Sleep is more than just rest – it is a vital biological process that supports our brain function, physical health, emotional balance, and overall well-being. Yet, as we age, the way we sleep changes dramatically. Understanding these changes is especially important for professionals in health, social care, and fitness, who support individuals across all stages of life.

 

Understanding sleep architecture

Sleep is not a single, uniform state – it is made up of cycles and stages that repeat throughout the night. This structure is known as ‘sleep architecture’, and it includes two main types of sleep:

• Non-Rapid Eye Movement (NREM) Sleep: Divided into three stages:
  • Stage 1: Light sleep, the transition from wakefulness.
  • Stage 2: Deeper light sleep, where heart rate slows and body temperature drops.
  • Stage 3: Also called slow-wave sleep, this is the deepest and most restorative stage.
• Rapid Eye Movement (REM) Sleep: The stage where most dreaming occurs. The brain is highly active, but the body remains still to prevent acting out dreams.

A typical night includes 4–6 sleep cycles, each lasting 90–120 minutes. Early in the night, deep NREM sleep dominates, while REM sleep becomes more prominent in later cycles. In healthy adults, about 75% of sleep is NREM and 25% is REM – though this balance can shift with age, health, and lifestyle.

 

Sleep across the lifespan

Newborns sleep a lot – between 16 and 20 hours a day – but their sleep is fragmented, with frequent awakenings and a high proportion of REM sleep. As children grow, sleep becomes more consolidated, naps decrease, and total sleep time gradually reduces. School-age children typically need 9 to 12 hours of sleep per night.

Teenagers experience a shift in sleep timing, often preferring later bedtimes and wake times. This is partly due to a delayed release of melatonin during puberty. Combined with early school start times and increased academic and social pressures, many adolescents face chronic sleep deprivation. They need around 8 to 10 hours of sleep per night, but often get less. Slow-wave sleep also begins to decline during this stage.

In adulthood, sleep duration stabilises at around 7 to 9 hours per night. Sleep cycles become more predictable, but work, family, and lifestyle factors can disrupt sleep quality. Adults may also experience sleep disorders such as insomnia or sleep apnoea, which can affect both duration and restfulness.

 

Sleep and ageing: What changes in older adults?

As people age, sleep tends to become lighter and more fragmented. Older adults often report sleeping less, waking more during the night, and feeling less refreshed in the morning. Key changes include:

• Reduced total sleep time and sleep efficiency (the percentage of time spent asleep while in bed).
• Decline in slow-wave and REM sleep, leading to less restorative rest.
• Phase advance in circadian rhythms, causing earlier bedtimes and wake times.
• Lower melatonin production, which can make it harder to fall and stay asleep.

These changes can significantly impact quality of life, making it important for caregivers and health professionals to understand and address sleep-related concerns in older adults.

 

Common sleep disorders in older adults

Sleep disturbances are widespread among older adults, and several specific disorders tend to become more prevalent with age.

Insomnia is one of the most common sleep disorders in older adults. Its prevalence increases with age, often due to chronic health conditions and the side effects of medications. Research shows that comorbidities and polypharmacy (the use of multiple medications) significantly contribute to sleep difficulties in this population.

Sleep-disordered breathing, including conditions such as obstructive sleep apnoea, become more frequent with age. These disorders disrupt breathing during sleep, leading to fragmented rest and reduced sleep quality – further compounding fatigue and cognitive challenges.

Restless legs syndrome and periodic limb movement disorder cause uncomfortable sensations and involuntary movements in the legs, particularly at night. They can make it difficult to fall asleep or stay asleep, reducing overall sleep satisfaction.

REM sleep behaviour disorder involves physically acting out dreams during REM sleep and is often linked to neurodegenerative diseases such as Parkinson’s and Lewy body dementia. It can be disruptive for both the individual and their bed partner and may signal underlying neurological changes.

 

What contributes to sleep difficulties in later life?

Sleep challenges in older adults are rarely caused by a single factor. Instead, they result from a combination of medical, lifestyle, and environmental influences.

