As we age, normal, age-related changes also occur in sleep. Changes usually begin to occur between the ages of 50 and 60 and become apparent after the age of 70. These changes are related to the structure of sleep and the distribution of sleep at different times of the day.
Normal sleep changes caused by aging
Changes in the structure of sleep are related to the regularity and length of the stages of sleep. As we age, the proportion of REM sleep and deep sleep (S3) decreases with increasing light sleep (S1, S2). The stages of sleep also become more irregular. In the elderly, the transition from one sleep phase to another is frequent, and there are periods of wakefulness lasting up to minutes between sleep phases, which make sleep feel intermittent.
In the elderly, the proportion of light sleep is high and nocturnal awakenings have increased. Figure 1 shows changes in sleep structure in the elderly relative to the young adult. In the lower section of the figure “Sleep Architecture”, in addition to the increase in the proportion of light sleep (N1 and N2), a decreased proportion of REM sleep and deep sleep (N3) is also observed compared to the younger adult. The “pacemaker” located in the supraciasmatic nucleus (SCN) regulates the circadian rhythm (24h), which normally causes a person to sleep at night and to be awake during the day. As we age, there is a decline in the function of the supraciasmatic nucleus, which impairs the ability to regulate the 24-hour circadian rhythm and does not synchronize and, for example, makes it difficult to adapt to the time difference.
Aging is associated with a decrease in the daily regulation of many body balance functions, such as sleep-wake rhythm and body temperature. As a result, older people often go to bed earlier and wake up earlier than younger adults. The time to fall asleep can also be prolonged, and falling asleep may take up to 10 to 20 minutes. Changes in sleep-wake rhythm are also affected by the hormone melatonin, the secretion of which decreases with age.
In the brains of the elderly, changes occur in the systems that regulate sleep and wakefulness. The brains of the elderly are less active during prolonged wakefulness, and the concentration of sleep-promoting molecules in the aging brain does not increase as at a young age. These changes result in a decrease in sleep pressure and the amount of deep sleep. With the changes, the brain’s ability to produce deep sleep is impaired. As we age, the level of metabolism in the brain does not change as much as in young people. In adolescents, the level of metabolism decreases sharply during sleep and manifests as a large amount of deep sleep. As we age, changes in brain metabolism decrease during sleep, leading to sleep superficiality.
There are conflicting research findings and views on the need and amount of sleep for older people. Others say the need for sleep decreases with age due to less brain activity during wakefulness. The need for sleep has been found to decrease with age in other studies as well. On the other hand, results have also been presented that the need for sleep does not decrease with age. There is also a growing perception that the amount of sleep does not necessarily decrease with age, but is distributed over the day differently than in younger people.
Figure 2 illustrates changes in sleep distribution; black areas depict sleep in adulthood and old age. A good example of a different distribution of sleep is naps. Daytime sleep increases with age. Studies have shown that daytime sleep has not been shown to have a negative effect on the amount of sleep or sleep quality the following night in elderly subjects. In contrast, daytime naps increased the overall amount of sleep in the elderly. In addition, daytime napping was found to have a positive effect on cognitive performance in older people.
Impaired sleep in the elderly
The quality of sleep can sometimes deteriorate. One sign of a decline in sleep quality in an elderly person may be daytime fatigue. Decreased quality of sleep affects cognitive functioning and its various components, such as problem-solving and decision-making.
A study was conducted in 2009 to investigate the association of self-reported sleep-related factors with cognitive function in the adult population. Examples of sleep-related factors mentioned were too short or too long a night’s sleep and perceived fatigue and exhaustion. These factors predicted impaired, self-tested cognitive functioning. Lack of sleep affects the elderly more strongly, as mental and cognitive functioning is impaired more easily in the elderly than in adults. Various studies have examined the effects of impaired sleep on the health of the elderly. In one study, 55 percent of elderly participants reported clinically significant sleep disorders. The more these sleep disorders occurred, the worse the health-related quality of life. Poor nighttime sleep also impaired daily functional survival and increased depressive symptoms. Regular nocturnal awakenings have been found to impair health-related quality of life in adults and the elderly. High age is associated with shorter sleep, decreased sleep efficiency, and increased awakening. According to one study, older women in particular experienced difficulty falling asleep, waking up at night and waking up too early. In men, high age more clearly contributed to an increase in S1 and S2 sleep phases and a decrease in deep sleep.
Factors affecting sleep in the elderly
As we age, sleep is affected by other factors in addition to changes in sleep structure and sleep-wake rhythm. Alteration, scarcity, or lack of a pacesetter may interfere with circadian rhythms or impair sleep quality. Low levels of physical activity during the day, plenty of indoor time and a lack of social activities have a disturbing effect on night sleep.
In addition, time spent in bed during the day, general inactivity, poor indoor lighting, and lack of natural light during the day can adversely affect sleep-wake rhythms. Lack of evening routines can also interfere with an elderly person’s sleep. As we age, care should be taken to ensure the persistence and adequacy of pacesetters, so that their scarcity or absence does not interfere with sleep in addition to other age-related changes affecting sleep. Changes associated with normal aging in themselves have relatively little effect on the decline in sleep quality with age. For example, insomnia is not part of normal aging changes, but is often the result of various somatic as well as mental ailments and illnesses.
