I’ve been writing about what sleep looks like at every age. Last week, we covered sleep in young adulthood, right up to the start of middle age. This week, I’m jumping back in to talk about how we sleep during middle age and throughout our older years.
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, 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.
If young adulthood gave some of us a hall pass when it comes to paying attention to sleep and investing time and attention in cultivating sleep habits, well…middle age is when that free ride typically ends. In order to sleep well and reap the benefits and protections of high-quality rest, we’ve got to pay attention to sleep on a daily basis. It helps to know what to expect from sleep during these years.
What sleep is like in your . . . mid 40s and 50s
Tell me if this sounds familiar. You slept like a log in your 20s, and pretty well in your 30s, maybe even into your early 40s. Then, somewhere in your later 40s or 50s, sleep started to get…wonky. You go to bed exhausted but still have trouble falling asleep. You wake at least once or twice a night—sometimes to go to the bathroom, sometimes just because. Often, you don’t sleep all the way to dawn, waking way ahead of your alarm, wishing you could grab that extra 45 minutes or hour of rest. Welcome to sleep in middle age.
These years are some of the most challenging for sleep. So many of my patients (and readers) fall into this age range. Given all that’s happening during this stage of life, it’s hardly a surprise that sleep is particularly complicated. Many of us during these years are in the throes of parenting, and doing our best to give our all to work at the same time. We’re helping look after aging parents at the same time we’re figuring out how we’ll pay for kids’ college and fund our own retirement. These are just a handful of reasons why chronic stress and worry are huge problems for sleep during middle age.
At the same time, there’s plenty happening biologically that also makes sleep more challenging. For both men and women, hormones that promote healthy sleep are on the decline. At the same time, sleep-disrupting hormones—including cortisol and others—are often spiking, thanks to stress and an ongoing lack of sleep.
For women, these years typically include both perimenopause and menopause, which bring significant challenges for sleep. More than half of perimenopausal women—56 percent—sleep less than 7 hours a night, on average. That’s a big jump from the third of pre-menopausal women who are sleeping less than 7 hours nightly. Nearly one-quarter—24.8 percent—of perimenopausal women say they have trouble falling asleep four or more times in a week.
Even more common than trouble falling asleep? Difficulty staying asleep. Among women in perimenopause, about 31 percent say they have trouble staying asleep at least four nights a week. Half of perimenopausal women—49.9 percent—wake in the morning feeling tired, rather than rested, four or more days weekly.
To learn all about how menopause affects sleep and health, and natural strategies for protecting your sleep in menopause, check out my series of articles on menopause and sleep.
Men face their own hormonal changes in middle age, including a natural reduction in testosterone, which can have an adverse effect on sleep quality. In turn, short sleep suppresses the production of testosterone, which contributes to more sleep and sleep-related health issues, including obstructive sleep apnea and sexual dysfunction.
Sleep architecture continues to change, as well spend less time in deep sleep (and to a subtler degree, less time in REM sleep). During these years, more of our sleep time is spent in the lighter, less restorative stages of non-REM sleep.
During these years, I see sleeplessness take a particular toll on weight gain and metabolic health, in both men and women. The combination of biological changes underway and crowded, stressful daily schedules isn’t friendly to sleep or to regular exercise, which can be a real difference maker for sleep and weight at any age, and especially during these years.
You’ve heard me talk many times about the connection between poor sleep and weight gain. I’m about to do it again. If you don’t get enough sleep to meet your individual needs, you will gain weight. This really interesting 2017 review of sleep-metabolism research found that running a sleep debt leads to consumption of an average of 285 additional calories a day.
Hormones have a lot to do with this. When you’re sleep deprived, cortisol levels are high and serotonin levels are low, and your body starts to crave starchy, sugary and fatty foods, to help boost serotonin and calm stress. At the same time, lack of sleep increases the hunger hormone ghrelin and suppresses the satiety hormone, leptin, which signals when we’ve eaten enough.
What to watch for: Supporting the daily habits and choices that boost sleep—and avoiding the ones that hurt it. A healthy diet, regular exercise, and attention to mindfulness and stress management can make the difference in sleeping well during some of the busiest, most challenging years of our lives.
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 (hello, kids in college and beyond), 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 after menopause. But the post-menopausal experience—like each phase of the menopausal transition—is highly individual, 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 risks 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—including a drop in energy, increased fatigue, and low mood—as well as the drop in testosterone itself all 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 for sleep 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 as we age. 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 sometimes get less 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 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 sleep stage that’s particularly important for mental and emotional restoration, also generally declines with age, but less drastically than slow-wave sleep does. Adults in their 70s, 80s and 90s are spending much more time in light sleep—which is where fragmented, unrefreshing sleep is more likely to occur. And shorter sleep times translate into 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? 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 the maintenance of healthy biorhythms, and its decline may be a significant factor in age-related sleep issues. (I’ve written about melatonin and its role for sleep and health, here.)
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.
Don’t know your chronotype? Take my quiz: http://www.chronoquiz.com/ to find out. To learn about how biotype affects sleep and nearly every part of your waking life, check out my book, The Power of When.
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. My big takeaway for people at every age? Make the investment in your sleep, NOW. It’s never too late to make improvements in your sleep that will benefit your health and performance. And the attention you give to healthy sleep today will pay off years, and decades, down the road.
Michael J. Breus, PhD, DABSM
The Sleep Doctor™