Chronic illnesses – such as cardiovascular disease, arthritis, diabetes, depression, and neurodegenerative disorders – can all interfere with sleep. Many older adults take multiple medications, and some (like beta-blockers and corticosteroids) are known to disrupt sleep patterns or cause insomnia.

Reduced physical activity, social isolation, and changes in daily routines can negatively affect sleep habits. Environmental sensitivities also increase with age – light, noise, and bedding discomfort can become more disruptive due to changes in sensory thresholds.

 

Why does sleep change with age?

Several biological changes contribute to altered sleep patterns in older adults. Age-related changes in brain structure – especially in the prefrontal cortex – affect sleep regulation. Additionally, the natural decline in growth hormone and melatonin production makes it harder to achieve deep, restorative sleep.

The homeostatic sleep drive, which balances sleep need based on prior wakefulness, weakens with age. This makes it harder to recover from sleep disruptions. The circadian rhythm, our internal body clock, also loses strength, leading to less consolidated sleep and more frequent awakenings.

Multiple health conditions and medications can interfere with sleep. Chronic pain, increased nighttime urination, and respiratory issues are especially disruptive, making uninterrupted sleep more difficult to achieve.

 

Implications for healthcare professionals

Poor sleep in older adults is linked to a range of negative outcomes:

• Sleep disturbances can impair memory, attention, and decision-making.
• Fatigue and poor coordination raise the likelihood of falls and injuries.
• Sleep-related impairments can affect daily functioning and self-care.
• Poor sleep can exacerbate existing health conditions and increase vulnerability to illness.
• Sleep disturbances are closely tied to depression and anxiety, often creating a cycle of worsening mood and sleep quality.
• Daytime sleepiness can reduce motivation and participation in social activities, increasing social isolation.

 

How sleep and health influence each other

Sleep and health are deeply interconnected. Poor sleep can contribute to the development or worsening of a wide range of health issues, including cardiovascular disease, cognitive decline, and mood disorders such as depression and anxiety

At the same time, existing medical conditions – like chronic pain, respiratory problems, and neurodegenerative diseases – can disrupt sleep. This creates a vicious cycle, where poor health leads to poor sleep, and poor sleep further deteriorates health.

In this way, sleep is not only a consequence of health status but also a key determinant of well-being and longevity in later life.

 

Interventions that improve sleep outcomes

Because of this close connection, improving sleep can have far-reaching benefits for older adults. But what works best?

Start with sleep hygiene: Encouraging good sleep habits is the first step. This includes:

• Keeping a consistent sleep schedule.
• Creating a quiet, dark, and comfortable sleep environment.
• Avoiding caffeine and screen time before bed.

While helpful, sleep hygiene alone may not be enough, especially for those with chronic sleep issues.

 

Combine behavioural and medical strategies: A more effective approach often involves multiple strategies:

• Managing underlying health conditions that disrupt sleep.
• Reducing or adjusting medications that interfere with rest.
• Making environmental adjustments to improve comfort and reduce disturbances.

 

Take a multidisciplinary approach: The most successful interventions are wide-ranging and collaborative, involving:

• Optimising treatment for chronic conditions and reviewing medication regimens
• Psychological support, such as Cognitive Behavioural Therapy for Insomnia (CBT-I), is especially effective in older adults
• Reducing loneliness and promoting social interaction can significantly improve sleep quality

By addressing sleep from multiple angles, these approaches offer the best chance of improving both rest and overall health.

 

Why sleep deserves more attention in older adults

Sleep is a dynamic process that changes throughout the lifespan. While children and adolescents experience shifts driven by development and lifestyle, the most profound and challenging changes often occur in older adulthood.

For healthcare professionals, understanding the biological, psychological, and social drivers of sleep changes – and their health consequences – is essential. By recognising the unique sleep needs of older adults and addressing the factors that disrupt rest, we can promote better sleep, greater independence, and a higher quality of life.