Sleep and aging

Sleep changes as you get older, and some of those changes are simply how an aging brain works. Sleep gets lighter, the night gets more interrupted, and the whole schedule drifts earlier. Plenty of 70-year-olds who feel fine during the day are sleeping exactly the way a healthy 70-year-old sleeps.

What is not normal is chronic trouble sleeping that spills into your days: lying awake for hours, fighting to stay awake through conversations, or waking every morning unrefreshed. The old folklore that "seniors just need less sleep" is mostly wrong. The National Institute on Aging puts the need for older adults at 7 to 9 hours a night, the same range as younger adults ¹. What shrinks with age is not the need for sleep but the ability to get it in one consolidated block, and when the gap gets wide enough to cause daytime problems, it is a treatable medical issue rather than a fact of life.

How sleep changes after 65#

Researchers describe a night of sleep by its sleep architecture: the pattern of light sleep, deep slow-wave sleep, and dream (REM) sleep that repeats in roughly 90-minute cycles. With age, that architecture shifts in predictable ways. Deep slow-wave sleep declines, light sleep takes up more of the night, awakenings become more frequent, and more time is spent awake after first falling asleep ². The body clock also drifts forward, a change called an advanced sleep phase: sleepiness arrives earlier in the evening and waking comes earlier in the morning, whether you want it to or not ².

The practical result is that sleep feels lighter and choppier even when nothing is medically wrong. The line between normal aging and a real problem runs through your daytime.

Sources for this section: [2]

Insomnia, and why CBT-I comes first#

Insomnia is the most common sleep complaint in later life. Around half of adults 65 and older report at least occasional insomnia symptoms, and roughly 12-20 percent meet criteria for chronic insomnia disorder: trouble falling asleep, staying asleep, or waking too early at least three nights a week for three months or more, with daytime consequences ³. Late-life insomnia usually has company. Pain from arthritis, nighttime urination, heartburn, medications, depression, anxiety, and the loss of a daily schedule after leaving work all feed it.

Since 2016, the American College of Physicians has recommended that every adult with chronic insomnia be offered cognitive behavioral therapy for insomnia (CBT-I) as the first treatment, before any medication ⁴. That is not a soft preference. In head-to-head research, CBT-I relieves insomnia about as well as prescription sleep medication over the first weeks, and it keeps working after treatment ends, which pills do not ⁴. It also carries none of the fall and memory risks that sedatives carry for older bodies.

CBT-I is a structured program, typically 4 to 8 sessions, not just a list of tips. The core techniques are sleep restriction (temporarily limiting time in bed so sleep consolidates), stimulus control (using the bed only for sleep, and getting up when you cannot sleep), and work on the anxious thoughts that keep the brain on alert at 3 a.m. It works well in older adults, including those with medical conditions.

The catch is access: trained CBT-I providers are scarce in many areas. Options worth knowing about include a referral from your doctor to a behavioral sleep medicine specialist (often deliverable by telehealth, and outpatient therapy is covered by Medicare Part B), and digital CBT-I programs. Insomnia Coach, a free self-guided app built by the Department of Veterans Affairs, is open to anyone, veteran or not. Structured online programs, including Somryst, a prescription digital therapeutic cleared by the FDA for chronic insomnia, deliver the full protocol over about six to nine weeks ⁵.

Sources for this section: [3] [4] [5]

Sleeping pills after 65: read the fine print#

The American Geriatrics Society's Beers Criteria, a regularly updated list of medications considered potentially inappropriate for people 65 and older (most recently revised in 2023), advises avoiding the most familiar sleep drugs ⁶. Aging changes how bodies process these medications, and the documented harms include falls, fractures, car crashes, daytime confusion, and dependence.

None of this means a short course of medication is never appropriate; the ACP guideline itself says drug therapy can be discussed when CBT-I alone has not worked ⁴. The pattern to avoid is the open-ended nightly prescription that quietly continues for years. Falls are the leading cause of injury in older adults, and sedatives are one of the most fixable contributors; a medication review is a standard part of fall prevention.

Caution: If you have taken a benzodiazepine or Z-drug nightly for months or years, do not stop abruptly. Sudden withdrawal can cause rebound insomnia, anxiety, and in some cases seizures. Ask your doctor or pharmacist for a gradual tapering plan.

