It’s normal for sleeping patterns to change as we age. Various lifestyle changes that come with age – for example getting insufficient daylight exposure – can alter the production of hormones like melatonin, which are essential for sleep. As a result, many people report having trouble falling asleep, staying asleep, and waking up early the following morning. It’s also common for people to feel tired earlier in the night as they get older.
While experiencing changes to your sleeping pattern is often just a normal part of ageing, sometimes it can be the result of a sleep condition, or underlying medical condition.
In this article, we’ll cover some various sleep conditions that you should be aware of, and the medical conditions that can sometimes underlie them.
Common age-related sleep conditions
Insomnia is a common condition that causes disrupted or irregular sleeping patterns. It’s largely categorised by a persistent difficulty of falling or staying asleep, even when you feel physically and/or emotionally exhausted. We all suffer from acute or short-term insomnia from time-to-time – for example when we’re nervous about something. But when symptoms appear at least three times a week for longer than a month, this is classed as chronic insomnia.
In many cases, insomnia can be treated with simple lifestyle changes. For example, reducing screen time and exposure to blue light before bed, getting enough exercise, sticking to a bedtime routine, and creating a comfortable and relaxing sleeping environment. In some cases, where insomnia is persistent and makes no improvement, professional help may be required.
You can find more tips on how to treat insomnia and what help is available in our article, What is insomnia and how can you improve it?
Sleep apnea is a sleep-related breathing condition where your breathing stops and starts during sleep. It’s common in older adults and the most common type is called obstructive sleep apnea, which is caused by blocked airways. There’s also central sleep apnea which is caused by a failed connection between the brain and muscles which signal your breathing, but this is much less common.
Sleep apnea often causes people to snore heavily, make gasping, snorting noises, and wake up a lot. This can disrupt sleep and cause daytime tiredness. Sleep apnea is also considered to be a predictor of underlying health conditions such as congestive heart failure, myocardial infarction, and stroke, so it’s important to speak to your doctor if you have any concerns. If they suspect you may have sleep apnea, they may refer you to a specialist sleep clinic for tests.
In mild cases, sleep apnea does not always require treatment. Many people use a CPAP machine, which is placed over the mouth and nose as you sleep to help you breathe. These are provided for free on the NHS where required. You can find out more about treatments for sleep apnea on the NHS website.
Restless leg syndrome and periodic limb movements
Restless leg syndrome (RLS) is a neurological condition that causes an overwhelming urge to move the legs. Periodic limb movements (PLMS) are involuntary, repetitive movements of the arms and legs during sleep that occur more than 15 times per hour. Both of these conditions are distressing and can be disruptive to sleep, leaving you feeling tired the next day.
The exact cause of the conditions is unknown, however, studies show that the risk of RLS and PLMS almost doubles with age. According to the Sleep Health Foundation, PLMS only affects around 2% of people under 30, but up to 40% of people over the age of 65. Symptoms for both conditions can range from mild to severe and are usually worse in the evening or at night. Some people only experience symptoms occasionally, while others have them every day.
Mild cases of RLS and PLMS can usually be treated with lifestyle changes such as quitting smoking, exercising regularly, and practising healthy sleep habits. If symptoms are more severe however, medication may be required. If you think you might have RLS or PLMS, then it’s best to book an appointment with your GP as they’ll be able to advise you on the best treatments.
Circadian rhythm sleep disorders
The circadian rhythm is the body’s internal clock that helps to regulate sleep. When disrupted, it’s often considered a circadian rhythm sleep disorder. There are various forms of circadian rhythm sleep disorder, all of which tend to be more common with age. This is because the internal mechanisms and hormones (like melatonin) that are responsible for regulating the sleep-wake cycle weaken as we get older. Certain medical conditions and medications can also make people more susceptible to developing a circadian rhythm disorder. These include chronic pain, dementia, heart disease, and medications like steroids, amphetamines, and clonidine.
Advanced sleep phase disorder (ASP) – which causes people to routinely go to bed between 6pm and 9pm and wake up between 2am and 5am – is particularly common in older adults. Similarly, irregular sleep-wake rhythm disorder (ISWRD), where sleeping patterns don’t follow a normal 24-hour day-night cycle, is common in adults with neurological and neurodegenerative conditions like Parkinson’s or Alzheimer’s disease. These conditions can lead to imbalanced sleeping patterns, excessive tiredness, trouble concentrating, and depression.
If you think that you might have one of the conditions mentioned here, then the first step is to speak to your doctor who may refer you to a specialist, to determine what’s causing your symptoms. In many cases, lifestyle adjustments are enough to re-regulate the circadian rhythm. However, in some cases other treatments, such as melatonin supplements, may be required. You can read about this in our article Everything you need to know about melatonin and the circadian rhythm.
REM sleep behaviour disorder
REM (rapid eye movement) sleep is the stage of the sleep cycle where most dreams occur. Muscles are usually paralysed during this stage to ensure we remain still, but people with REM sleep behaviour disorder (RBD) will physically act out their dreams. The dreams are usually very vivid and can involve a whole range of movements. For example, people may talk, shout, punch, kick, or jump. Unlike sleepwalking or night terrors, people with REM sleep behaviour disorder also recall their dreams after waking up.
Studies show that RBD is unusually common in elderly men. Experts are unsure of the exact cause of RBD, but studies have shown that it has to do with issues affecting certain neural pathways in the brain. As a result, there’s a strong link between the condition and neurologic conditions such as Parkinson’s and Alzheimer’s disease. Studies have suggested that RBD is a powerful early sign of Parkinson’s and dementia, and provides an opportunity to intervene early with neuroprotective therapy.
