Sebastian Frey( Seasoned Professional )

Seb Frey is a REALTOR® and founder of Team Sixty Plus, a curated network connecting older adults and their families with trusted professionals across California. With decades of experience helping homeowners 60+ navigate major life transitions—like downsizing, aging in place, or passing on a legacy—Seb brings deep market knowledge, a compassionate approach, and a commitment to simplifying complex decisions. When he’s not advising clients, he’s sharing expert insights on real estate, retirement strategies, and quality-of-life resources for the 60+ community.

A comprehensive guide to understanding sleep changes in older adults, diagnosing common sleep disorders, and evidence-based strategies to get a better night’s rest.

If you’re over 60 and struggling to get a good night’s sleep, you’re not imagining it — and it’s not just a normal part of getting older that you have to accept. While sleep does change as we age, many of the disruptions that seniors experience are treatable, preventable, or at least manageable. And the stakes couldn’t be higher: poor sleep in older adults is linked to cognitive decline, increased fall risk, weakened immune function, and worse cardiovascular outcomes.

This article draws on insights from a sleep medicine physician affiliated with Stanford University — home to some of the most foundational sleep research in the world — to give you a clear, practical, science-backed guide to improving sleep hygiene as you age.

What Happens to Sleep as We Age

To understand why sleep hygiene matters so much for seniors, it helps to first understand what normal sleep looks like — and how aging changes it.

The Four Stages of Sleep

Every night, your brain cycles through four distinct stages of sleep, each serving a different purpose:

• N1 (Light Sleep): The transition between wakefulness and sleep. Brief and easy to wake from.
• N2 (Light Sleep): A deeper version of light sleep, where the majority of your night is actually spent.
• N3 (Deep Sleep): Also called slow-wave or restorative sleep. This is where physical repair happens — tissues rebuild, the immune system activates, and the brain consolidates memories.
• REM Sleep (Dream Sleep): REM stands for Rapid Eye Movement, named for the characteristic back-and-forth movement of the eyes during this phase. REM sleep is nearly a wakeful state from a brainwave standpoint — the mind is highly active, which is why we perceive vivid dreams. Interestingly, during REM sleep, the brain actually paralyzes the body’s muscles to prevent you from acting out your dreams.

Together, these stages cycle multiple times throughout the night, creating the architecture of a healthy night’s sleep.

How Aging Disrupts This Architecture

As we get older, sleep becomes more fragile in measurable ways. Deep sleep — the most restorative stage — can decline by as much as 60 to 70 percent over a lifetime. Total sleep time also tends to decrease, and the sleep that does occur is lighter and more easily disrupted. Transitions between stages become less smooth, and the overall structure of the night becomes more fragmented.

“As we age, our sleep tends to be much more fragile, and total sleep time tends to decrease. This is natural — but it’s not the whole story.” — Sleep Medicine Physician, Stanford-affiliated

It’s important to distinguish between these natural, age-related changes and sleep disorders that mimic or worsen them. Many seniors — and even their doctors — chalk up sleep problems to “just getting older,” when in fact a treatable condition is responsible. Recognizing the difference is where better sleep begins.

Why Sleep Hygiene Matters: The Health Consequences of Poor Sleep

Sleep isn’t a passive state. While you’re unconscious, your body and brain are doing some of their most important work. When that work gets cut short — night after night — the consequences accumulate.

Cognitive Health and Brain Function

The brain uses sleep to clear out metabolic waste products, consolidate memories, and process emotional experiences. For older adults, chronic poor sleep is associated with accelerated cognitive decline and higher risk of dementia. The restorative work of deep sleep is particularly critical for brain health — which is why the age-related decline in N3 sleep is such a concern.

Fall Risk

Balance, coordination, and reaction time all suffer when we’re sleep-deprived. For seniors, where a fall can have life-altering consequences, this is not a minor issue. Consistently poor sleep is a recognized risk factor for falls — one of the leading causes of injury and death among older adults.

Cardiovascular and Immune Health

Sleep deprivation puts the body under chronic low-grade stress. Over time, this contributes to elevated blood pressure, increased inflammation, and weakened immune response. Studies consistently link poor sleep in older adults to worse cardiovascular outcomes and greater susceptibility to illness.

Mood and Quality of Life

Sleep affects how we feel, how we cope, and how we engage with the world. A poor night’s sleep reliably produces irritability, difficulty concentrating, and reduced emotional resilience. For seniors who may already be navigating health challenges, loss, or life transitions, the compounding effect of chronic sleep disruption on mood can be significant.

