At every stage of life, we face different challenges to sleep. But often, sleep starts to get increasingly complicated during middle age. Changes to hormones that influence sleep and circadian rhythms, a greater risk for presence of health conditions that interfere with sleep, and the presence of chronic stress are some of the most common reasons why sleep tends to become more challenging the older we get.
What sleep is like in your. . . 60s
To a lot of my patients, it seems deeply unfair: Just as their lives start to become more sleep friendly, their ability to sleep declines. Men and women in their 60s often have more downtime, more control over their daily schedules, and some lessening of daily stress. But a host of physiological changes can make sleep more challenging than ever.
For women, this is usually the first decade of post-menopausal life. That can actually bring improvements to sleep, but it also brings new risks. The symptoms that begin for many women during menopause—hot flashes, headaches and other physical pain, anxiety, lack of focus, mood swings—often ease after a woman reaches post-menopause. That’s true for sleep problems, too. With the settling of hormonal fluctuations, sleep problems may gradually improve for some women. But the post-menopausal experience—like each phase of the menopausal transition—is highly individual, and varies significantly from woman to woman.
I’ve treated women who struggle with sleep and performance throughout perimenopause, and who relatively quickly find a “new normal” and improved sleep as they move into post-menopause. But I also see women continue to grapple with poor quality sleep and contend with new sleep disorders such as obstructive sleep apnea and insomnia, in their post-menopausal lives.
Both men and women face greater risk for sleep disorders, including sleep apnea and insomnia, as they age. And men, too, have some significant hormonal shifts to contend with in their 60s. You’ve heard of menopause, of course. But do you know about andropause? Andropause refers to a significant drop in testosterone that happens to some, but not all, men, typically after age 60. Research suggests about 20% of men in their 60s, and as many as 50% of men in their 80s, go through andropause. The symptoms of andropause—a drop in energy, increased fatigue, and low mood—as well as the drop in testosterone itself can affect sleep.
Men and women in their 60s may experience some significant changes to sleep architecture that make sleep a profoundly different experience than it was when they were younger. During our 60s, it often takes longer for us to fall asleep, and nightly sleep amounts decrease. Sleep may become more restless and fragmented. We’re often easily awakened at night and it may be harder to fall back asleep. Pain conditions and other health issues become more common, and they pose challenges as well.
What to watch for: Focusing on the fundamentals of sleep hygiene. Continuing to sleep well is completely possible as we enter older adulthood, but it doesn’t usually happen by accident. Maintaining a high level of sleep takes some commitment and attention. Sticking to a regular sleep and wake schedule, getting sunlight in the morning, avoiding stimulants at the wrong times (that goes for caffeine and light exposure, as well as others), can help you continue to get restful sleep in your 60s.
What sleep is like in your. . . 70s and beyond
There’s an impression that as we age, we need less sleep. While it’s true that older adults sometimesgetless sleep—and that their sleep sometimes is scattered in shorter segments throughout a 24-hour day—that’s not necessarily a result of diminished need. Like many important questions about sleep, we don’t have a definitive answer to this question yet. But most research suggests that our individual sleep needs remain largely the same throughout our lives. If you needed 7 hours to function at your best in your 30s, that’s probably what you’ll need in your 70s to feel good, too.
It’s true, though, that the sleep cycles of a person in their 70s look very different than those of a young adult. A person in their 20s may spend 20% of their total sleep time in the restorative stage of deep, slow-wave sleep. By their early 70s, time in deep sleep may be as little as 5%. REM sleep, the stage that’s particularly important for mental and emotional restoration, also generally declines with age, but less drastically than slow-wave sleep. Adults in their 70s, 80s, and 90s are spending much more time in light sleep, where fragmented, unrefreshing sleep is more likely to occur. And shorter sleep times translate to fewer sleep cycles in any given night—which means less time in all the stages of sleep.
Other physiological changes that can happen at this age include a shift in bio time, and a drop in melatonin production. Melatonin levels have been gradually dropping since adolescence, and research suggests that by our 70s, nighttime melatonin levels may be as low as daytime melatonin levels were in our teenage years. Melatonin is an important hormone for sleep and for maintenance of healthy biorhythms. Its decline may be a significant factor in age-related sleep issues.
In older adults, biorhythms themselves can advance, shifting their timing to earlier in the day. That means preferences for waking and activity shift to earlier in the morning, with a nighttime shift to preferences for earlier bedtimes. Some adults in their 70s and older will find themselves with a new biotype—sometimes they become Lions, but there’s also a pretty common shift to the short-sleeping Dolphin biotype that happens in older adulthood.
This biotype and bio time doesn’t happen for everyone. As with so much about sleep needs and preferences, there’s evidence that this shift is heavily influenced by our genes. As many as 50% of people who experience advanced circadian phase syndrome (the medical term for this bio time shift) have at least one relative who has also gone through this sleep phase change. There’s also some fascinating evidence of gender differences in the way age affects sleep, with studies showing that men may experience more of aging’s direct impact on sleep than women.
Individual genetics play a role in how sleep looks and feels in our older adult years—and so does our individual health. A growing body of research shows that older adults who are healthy aren’t more sleep-deprived than younger adults, and that it’s the impact of health conditions on sleep, rather than aging itself, that account for a significant percentage of sleep complaints in older adulthood.
As a sleep clinician who sees patients at nearly every stage of life, I’m not sure there is a time when sleep is more individually varied than in older adulthood. Individual genetics, lifestyle habits, mental and physical health conditions—and a history of sleep habits and practices—all come together to make sleep in older age a complex, highly individual experience.
Michael J. Breus, PhD, DABSM
The Sleep Doctor™