Sleep changes with age, insomnia and sleeping pills

Many older adults say they do not sleep the way they used to. They wake up more at night, get up earlier, and feel less rested. Some changes are a normal part of aging. But long-lasting trouble sleeping is not something you have to live with, and it is very treatable.

This guide explains how sleep changes with age, what insomnia is, and what works best. It also explains why many common sleeping pills and "PM" products carry extra risks after 65. For a shorter overview, see Sleep in older adults.

How sleep changes with age

As we age, we tend to go to bed and wake up earlier. Sleep is often shorter and lighter, and waking during the night becomes more common.¹ That does not mean older adults need less sleep. Most still need about 7 to 9 hours a night.¹

Some waking is normal. A problem is more likely when poor sleep makes your days harder.

Signs of insomnia

Insomnia means trouble falling asleep, staying asleep, or waking too early, even when you have time to sleep. When it lasts more than three months, it is called chronic insomnia.¹

Signs include:

• Lying awake for a long time before falling asleep
• Waking in the night and not getting back to sleep
• Waking very early and not being able to sleep again
• Feeling tired, irritable or foggy during the day
• Worrying about sleep, or dreading bedtime

Take our free insomnia test to see how your sleep compares. A sleep diary for two weeks can show patterns your doctor can use.¹

Why sleep problems happen in later life

Many things can disturb sleep after 65:

• Health problems such as pain, heart or breathing trouble, needing to urinate at night, or reflux
• Other sleep disorders. Sleep apnea causes breathing to stop and start during sleep. Restless legs syndrome causes uncomfortable feelings in the legs at night. REM sleep behavior disorder makes people act out their dreams.¹ See Sleep apnea and Restless legs.
• Mood. Anxiety, depression and grief often disrupt sleep. See Anxiety in later life and Grief and widowhood.
• Medicines that keep you awake or make you drowsy in the day. See Medicines that can affect mood and memory.
• Alcohol. A nightcap may help you fall asleep, but drinking to improve sleep can make sleep problems worse.⁹ See Alcohol and older adults.
• Routine changes. Retirement, less daytime activity, long naps, and more time in bed can all weaken the body's sleep drive.
• Dementia. Dementia can change sleep and cause night wandering, and poor sleep can make dementia symptoms worse.¹

How poor sleep affects you

Day to day, poor sleep can affect memory, mood and relationships, and raise the risk of falls and accidents.¹ Over time, it may raise the risk of high blood pressure, heart disease and diabetes.¹

Insomnia and depression are closely linked. In a trial of 291 adults aged 60 and older with insomnia, those who got CBT-I were about half as likely to develop major depression over three years as those who got sleep education alone (about 1 in 8 compared with about 1 in 4).⁴ Read more in Sleep, mood and anxiety.

What helps

Sleeping pills: risks after 65

The American Geriatrics Society's Beers Criteria list medicines that are often riskier than helpful for older adults.⁶

• Benzodiazepines (such as temazepam, lorazepam or alprazolam): advised to avoid in most older adults. They raise the risk of memory problems, delirium (sudden confusion), falls, broken bones and car crashes.⁶ They can also cause dependence.⁸
• "Z-drugs" (zolpidem, eszopiclone and zaleplon): advised to avoid. They have similar risks to benzodiazepines, with only small gains in sleep.⁶ The FDA added its strongest warning because these medicines can cause sleepwalking, sleep driving and other activities while not fully awake, sometimes with serious injury or death.⁷
• Older antihistamines such as diphenhydramine: advised to avoid. They can cause confusion, constipation and dry mouth, and the body gets used to them quickly when used for sleep.⁶ Many "PM" pain relievers and nighttime cold products contain them, so read labels.
• Mixing: Taking three or more medicines that act on the brain, such as sleeping pills, opioids, some antidepressants and muscle relaxants, raises fall risk.⁶ Never mix sleeping pills with alcohol.⁸

Practical steps for better sleep

1. Keep the same wake-up time every day, even after a bad night. This is one of the strongest signals for your body clock.¹
2. Go to bed only when sleepy, not just because it is "bedtime."
3. Get out of bed if you cannot sleep. Do something quiet in dim light, then go back when sleepy. This is part of stimulus control.²
4. Avoid late-afternoon or evening naps.¹
5. Be active during the day, but finish exercise about three hours before bed.¹
6. Limit caffeine late in the day and avoid alcohol.¹
7. Keep the bedroom comfortable and keep screens out of it.¹
8. Write worries down earlier in the evening so they do not follow you to bed. Our Thought Check can help.
9. Use a night light on the path to the bathroom to lower the risk of falling.

For family caregivers

• Notice snoring with pauses or gasping, acting out dreams, or kicking legs at night. These can be signs of a sleep disorder that needs a doctor.¹
• Check the medicine cabinet for over-the-counter sleep aids and "PM" products. Bring them to a medicine review.⁶
• Encourage daytime light and activity. A walk outside or time at a senior center can help nighttime sleep.
• For a person with dementia, keep a steady daily routine and calm evenings. See Sleep problems in dementia and Sleep medicines in dementia.
• Protect your own sleep. Caregivers who are woken every night burn out quickly. See Respite care.

Special situations

Living alone. Night waking can bring loneliness and worry. A calming routine, a radio or audiobook at low volume, and a plan for whom to call if you feel unwell can help.

Living with dementia. Sleep changes are common, and poor sleep can worsen symptoms.¹ Sleeping pills carry extra risk of confusion and falls.⁶

Grief. Sleep often falls apart after a loss. It usually improves with time. If it does not, CBT-I can help. See Losing a spouse.

Frequently asked questions

Is it normal to sleep less as I get older?

Sleep often gets lighter and you may wake more, but most older adults still need 7 to 9 hours.¹ If poor sleep is affecting your days, it is worth treating.

Is melatonin safe to take?

Melatonin is sold as a supplement in the U.S. AASM suggests not using it to treat chronic insomnia because the evidence for benefit is weak.³ Ask your doctor or pharmacist before trying it, especially if you take other medicines.

Can CBT-I work for people in their 70s and 80s?

Yes. CBT-I has been tested in older adults and in people with other health problems.^4,5 It may take a few weeks to see results.

I've taken a sleeping pill for years. Is it too late to change?

It is not too late. Talk with your doctor about whether a slow, planned taper makes sense. Do not stop suddenly.⁸ Starting CBT-I can make it easier.

When to get help

See your doctor if:

• Poor sleep lasts more than a few weeks or affects your days
• Someone notices loud snoring, pauses in breathing, or gasping in sleep
• You act out dreams, kick, or fall out of bed
• You feel very sleepy while driving
• You are using alcohol or over-the-counter sleep aids most nights

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.