Common Sleep Disorders in Older Adults

Before diving into sleep hygiene strategies, it’s worth understanding the sleep disorders that disproportionately affect seniors — because if an underlying condition is present, sleep hygiene alone won’t fully solve the problem.

Insomnia

Insomnia is clinically defined as difficulty falling asleep, staying asleep, or waking too early — occurring at least three times per week for at least three months — with noticeable daytime consequences. By this definition, insomnia affects between 30 and 50 percent of older adults, making it by far the most common sleep disorder in this population.

Common contributors to insomnia in seniors include:

• Chronic pain — often unvoiced, but a significant disruptor of sleep
• Nocturia (frequent nighttime urination) — the number one sleep disruptor in older adults
• Medications — many common prescriptions have insomnia as a side effect; a medication review is essential
• Caffeine — particularly when consumed in the afternoon or evening
• Alcohol — widely misunderstood as a sleep aid, alcohol actually disrupts sleep architecture, reducing overall sleep quality even if it induces initial drowsiness
• Depression, anxiety, grief, and major life transitions

One critical point: obstructive sleep apnea is one of the most common mimickers of insomnia. Many patients who believe they have insomnia actually have undiagnosed sleep apnea. A sleep study to rule out apnea should always be part of the evaluation.

Obstructive Sleep Apnea (OSA)

The statistics on sleep apnea in older adults are striking: it affects approximately 70 percent of older men and 55 percent of older women. Across all age groups, roughly one in four people has sleep apnea significant enough to cause daytime symptoms — and it remains massively underdiagnosed.

Sleep apnea occurs when the upper airway collapses during sleep, blocking airflow. The brain, deprived of oxygen and building up carbon dioxide, triggers a waking response. This cycle can repeat dozens or even hundreds of times per night, fragmenting sleep without the person ever being fully aware of it.

Mild sleep apnea averages 10 apnea events per hour — meaning the brain is being jarred awake 6 times per hour even at the “mild” level. Moderate to severe cases are far more disruptive.

A common misconception is that sleep apnea only affects overweight people. While obesity does increase risk, thin people can and do have sleep apnea. Anyone with persistent sleep complaints should be screened for it.

Treatment options range from CPAP (Continuous Positive Airway Pressure) machines — the gold standard — to oral appliances, positional therapy (sleeping on your side rather than your back), and in some cases surgical interventions. New hypoglossal nerve stimulator devices are also showing strong results for patients who can’t tolerate CPAP.

Restless Leg Syndrome (RLS)

Restless leg syndrome is characterized by uncomfortable sensations in the legs — often described as creeping, crawling, or tingling — that create an irresistible urge to move them. Symptoms typically worsen in the evening and at night, directly interfering with the ability to fall asleep. RLS is common in older adults and is often underreported; many patients don’t realize it’s a recognized, treatable condition.

REM Behavioral Disorder

As mentioned earlier, REM sleep normally involves muscle paralysis — a safety mechanism that prevents us from physically acting out our dreams. In REM Behavioral Disorder (RBD), this paralysis fails, and people physically move, talk, shout, or even strike out during dream sleep. This is not only disruptive and potentially dangerous, but RBD has been identified as an early marker of certain neurodegenerative conditions, including Parkinson’s disease. It warrants prompt medical evaluation.

Sundowning

Sundowning refers to increased confusion, agitation, or behavioral changes that occur in the late afternoon and evening, predominantly in people with dementia or Alzheimer’s disease. It is closely tied to disruptions in the circadian rhythm — the body’s internal clock — and can make nighttime sleep extremely difficult for both the affected person and their caregivers.

A Special Note on Women’s Sleep and Hormones

For women, hormonal changes — particularly those associated with menopause — have a direct and significant impact on sleep. Hot flashes, night sweats, and hormonal fluctuations all disrupt sleep architecture. For years, hormone replacement therapy (HRT) was broadly discouraged following a study that suggested elevated cancer risks. That data has since been substantially reanalyzed.

The current understanding is that for most women — particularly those in early menopause — hormone therapy carries no meaningful increase in cancer risk and can provide significant relief from sleep-disrupting menopausal symptoms. Women whose sleep has deteriorated since menopause are encouraged to seek out specialists in women’s health and menopause who are current on the evolving evidence around hormone therapy.

Sleep Hygiene Strategies That Actually Work

Sleep hygiene refers to the behavioral and environmental practices that support consistent, quality sleep. For many seniors, addressing these factors can produce meaningful improvement — and for those with diagnosable sleep disorders, good sleep hygiene is an important complement to medical treatment.

