How Does Sleep Change as You Age?

It’s the middle of the night, and you’re awake. You’ve noticed that’s happening more often, making you long for your teenage years, when you could sleep through anything (and your bladder allowed for that).

Don’t assume that less sleep and daytime exhaustion is your new normal just because you’re aging.

“The total amount of sleep we need doesn’t really change over the adult lifespan,” says UNC Health neurologist and sleep medicine physician Nathan Walker, MD. “The breakdown of our sleep changes, so that you may not sleep fully through the night, but you should still feel good and awake during the day.”

If you’re not feeling rested, it’s important to fix that for optimal brain health in your later years.

“Sleep is something that helps you age better,” Dr. Walker says. “It makes your brain better, while poor sleep is associated with an increased risk of developing dementia or having a faster progression of it.”

Dr. Walker explains what you need to know about sleep as you age.

1. You get less deep sleep.

Sleep has several stages. Your brain is more active during rapid eye movement (REM) cycles, when you dream. On the contrary, there is minimal brain activity during the deeper sleep that comes during non-rapid eye movement, or NREM, cycles.

You know how kids are generally harder to wake up than adults? There’s a reason for that.

“Kids get a bunch of deep sleep, because that sleep is needed for the release of growth hormone,” Dr. Walker says. “We lose that deep sleep as we get older.”

That change starts to happen in your 30s, but you may not notice it until later, when health issues have you waking more in the night, which is why you might think it’s a function of aging.

Adults still spend some time in deep sleep, but because you’re spending more time in the other stages, you’re easier to rouse. That may be why you notice more nighttime wakings—you’re more likely to hear a noise or wake up when you roll over.

2. The total amount of sleep you need remains the same.

During sleep, your brain removes waste and strengthens neural connections, making it essential for learning, mood and memory.

So while you may wake in the night, the total amount of sleep you need doesn’t change during the course of your adult life. Adults need about seven to nine hours of sleep; you may find you need about an hour less after the age of 65, Dr. Walker says, but that’s the most change you should see—if you’re spending more of the night awake than asleep, that’s not a function of aging.

If you’re retired, you may find that you enjoy the luxury of an afternoon nap.

“If you’re not sleeping as much at night, a short nap during the day is fine,” Dr. Walker says, noting that these naps shouldn’t last hours. “It’s OK if you’re not getting all of your sleep in one go, as long as you’re getting the right amount over a 24-hour period.”

3. Most sleep medications have troubling side effects as you age.

Be cautious about both prescription and over-the-counter sleep medications.

“Sleep aids may help you get into lighter sleep faster, but they won’t make your sleep deeper,” Dr. Walker says. “They also don’t work in the long-term, so if you’re using medications for longer than six months, you’re just getting side effects with no benefits.”

The side effects of sleep medications such as benzodiazepines (like diazepam, or Valium, and lorazepam, or Ativan) or sedative-hypnotics (like zolpidem, or Ambien, and eszopiclone, or Lunesta) are particularly concerning for brain health as you age.

“There’s a high correlation and association—but not necessarily a causation—of benzodiazepines with the risk of dementia,” Dr. Walker says. “Same with sedating meds like Ambien. They slow the brain down, which is not a good thing when you want the brain working as best it can.”

That sedation is especially dangerous when you’re getting up in the middle of the night to use the bathroom, because it puts you at higher risk of falling.

A new class of sleep medications, dual orexin receptor antagonists (DORAs), works on a different brain receptor than benzodiazepines and sedative-hypnotics to improve wakefulness. Early research in animal models has shown potential to slow the progression of dementia and Alzheimer’s by improving the brain’s ability to remove waste during sleep, Dr. Walker says, noting that more human studies are necessary. Currently, there are two FDA-approved DORAs: suvorexant (Belsomra) and lemborexant (Dayvigo).

Sleep medications may be appropriate for short-term or intermittent use, so talk to your doctor about maximizing benefits while minimizing side effects.

4. No matter your age, sleep hygiene is important.

If you’re not getting good quantity or quality of sleep, it’s time to return to the basics of sleep hygiene. Make sure your bedroom is cool, quiet and dark, and don’t fall asleep to the television. Try to go to sleep and wake up at the same time each day.

If you’ve gotten into the habit of sleeping less at night and napping longer during the day, you can work to reset your body’s awareness of its natural circadian rhythm.

“Take a walk outside and get exposure to light during the day, which reinforces to your brain and body that it should be awake and active during the day,” Dr. Walker says. “Exercising will also help with your ability to sleep at night.”

That’s also why it’s so important to stop using phones, tablets and other devices in the hours before bed—that light is making your brain think it should be active at the time when you want to be winding down.

As you age, it’s normal to have to get up to go to the bathroom, but you can cut down on those trips by not eating or drinking three hours before bed. You may need to reduce—or completely eliminate—caffeine.

If you struggle with insomnia, don’t toss and turn or lie in bed; your brain will stop associating your bed with sleep. Get up and do a quiet activity until you’re ready to sleep again. And try not to get too anxious about those sleepless moments—it can kick off a cycle of associating worry with sleep.

“Don’t track your sleep with devices like watches or rings, which really don’t know how much sleep you get,” Dr. Walker says, noting that tracking can needlessly increase your stress about how you slept. “Most people are good judges of their night of sleep, so focus on giving yourself the opportunity to sleep.”

5. Your doctor can help if your sleep isn’t restful.

As you age, you may have other health conditions that affect the quality of your sleep. The risk for sleep apnea increases. You may have aches and pains that keep you awake. You may be put on a medication that impacts your sleep. You may feel like you’re going to the bathroom all night long.

Talk to your primary care provider about the factors affecting your ability to fall asleep and stay asleep. With pain, they may be able to recommend an exercise regimen that helps; you may benefit from taking certain medications at different times of the day.

A conversation with your doctor about what’s reasonable to expect as you age can also be helpful.

“If you’re tired all the time or sleeping all the time, that’s not normal aging,” Dr. Walker says. “If you’re not feeling refreshed, talk to your doctor. You’ll live better and feel better if your sleep is good.”

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Having trouble sleeping? Talk to your doctor or find one near you.