Sources for this section: [4] [6]

Sleep apnea is not just a younger person's snore#

Obstructive sleep apnea (OSA), in which the throat repeatedly collapses during sleep and blocks breathing, becomes more common with age, and it is frequently missed in older adults because the stereotype patient is a heavy-set middle-aged man. After 65, apnea often shows up in people of normal weight, and in women as often as men after menopause. Signs include loud snoring, pauses in breathing or gasping that a bed partner notices, waking with a dry mouth or morning headache, several nighttime bathroom trips, and sleepiness that no amount of time in bed fixes. Untreated apnea is linked to high blood pressure, atrial fibrillation, stroke, and worse memory and thinking, which is one reason it comes up in dementia evaluations.

Testing is easier than it used to be. For most people without complicating heart, lung, or neurological conditions, a home sleep apnea test (a small sensor kit worn for a night or two in your own bed) can make the diagnosis; an overnight lab study is reserved for more complicated situations. Treatment usually starts with CPAP, a bedside machine that holds the airway open with gentle air pressure. Medicare Part B covers a sleep test when apnea is suspected and then a 12-week CPAP trial; coverage continues if you use the machine and your doctor documents in person that it is helping. Medicare rents the machine for 13 months of continuous use, after which you own it, and you pay 20 percent coinsurance after the Part B deductible ⁷. Oral appliances fitted by a dentist are an option for some people who cannot tolerate CPAP.

Sources for this section: [7]

What the evidence says about naps#

Short naps are fine and can genuinely help alertness. Sleep specialists suggest keeping naps to about 20-30 minutes and finishing by early afternoon, roughly 3 p.m., so they do not eat into nighttime sleep ⁸. Longer naps tend to end in sleep inertia, that heavy-headed grogginess after waking from deep sleep.

Studies that link napping to poor health mostly involve long or unintended daily napping, and the arrow of causation is unclear: needing a 90-minute nap every afternoon is often a symptom of bad nighttime sleep, apnea, medication effects, or illness rather than a cause of them ⁸. The useful question is not "are naps bad" but "why do I need one this long."

Sources for this section: [8]

Restless legs and nighttime movement#

Restless legs syndrome (RLS) is an urge to move the legs, often with crawling, tingling, or aching sensations, that shows up in the evening or at rest and eases with movement. It becomes more common with age and is a well-documented sleep thief. Low iron stores are a frequent and correctable contributor, so clinicians typically start with blood work that includes ferritin, a measure of stored iron, and treat low levels before considering other medications. Some common drugs make RLS worse, including sedating antihistamines and certain antidepressants, so a medication review matters here too. Many people with RLS also have periodic limb movements, repetitive leg jerks during sleep that the sleeper never notices but a bed partner does.

Sleep habits with real evidence, and the folklore#

The habits with the best evidence behind them are the ones embedded in CBT-I. Keep a consistent wake time seven days a week, since a steady anchor matters more than a steady bedtime. Get bright light, ideally outdoors, in the morning. Stay physically active; regular exercise reliably improves sleep quality. Keep the bedroom dark, quiet, and cool. Stop caffeine by early afternoon, and treat alcohol honestly: a nightcap may speed the first minutes of sleep but fragments the second half of the night. If you are awake in bed for what feels like 20 minutes or more, get up, do something calm in dim light, and return when sleepy. What you eat and drink in the evening plays a supporting role, covered further in nutrition for seniors.

The folklore is mostly harmless but weak. Warm milk has little evidence behind it. "Resting" in bed for hours to make up for a bad night teaches the brain that bed is a place for lying awake. Sleeping in on weekends deepens schedule whiplash. And rigidly chasing a perfect eight hours can itself feed insomnia; sleep researchers see plenty of people whose main problem has become anxiety about sleep. One more finding from the research: tidy sleep-hygiene lists alone rarely fix chronic insomnia ³. They are the supporting cast; the structured behavioral treatment is the lead. If your sleep problem persists, or your mood has sunk with it, that is a conversation for your doctor, and mental health deserves a place in it.

Sources for this section: [3]

RetiredWiki. (2026, July 18). Sleep and aging. https://retiredwiki.com/article/sleep-and-aging