How do sleep and diseases affect each other?
There is an influential connection between sleep and diseases. Impaired sleep quality and chronic sleep deprivation affect the functioning of the brain and the rest of the body. Chronic sleep deprivation weakens the body’s immune response and, for example, shift workers have been found to have an increased incidence of inflammatory diseases. Reduced sleep time and chronic sleep deprivation increase the risk of coronary heart disease and impair the body’s glucose tolerance. This predisposes to metabolic diseases such as type 2 diabetes, cholesterol changes, high blood pressure, and middle body obesity.
Many diseases themselves have also been found to have a disturbing effect on sleep, especially when poorly treated. Certain vascular diseases and musculoskeletal disorders (osteoarthritis, osteoporosis) can cause pain that has a debilitating effect on sleep. Such pain can also become chronic, meaning pain lasting more than three months. Chronic pain is not part of normal aging changes, although the risk increases with age. Chronic pain makes it difficult to fall asleep and increases nocturnal awakenings. Inadequate sleep and impaired quality due to the above factors, in turn, can have a depressing effect on the tolerable pain threshold.
Other illnesses that interfere with night sleep include reflux disease and shortness of breath. Chest and abdominal pain associated with reflex disease, as well as chronic obstructive pulmonary disease and heart failure that cause shortness of breath, can have a debilitating effect on night sleep. In addition, certain mental and neurological diseases, such as anxiety disorders, depression, Parkinson’s disease, and some dementias, are themselves associated with sleep disorders. Disease-related medication can also cause difficulty sleeping.
Good quality sleep for the aging – Guide
This guide contains information on sleep for the elderly and instructions for quality sleep. As you age, changes occur in your sleep, most of which are completely normal. The quality of sleep can be positively affected even with small choices. Quality sleep is an important part of a good quality of life. A well-slept night improves the functioning of the brain and body. In the examples, Laura, a 75-year-old single woman, reflects on her own sleep.
Sleep changes as you get older
Sleep changes usually begin at the age of 50-60. Normal changes in sleep :
- The structure of sleep changes; sleep becomes lighter, making it easier to wake up at night.
- Waking up at night can cause a feeling of poor night’s sleep.
- Falling asleep in the evenings can take more time than at a younger age.
- Sleep is divided into different times of the day. Going to bed and waking up earlier and the daytime naps increases.
- Illnesses and their symptoms such as pain or shortness of breath can have a debilitating effect on night sleep and force you to wake up at night.
After retiring, Laura noticed that her sleep was different than before. It seems like it takes more time to fall asleep and the sleep feels lighter than before. At night, she wakes up more easily to various sounds, such as traffic noise. You also have to wake up to go to the toilet more often than before. Laura goes to bed earlier in the evenings and wakes up often before six in the morning.
Ingredients for quality sleep
Your own choices and lifestyle can affect the quality of your sleep. For example, diet and daily rhythm affect the quality of sleep.
A varied diet and a regular eating rhythm improve health and promote quality sleep.
Food and drink can have an invigorating or tiring effect. Caffeinated beverages consumed in the evenings, such as coffee and tea, can make it difficult to fall asleep. In the evening, a proper meal eaten 1-2 hours before going to bed, which includes chicken, milk and nuts, for example, can instead increase drowsiness and prevent hunger at night.
To improve her night’s sleep, Laura began to pay attention to her eating habits. Before, he only ate lunch and small snacks throughout the day. Coffee was enough for dinner. Now Laura also eats dinner later in the evening and drinks coffee only in the afternoon. This is when Laura feels tired in the evenings and falling asleep is easier.
Regular exercise promotes falling asleep in the evenings, has a positive effect on sleep quality and overall health. For example, outdoor activities according to one’s own strengths and opportunities are good exercise. In order to guarantee a quality night’s sleep, care should be taken to maintain daily activities, such as hobbies, as you get older. Everyday chores, hobbies and outdoor activities increase the need for sleep and improve night’s sleep.
Laura often walks to the store and goes out during the day. Laura and her neighbor exchange news whenever they meet. When Laura can’t get out for a walk, she goes to her balcony enjoying the outdoors and daylight to liven up their day. She calls her children and grandchildren at least once a week. Laura enjoys knitting and crossword puzzles, which are nice things to do during the day. When Laura is active during the day, it’s easier to fall asleep in the evenings.
Daily rhythm and sleeping environment
Regular bedtime and wake-up times synchronize the day. Maintaining regular circadian rhythms and routines can improve sleep quality.
Short naps during the day can be refreshing. There is no harm in daytime sleep if you fall asleep easily in the evenings as well. Soothing in the evening makes it easier to fall asleep. Familiar evening routines prepare the body for bedtime. Evening routines can include for example listening to calm music or reading. As you age, your body’s ability to regulate temperature decreases. The sleeping environment should be suitably warm and sufficiently dim.
Laura has noticed that small naps in the morning are invigorating, but there is enough sleep for the next night as well. Laura tends to knit or read magazines in the evenings after dinner. Normally Hilma goes to bed at nine in the evening. At eight o’clock she goes for an evening wash and changes into pajamas. When she feels sleepy, Laura moves to bed.