Sleep in later life

Many people notice their sleep changes as they get older. You may get sleepy earlier, wake up more often, or feel like a lighter sleeper. Some of this is a normal part of aging.¹

But feeling tired, cranky or foggy most days is not something you just have to accept. Poor sleep in later life often has causes that can be treated, such as pain, bathroom trips, medicines, low mood or sleep apnea.¹ This page explains what is normal, what is not, and the safest ways to sleep better.

How sleep normally changes with age

Sleep moves through cycles of light sleep, deep sleep and dreaming sleep (REM) several times a night. With age, the body spends less time in deep sleep. This is a main reason older adults wake up more often.¹

Here is what many people notice:¹

• Falling asleep takes longer.
• Waking more often. On average, older adults wake three or four times a night. They are also more aware of being awake.
• Waking early in the morning.
• About the same total sleep, or a bit less. Many older adults sleep about 6½ to 7 hours a night, but spend more time in bed.
• Feeling like a light sleeper. Waking up can feel sudden.

You still need a full night's rest. The CDC suggests 7 to 9 hours for adults aged 61 to 64, and 7 to 8 hours for people 65 and older.² Broken sleep can leave you feeling short on sleep even when your total hours have not changed.¹

An earlier body clock

Your body clock (the inner timer that tells you when to feel sleepy and awake) can run early. A strong form of this is called advanced sleep-wake phase. People with it get sleepy in the early evening and wake between about 2 and 5 a.m. It is more common in older adults.³

If an early schedule suits your life, it may not need any treatment. It becomes a problem when it causes heavy sleepiness, too little sleep, or trouble with family plans. Bright light in the early evening may help shift the clock later.³ See bright light therapy and talk with your doctor before you start.

Napping: helpful or harmful?

Napping is common in later life, and a short nap can be a good thing. The National Council on Aging (NCOA) suggests keeping naps to about 20 to 30 minutes. Try to nap in the early afternoon, around 1 to 3 p.m.⁴

Naps of an hour or more can lead to deep sleep. That can leave you groggy and make it harder to sleep at night. Late-day naps can do the same.⁴

When napping is a warning sign

A large study followed more than 1,400 older adults for up to 14 years. They wore a watch-like device that measured napping. People tended to nap longer and more often as they aged. In people developing Alzheimer's disease, napping grew more than twice as fast each year.⁵

Longer and more frequent naps were linked to a higher risk of Alzheimer's dementia later. The link seemed to go both ways. Heavy napping came before worse thinking, and worse thinking came before heavier napping.⁵ This does not prove that naps cause dementia. A big change in napping may be an early sign worth checking.

Talk with your doctor if you:⁴

• Nap more than an hour most days, or late in the day
• Feel you need naps just to get through the day
• Doze off without meaning to
• Do not feel rested after a nap

Daytime sleepiness can come from sleep apnea, depression, anxiety, medicines or alcohol.⁴

Waking up at night to urinate

Getting up during the night to urinate is called nocturia. Doctors take it seriously when it happens two or more times a night. It affects more than 30% of adults over 60, or about 1 in 3, and it becomes more common with age.⁶

It is more than a nuisance. Nighttime bathroom trips are linked to falls and broken bones, and to depression and lower quality of life, mostly because of lost sleep.⁶

Common causes include:⁷

• Drinking a lot, especially caffeine or alcohol, in the hours before bed
• Water pills (diuretics) and some other medicines
• Swelling in the legs during the day. When you lie down, that fluid returns to the blood and becomes urine.
• Diabetes, high blood pressure, heart disease or an overactive bladder
• An enlarged prostate in men
• Sleep problems such as insomnia or sleep apnea

Things that may help:⁷

• Drink most of your fluids earlier in the day. Cut back on fluids for 2 to 4 hours before bed.
• Limit coffee, tea, soda and alcohol, especially later in the day.
• Raise your legs in the afternoon or wear compression socks, if your doctor agrees.
• Ask your doctor whether the timing of a water pill could be changed. Do not change it on your own.
• Keep naps short.

A doctor may ask you to keep a bladder diary for two or three days. You write down what you drink, when you urinate, and when you sleep and wake.⁶ Lifestyle changes and treating the underlying cause come first. Medicines are an option when those do not work.⁶

For bladder leaks, see bladder and bowel problems.

Pain and sleep

Pain from arthritis, back problems or other long-term illness is a common reason older adults wake up at night.¹ Poor sleep can then make pain feel worse, and the two can feed each other. Read more in chronic pain and mood.

