Sleep in older adults

Published: 18-07-2024

By Hemangi Sanjavini & Associate Professor Melinda Jackson
School of Psychological Sciences, Monash University

Taylor’s story: After retirement, Taylor struggled with going to bed at night.

“I just can’t fall asleep when I go to bed. I fall asleep hours after lying in bed and then keep waking up in the middle of the night. Some nights I can’t fall asleep after waking up at 3 or 4am in the morning. This is so frustrating, and I just want to get a good night’s sleep.”

Unfortunately, Taylor’s story is not unique. It is an experience shared by older adults around Australia. Research suggests that over half of the older adults in Australia have at least one sleep complaint¹. These complaints can be about dissatisfaction with their sleep quality, difficulty falling asleep after going to bed, waking up multiple times in the night, waking up extremely early in the morning or even getting only a few short hours of sleep. Many older adults who don’t sleep well, wake up feeling tired or irritable and don’t feel alert and healthy when going about their day-to-day.

There can be many reasons why older adults may not be able to sleep well at night. For example, feeling sick, being in pain, feeling worried and changes in lifestyle can all cause temporary problems with sleeping. When these problems continue for a long time even after the changes that started them go away, it can become a serious issue. This is because ongoing poor sleep is related to a higher risk of developing health conditions such as cardiovascular problems, mental health disorders and metabolic disease.

Older adults can struggle with sleep because there are some natural changes to the quality and duration of sleep as people age.  One of the reasons for this is a change in the body’s internal clock. As people get older, their internal clock ages as well. These changes to the internal clock can cause it to become less sensitive to the signals that help direct when people feel sleepy, tired or alert. As a result, many older adults experience getting tired earlier in the afternoons and waking up earlier in the morning.  As people age, they spend more time in lighter stages of sleep, and it’s easier to be woken from these lighter stages of sleep, causing sleep to feel fragmented and less restful. Not getting enough restful sleep during the night can also encourage daytime napping for older adults. Longer naps during the day can make it much harder for older adults to fall asleep during the night and can add to their sleep difficulties. But these natural changes to sleep in older adults don’t mean that older adults should expect their sleep to be poor and uncomfortable.

What is the impact of poor sleep on our brains?

Sleep is critical for cognitive functioning and memory formation. Many research studies have shown that sleep issues in midlife are associated with cognitive decline in later life^2,3. Sleeping less than six hours a day is also linked to 30% higher dementia risk for middle-aged to older⁴. A possible reason for the link between sleep and dementia risk is related to beta-amyloid proteins in the brain – the hallmark feature of Alzheimer’s disease. These plaques damage the parts of the brain responsible for forming memories and cause issues in speech, behaviour and logic. We all produce beta-amyloid in the brain during the day, and the build-up of these proteins is naturally flushed away during sleep. So, if we don’t get enough quality sleep, it is possible that the brain doesn’t have enough time to clean up this toxic protein build-up. It is thought that these plaques then continue to gather every day, which can increase one’s risk of dementia.

Once dementia occurs, it causes further deterioration of sleep structure and quality. This is because, like most other health conditions, sleep and dementia share a bidirectional relationship. So, when sleep worsens, it increases the likelihood of cognitive decline. Similarly, when cognitive decline occurs, it can lead to poorer sleep.

What can older adults do to get help for ongoing sleep difficulties?

Common suggestions given to people struggling with poor sleep usually involves:

• Aim for 7 to 8 hours of sleep everyday
• Getting at least 30min of daylight exposure in the mornings
• Having a regular sleep routine with consistent bed and wake-up times
• Avoiding long day-time or evening naps
• Taking devices like computers, phones and tablets away before bed-time
• Keeping the bedroom at a comfortable temperature
• Keeping noise low in the bedroom
• Keeping the bedroom dark and ensuring the bed and pillow you are using are comfortable
• Preparing a relaxing wind-down routine before bed which may involve calming activities like meditation, deep breathing, stretching, reading, journaling or listening to ambient sounds
• Reducing caffeine, nicotine and alcohol intake
• Maintaining good diet and a regular exercise routine

Another treatment option to manage poor sleep is known as Cognitive Behavioural Therapy for Insomnia (CBT-I). CBT-I involves talking to a trained psychologist who will assess your needs and guide you through various strategies to create changes in your behaviour to improve your sleep. Mindfulness practice can be used along with CBT-I strategies to help improve sleep. This is called Mindfulness-based Intervention for Insomnia (MBT-I). Mindfulness involves practicing a meditation technique that creates a purposeful awareness of the current moment including sensations felt by the body and thoughts appearing in the mind. By leaning on non-judgmental and calm awareness of the coming and going of these thoughts and sensations, people can change their reactions to worrying or harmful thoughts. This can help older adults feel calmer, more empathetic, attentive, and focused throughout the day. Together with CBT-I strategies to help improve sleep related behaviours, older adults can learn some useful tools to improve their sleep after the treatment period ends.

Where can an older adult find a CBT-I or MBT-I practitioner?

Speak to your General Practitioner or mental health service provider about how to get referred to a service or practitioner that offers CBT-I or MBT-I, and whether this is the right option for you.

There are also digital CBT-I programs available, which can be helpful for people who live in rural or regional areas with limited access to service providers or simply enjoy self-directed online treatment programs.

Associate Professor Melinda L. Jackson is an academic and sleep psychologist, and heads the Sleep, Cognition and Mood Laboratory in the School of Psychological Sciences, Monash University. Her research examines the impact of different treatment approaches, including cognitive behavioural therapy for insomnia and mindfulness, to address sleep issues in community and cognitive populations.

1. Adams RJ, Appleton SL, Taylor AW, Gill TK, Lang C, McEvoy RD & Antic NA (2017). Sleep health of Australian adults in 2016: results of the 2016 Sleep Health Foundation national survey. Sleep Health 3(1):35–42. doi:10.1016/j.sleh.2016.11.005.
2. Leng, Y., Knutson, K., Carnethon, M. R., & Yaffe, K. (2024). Association Between Sleep Quantity and Quality in Early Adulthood With Cognitive Function in Midlife. Neurology, 102(2), e208056. doi:10.1212/WNL.0000000000208056
3. Ma Y, Liang L, Zheng F, Shi L, Zhong B, Xie W. Association Between Sleep Duration and Cognitive Decline. JAMA Netw Open.2020;3(9):e2013573. doi:10.1001/jamanetworkopen.2020.13573
4. Association of sleep duration in middle and old age with incidence of dementia. Sabia S, Fayosse A, Dumurgier J, van Hees VT, Paquet C, Sommerlad A, Kivimäki M, Dugravot A, Singh-Manoux A. Nat Commun. (2021) 12(1):2289. doi: 10.1038/s41467-021-22354-2.