According to the National Institute on Aging, older adults need approximately 7 to 9 hours of sleep per night. However, a number of factors can lead to sleep problems in older adults, including sleep changes caused by the natural process of aging, health conditions that cause pain, and medications whose effects disturb sleep.
The 2020 Canadian Community Health Survey (CCHS) found that 77% of adults aged 18 to 64 met sleep duration guidelines, while only 55% of adults aged 65 and over achieved the recommended amount of sleep each night. Older adults may be more likely to be affected by certain sleep disorders, such as insomnia and sleep-related breathing disorders.
What sleep disorders affect older adults?
Insomnia is believed to be the most common sleep disorder in adults over the age of 60. Symptoms of insomnia include problems falling or staying asleep, regularly waking up earlier than intended, and impairment to daytime function (such as mood disturbances or feelings of extreme fatigue). People with insomnia may also experience irritability, trouble concentrating, and difficulty handling social situations.
Primary insomnia involves insomnia symptoms that present independently, whereas secondary insomnia occurs as a result of an underlying health issue that leads to sleep loss. In cases of secondary insomnia, patients are usually first required to address the primary condition that is at the root of their sleep problems.
If symptoms happen at least three times per week and continue for at least three months, insomnia may be considered chronic. In addition to interfering with sleep quality and duration, insomnia can have an impact on many other aspects of a person’s life. It is important to consult a doctor if short-term or chronic insomnia begins to impair function or interfere with daily activities.
Sleep apnea is a health condition in which breathing repeatedly stops and starts during sleep. A person with sleep apnea might notice symptoms like excessive daytime sleepiness, loud snoring, and a dry mouth or sore throat upon awakening.
Results from the 2016 and 2017 Canadian Health Measures Survey (CHMS) indicate that adults aged 60 to 79 were three times as likely to report being diagnosed with sleep apnea in comparison to younger adults. The European Respiratory Society lists several reasons why older adults may develop sleep apnea, including changes in sleep architecture and increased collapsibility of the upper airway due to deterioration in muscle function.
Obstructive sleep apnea (OSA) is often treated with continuous positive airway pressure (CPAP) therapy, which involves a machine that delivers a steady flow of air to the user via a mask or nosepiece to keep airways open and aid breathing during sleep. Left untreated, sleep apnea can lead to a wide array of health problems, including an increased risk of stroke and heart attack. Anyone who is experiencing symptoms of sleep apnea should seek guidance from a doctor, who will be able to perform additional testing (if necessary) to make a diagnosis and establish suitable treatment options.
Circadian rhythm sleep disorders
Circadian rhythms are 24-hour cycles that manage some of the body’s most important functions and processes, including the sleep-wake cycle. They are linked to the passage of day and night because the body’s internal clock responds to environmental cues — especially light. Circadian rhythm sleep disorders can occur when a person’s circadian rhythm is not synchronized with their external environment. The mechanisms within the body that control circadian rhythm degenerate as people age, putting older adults at an increased risk of circadian rhythm sleep disorders.
Advanced sleep phase disorder (also known as advanced sleep phase syndrome) is the most common circadian rhythm sleep disorder in the older population. This disorder causes a person to frequently feel tired in the early evening, often between 6pm and 9pm, and to awaken naturally between 2am and 5am. Older adults can also be affected by irregular sleep-wake rhythm disorder (ISWRD), in which people have fragmented sleep patterns that do not align with the typical 24-hour day-night cycle. ISWRD is mostly found in adults with neurological and neurodegenerative conditions like Alzheimer’s disease.
Sleep-related movement disorders
Sleep-related movement disorders — such as restless legs syndrome (RLS) and periodic limb movement disorder — are conditions that are characterized by movements that can disturb sleep.
Symptoms of RLS include an irresistible urge to move the legs, and a burning, itching, or “pins and needles” sensation that is alleviated when the legs are moved. RLS tends to worsen during periods of rest and can become more intense in the evenings, which may lead to difficulty falling or staying asleep. Prevalence rates of RLS increase with age and the condition is understood to affect women more often than men.
The symptoms caused by sleep disorders can affect a person’s quality of life, and dealing with sleeping problems can be frustrating. Establishing a consistent resting and waking schedule can support better sleep: a 2020 study found that a structured sleep schedule reduced night-to-night variability in sleep timing and duration among participants. Practising good sleep hygiene — such as maintaining a comfortable, quiet sleeping environment — is also beneficial to older adults with sleep disorders.
If problems with sleep are beginning to affect a person’s day-to-day life, have become chronic, or if a medication is suspected to be the cause of sleep issues, it is important to consult a doctor for guidance and treatment.