Treating sleep directly can help. One trial included 327 adults aged 60 and older who had both insomnia and arthritis pain. Their average age was 70. Half got CBT-I over the phone, in six short calls over eight weeks. The other half got education calls.⁸

• A year later, about 56 in 100 people in the CBT-I group no longer had insomnia, compared with about 26 in 100 in the education group.⁸
• Pain eased a little in the CBT-I group at first, but that gain faded by one year.⁸
• Tiredness during the day improved, and that lasted.⁸

This shows that insomnia can be treated even when pain does not go away. Also ask your doctor about better pain control at night. Gentle movement such as tai chi and relaxation such as progressive muscle relaxation may also help you settle.

Dementia and sleep

Sleep often changes a lot in Alzheimer's disease and other dementias. A person may be awake at night, nap during the day, or become more confused and upset in the late afternoon and evening. This is called sundowning.¹¹

Changes in the brain and the body clock play a part. So can a tiring day, a strange place, and shadows in dim light.¹¹ Physical problems can also cause or worsen night waking. Examples are a urinary tract infection, bladder leaks, restless legs and sleep apnea.¹¹

What caregivers can try first:¹¹

• Get the person outside in daylight during the day. Keep the home well lit in the evening.
• Keep regular times for waking, meals and bed.
• Plan outings, appointments and baths for the morning or early afternoon.
• Limit daytime naps if night sleep is a problem.
• Cut back on caffeine, alcohol and nicotine.
• Serve a bigger lunch and a lighter supper. Keep evenings quiet and calm.
• Note what happens before a hard night. Patterns can point to triggers.

If the person wakes up upset, stay calm. Ask whether they need something, such as the bathroom. Gently remind them of the time. Do not argue, and never use restraints.¹¹

Experts generally recommend non-drug steps first for sleep problems caused by dementia.¹¹ Sleep experts also advise that some older adults with body-clock sleep problems avoid both sleeping pills and melatonin.¹³ One newer sleep medicine, suvorexant (Belsomra), was tested in 285 people with mild to moderate Alzheimer's disease. It helped them sleep longer, but falls were more common than on placebo.¹² Any medicine is a decision to make with the doctor.

For more, see sleep problems in dementia, sundowning and sleep medicines in dementia. The Alzheimer's Association 24/7 Helpline at 800-272-3900 can help any time.¹¹ Night waking is hard on caregivers too. See caregiver burnout.

A safer approach to sleep problems

Older adults respond to medicines differently than younger people, so many sleep aids carry more risk.¹

Here is a safer order of steps, based on expert guidance:

1. Look for a cause. Tell your doctor about pain, bathroom trips, snoring, low mood, worry, and every medicine and supplement you take. Some medicines and alcohol can disturb sleep.¹ See medicines that can affect mood and memory and alcohol in later life.
2. Build steady habits. Keep the same wake time every day. Avoid caffeine for 3 to 4 hours before bed. Exercise at regular times, but not within about 3 hours of bedtime. If you cannot fall asleep in about 20 minutes, get up and do something quiet until you feel sleepy.¹ See healthy sleep habits.
3. Try CBT-I for insomnia that lasts. The American College of Physicians recommends CBT-I as the first treatment for long-term insomnia in all adults. In people over 55, it improved sleep quality and time awake at night.⁹ You can start with our free CBT-I lessons, beginning with the sleep diary.
4. Consider medicine only with your doctor. If CBT-I alone does not help, you and your doctor can decide together whether short-term medicine makes sense. Weigh the benefits, harms and costs.⁹ Read sleep medicines: what to know.

When to get help

Talk with your doctor if:

• Poor sleep lasts more than a few weeks or makes your days hard. See insomnia.
• Someone notices loud snoring, gasping or pauses in your breathing.
• You get up to urinate two or more times most nights.⁶
• You doze off when you do not mean to, especially while driving.
• Sleep changes come with memory problems, or a person with dementia is suddenly much more confused. An infection, such as a urinary tract infection, can make sleep and behavior worse.¹¹
• Sleep problems come with sadness or loss of interest. Trouble sleeping is a common sign of depression, and depression can be treated.¹ See depression in later life and sleep, mood and anxiety.

Call 911 for a fall with injury, a head injury, or sudden confusion, weakness or trouble speaking. Call or text 988 if you or someone you love has thoughts of suicide or feels in crisis. Help is free and available 24 hours a day.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.