1. Get Screened for Sleep Apnea First

Before implementing any other strategy, it’s worth ruling out obstructive sleep apnea. Given how prevalent it is — and how often it masquerades as insomnia — this step is foundational. A home sleep test or in-lab polysomnography can confirm or rule out apnea. If apnea is present, treating it often resolves most sleep complaints.

2. Address the Root Cause of Nocturia

Waking up multiple times per night to use the bathroom is the single most common sleep disruptor in older adults. But it’s worth knowing that sometimes the cause is reversed: sleep apnea itself can trigger the sensation of needing to urinate. Before assuming it’s a bladder or prostate issue, apnea should be ruled out.

For men, the most common underlying cause is an enlarged prostate, which can be treated with medications or, if needed, minimally invasive procedures. Women may be dealing with overactive bladder, underactive bladder, or pelvic floor weakness — conditions best evaluated by a urogynecologist or pelvic floor specialist. Pelvic floor physical therapy is often highly effective and is a good first-line option.

3. Audit Your Medications and Substances

Many commonly prescribed medications — including certain antidepressants, decongestants, corticosteroids, and blood pressure drugs — have insomnia as a documented side effect. If you’ve developed sleep problems after starting a new medication, bring this up with your prescriber. Do not stop medications without medical guidance, but do advocate for a medication review.

On the substance side:

• Caffeine: Eliminate or strictly limit caffeine after noon. The half-life of caffeine is longer than most people realize — a cup of coffee at 2 PM still has measurable effects at bedtime.
• Alcohol: Despite its reputation as a sleep aid, alcohol consistently disrupts sleep architecture. The initial sedating effect is real, but alcohol suppresses REM sleep and causes early morning awakenings. People with long histories of heavy alcohol use may find these effects persist even after reducing consumption.

4. Prioritize Consolidated, Consistent Sleep

A question that often comes up: is it okay to sleep in fragments — a few hours here, a nap there — as long as the total adds up to seven or eight hours? The answer, unfortunately, is no. Consolidated sleep is more restorative than fragmented sleep. Because the opportunity for deep, restorative N3 sleep is already reduced as we age, fragmenting the sleep window further diminishes the odds of getting enough of it.

This also means being thoughtful about daytime napping. Brief naps (20 to 30 minutes) earlier in the day are generally fine, but long or late-afternoon naps can compromise nighttime sleep onset and consolidation.

5. Sleep Position Matters

For snorers and those with mild sleep apnea, sleeping on your back dramatically worsens airway collapse — gravity pulls the relaxed soft tissues of the throat downward, narrowing the airway. Sleeping on your side is a simple, zero-cost intervention that can meaningfully reduce apnea events and snoring. Positional therapy devices (specialty pillows or body positioning aids) can help maintain side-sleeping through the night.

6. Practice Nasal Breathing

The nose is equipped with reflexes that help maintain airway tone during sleep. The mouth is not. Mouth breathing during sleep bypasses these protective mechanisms entirely, increasing the likelihood of airway collapse and snoring. Retraining yourself to breathe through the nose at night — sometimes aided by a chin strap or nasal strips — can improve sleep quality, particularly for those with mild airway issues.

This is supported by growing interest in nasal breathing as a general health practice, popularized by books like James Nestor’s Breath, which explores the physiological differences between nasal and mouth breathing.

7. Optimize Your Sleep Environment

• Temperature: Most people sleep best in a cool room (around 65–68°F). The body needs to drop its core temperature to initiate and maintain sleep.
• Light: Darkness signals the brain to produce melatonin. Blackout curtains and minimizing light exposure in the hours before bed support natural melatonin production.
• Screens: Blue light from phones, tablets, and televisions suppresses melatonin production. Avoid screens in the 60–90 minutes before bedtime, or use night mode settings that reduce blue light emission.
• Noise: A quiet environment is ideal; white noise machines can be helpful for blocking intermittent disruptions.
• Consistency: Going to bed and waking at the same time every day — including weekends — reinforces the body’s circadian rhythm and makes falling asleep easier over time.

8. Exercise Regularly — But Time It Right

Regular physical activity is one of the most evidence-supported ways to improve sleep quality. It promotes deeper sleep, reduces the time it takes to fall asleep, and improves overall sleep duration. However, vigorous exercise in the two to three hours immediately before bedtime can be stimulating and delay sleep onset. Aim for regular movement earlier in the day.

9. Address Mental Health and Emotional Well-Being

Depression, anxiety, grief, and major life transitions are among the most common contributors to insomnia in older adults. Sleep and mental health are deeply intertwined — poor sleep worsens mood disorders, and mood disorders worsen sleep. If emotional factors are at play, addressing them directly — whether through therapy, medication, or both — is essential.

