition may sometimes be due to iron deficiency. If so, take more iron-rich foods such as seafood, liver, dark chocolate, or supplementary iron. https://pubmed.ncbi.nlm.nih.gov/31347095/
Managing night cramps
Stretching exercises before sleep may significantly reduce the severity of nocturnal leg cramps. The effects of daily calf and hamstring stretching on cramp frequency had been considered uncertain - but a pilot study published in 2020 suggested this could be effective..
Managing sleep hypopnea and apnoea.
If you have serious breathing problems at night (shallow breathing or a decrease of air flow: hypopnea) you may need positive ‘airway pressure therapy’.
Sleep apnoea (when your breathing is interrupted or ‘pauses’ during your sleep) needs to be treated because it can lead to more serious problems
What about the use of sleeping tablets?
If best efforts to treat the causes of your poor sleep patterns fail, then you may need to consider sleeping tablets. The choice here is best left to your doctor. There can be side effects to taking sleeping pills, so please discuss this with your doctor.
There are limitations to the long-term use of sleeping tablets, so the ’complementary therapies’ described in the next section may have greater value in the long run.
Cognitive Behavioural Therapy (CBT)
CBT is a safe therapy that can effectively normalise altered sleep patterns in older people. CBT for insomnia (CBTi) covers sleep hygiene, stimulus control, sleep restriction, cognitive therapy, and relaxation training.Mind–Body interventions
These interventions involve meditative movements (e.g., Tai Chi/Qigong and yoga/Pilates) have been shown in a pooled analysis of 37 trials to have a small to moderate, but significant, overall effect on sleep quality in older adults.
Even moderate exercise such as dancing or walking may help promote more restorative and relaxing sleep.
A 2021 analysis of 22 random controlled trials showed that traditional Chinese exercises such as Tai Chi and Qigong can be effective as general aerobic exercise for improving sleep quality. However, there was not enough evidence to determine whether there was a difference between the two activities.Herbal and other ‘over the counter’ remedies
A 2021 review of the most recent research on the use of herbal medicines for treating insomnia and anxiety reported that the three plants with the most potential are valerian, passionflower and ashwagandha, with the combination of valerian with hops and passionflower giving the best results in clinical tests. However, more rigorous studies are needed to support these findings.
To improve our prospects of a good night’s sleep we should
- Reinforce our natural body clock by getting enough light during the day and avoiding light (especially ‘blue light’) at night.
- Make sure any medical condition that keeps us awake at night is adequately treated
- Avoid coffee and alcohol before bedtime.
- Consider alternative self-help options, including CBT and mind–body activities such as yoga, Pilates and Tai Chi.
- Take some form of exercise every day.
- Make only sparing use of sleeping tablets (if these prove necessary).
Barbara Baker. Reviewed and updated March 2022. Next review February 2026.