The Gold Standard Non-Drug Treatment: CBT-I

Cognitive Behavioral Therapy for Insomnia (CBT-I) is consistently rated by sleep medicine experts as the most effective long-term treatment for chronic insomnia — outperforming sleep medications in head-to-head studies and producing benefits that persist long after treatment ends.

CBT-I works by identifying and restructuring the thoughts and behaviors that perpetuate insomnia. It’s not simply relaxation training — it’s a structured, evidence-based protocol that typically includes:

• Sleep restriction therapy — temporarily limiting time in bed to consolidate sleep and rebuild sleep drive
• Stimulus control — reestablishing the bedroom as a cue for sleep rather than wakefulness
• Cognitive restructuring — challenging unhelpful beliefs about sleep (“I have to get 8 hours or tomorrow will be ruined”)
• Relaxation training and sleep hygiene education

Multiple large studies have validated CBT-I for older adults specifically. It produces results comparable to sleep medications for short-term improvement, without the risks of dependency, falls, cognitive side effects, or drug interactions that make sleep medications problematic in older populations.

CBT-I is available through trained therapists, but also through validated digital programs and apps — making it accessible even for those in areas with limited access to sleep specialists.

What About Sleep Supplements and Medications?

Melatonin

Melatonin is the safest over-the-counter sleep supplement available. It’s a hormone the body naturally produces in response to darkness, and supplementing it can help with sleep onset — particularly for circadian rhythm issues or jet lag. For seniors, a “start low, go slow” approach is best: begin with 1 to 3 milligrams rather than the higher doses commonly sold, as too much can cause morning grogginess.

One important nuance: melatonin appears to lose effectiveness when taken every single night. Using it on an as-needed basis — rather than as a nightly routine — tends to produce better results.

Prescription Sleep Medications

Prescription sleep medications can be useful in the short term, but come with significant caveats for older adults. Many traditional sleep medications increase fall risk, impair next-day cognition, and carry dependency risks. Some — like the Z-drugs (zolpidem, eszopiclone) — are on the Beers List of medications that should be used with caution in older adults. Newer options, including orexin receptor antagonists like suvorexant, have a more favorable side effect profile and are worth discussing with a physician.

Prescription sleep aids should generally be viewed as a short-term bridge while addressing underlying causes — not as a long-term solution.

Emerging Treatments

Research into new treatments for sleep disorders continues to advance. Vagus nerve stimulation is one area of active investigation — the vagus nerve plays a central role in regulating the autonomic nervous system, and modulating it theoretically offers pathways to improved sleep. While FDA-cleared products for insomnia in this category are not yet widely established, several are in late-stage development and may offer new options in the coming years.

When to See a Doctor About Your Sleep

If you recognize yourself in any of the following, it’s time to have a dedicated conversation with your physician about your sleep:

• You snore loudly, gasp during sleep, or have been told you stop breathing
• You wake frequently to urinate and it’s disrupting your sleep
• You feel unrested despite spending adequate time in bed
• You experience excessive daytime sleepiness
• You have uncomfortable sensations in your legs at night that improve with movement
• You or your partner has noticed you physically acting out dreams
• Your sleep has significantly worsened since starting a new medication
• You’ve tried standard sleep hygiene measures and continue to struggle

Ask specifically about a referral to a sleep specialist and whether a sleep study is appropriate. These are reasonable, standard requests — not something to feel hesitant about.

The Bottom Line

Sleep problems in seniors are common, but they are not inevitable — and they are not harmless. The good news is that the field of sleep medicine has matured significantly. We now have a much clearer understanding of what causes poor sleep in older adults, how to diagnose it properly, and how to treat it effectively.

The most important steps are: rule out sleep apnea, address treatable causes like nocturia and medication side effects, optimize your sleep hygiene consistently, and — if insomnia persists — seek out CBT-I. These are not small steps, but they are meaningful ones. Better sleep at any age is possible.

Sleep is not a luxury. For older adults, it is one of the most powerful levers available for protecting cognitive health, physical vitality, and quality of life.

About This Article

This article was developed from a sleep medicine presentation by a Stanford-affiliated physician. It is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider regarding your specific health concerns.

Sebastian Frey Seasoned Professional

Seb Frey is a REALTOR® and founder of Team Sixty Plus, a curated network connecting older adults and their families with trusted professionals across California. With decades of experience helping homeowners 60+ navigate major life transitions—like downsizing, aging in place, or passing on a legacy—Seb brings deep market knowledge, a compassionate approach, and a commitment to simplifying complex decisions. When he's not advising clients, he's sharing expert insights on real estate, retirement strategies, and quality-of-life resources for the 60+ community.

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