If you believe you may have RBD, it’s best to book an appointment with your GP. In many cases, medication is prescribed for RBD. Some people also identify and avoid triggers that make their behaviour worse, for example, alcohol or prescription drugs. Precautions can also be taken to improve the safety of the person’s sleep area. This might include locking windows, removing objects that could cause injury from the bedroom, and placing the mattress on the floor.
What medical conditions can cause sleep problems?
In many cases, underlying medical conditions can cause sleep problems. This study found that people who had trouble sleeping were more likely to have an existing condition and be less physically active. Below are some of the most common examples.
Parkinson’s disease causes parts of the brain to become progressively damaged over time. Symptoms include involuntary shaking, slow movement, and stiff and inflexible muscles.
Unfortunately, both the disease itself and the medications used to treat it can lead to various sleep problems that kickstart a cycle of insomnia and excessive daytime fatigue. This is because people with motor (movement) symptoms often struggle to find comfortable sleeping positions, or may experience nocturnal hallucinations as they try to fall asleep. People with Parkinson’s are also more susceptible to sleep conditions such as REM sleep behaviour disorder, restless legs syndrome, and obstructive sleep apnea.
Parkinson’s is thought to affect 1 in 500 people in the UK. While the majority of people start to develop symptoms over the age of 50, around 1 in 20 experience first symptoms before they’re 40. If you’re worried about Parkinson’s, it’s a good idea to book an appointment with your GP. They’ll be able to assess your symptoms and advise you on treatments. Parkinson’s UK is the main Parkinson’s support and research charity in the UK. They offer a range of information and guidance, and can also point you in the direction of a support group near you.
Stomach pain caused by common gastrointestinal conditions like irritable bowel syndrome (IBS) can cause insomnia. IBS has been linked with lower sleep quality, inadequate light sleep, and significant sleep disturbance. This study found that 39% of 2,269 people with IBS suffered from insomnia at least once a month, with 15% reporting stomach pain waking them up.
Equally, insomnia can also worsen stomach upsets too. This is because it can cause feelings of stress or anxiety, which are known to exacerbate gastrointestinal symptoms. There’s no single diet or medicine that works for everyone with IBS, but treatments include eating a low-FODMAP diet, taking probiotics, and keeping a food diary. You can find more information and guidance on the NHS website.
Chronic pain is defined as pain that lasts for at least 12 weeks. It might be sharp or dull pain, be steady or intermittent, come and go or be constant. Some of the most common types of chronic pain include arthritis pain, postsurgical pain, cancer-related pain, lower back pain, and headaches.
Chronic pain is closely linked with insomnia. While the pain makes it difficult to get comfortable or fall asleep, or stay asleep, a lack of adequate sleep the next day can make symptoms even worse.
If you’re suffering from chronic pain, your GP will be able to advise you on how to get your pain under control. Some methods include prescription medicine, physical therapy, acupuncture, surgery, and cognitive behavioural therapy (CBT). There are also various lifestyle changes that can help alleviate your pain and break the cycle of insomnia. These include creating a healthy sleep environment, eating foods that help promote sleep, practicing yoga daily, taking short walks in the evening, and using breathing techniques.
Alzheimer’s disease and other forms of dementia
Alzheimer’s disease is the most common cause of dementia in the UK. Dementia is the umbrella term for a group of symptoms associated with brain function decline.
People with Alzheimer’s often struggle to sleep, or may experience disruption to their sleep schedule. It’s not yet completely understood why Alzheimer’s causes sleep disturbance, but as with its effect on memory and behaviour, it’s down to the impact that the disease has on the brain.
Sleep changes that can occur with Alzheimer’s include difficulty getting to sleep, needing to nap in the daytime, and other shifts in the sleep-wake cycle. You can read more about these changes on the Alzheimer’s Association website.
Experts recommend implementing lifestyle changes to start – for example maintaining a regular sleep schedule, getting enough light during the day, avoiding alcohol and caffeine, and exercising regularly. If however, further intervention is required, it’s advised that you speak to your GP. They’ll be able to recommend potential medications to help address your sleep changes.
Mental health conditions
Sleep problems are having an impact on my life - what support is available?
If you’re struggling with a sleep condition and feel you’d benefit from some extra support and guidance, there are places that you can reach out to.
Firstly, it’s best to speak to your GP as they’ll be able to talk to through options and offer help based on your individual circumstances. If you’d like to connect with other people experiencing similar difficulties, you could join this discussion on the Rest Less community forum. Members are sharing their experiences with sleep problems and sharing methods that have worked for them. Alternatively, The Brain Charity has a whole list of resources that can help with sleep problems.
It’s normal for our sleeping patterns to change as we age. Various factors, including slowed production of melatonin, can make it harder to fall asleep, stay asleep, and wake up the next day. Sometimes these changes can be down to sleep conditions such as sleep apnea, REM behaviour disorder, and circadian rhythm disorders. In certain cases,these conditions can be linked to underlying medical conditions, namely Parkinson’s, chronic pain, and gastrointestinal conditions.
It’s often much easier to address sleeping problems when we understand the cause, so it’s always worth taking the time to explore any issues further, and to make an appointment with your GP if needed.
The good news is that the majority of sleep conditions can be improved with simple lifestyle changes like establishing a nighttime routine, getting enough exercise, and creating a relaxing bedroom space. In other cases where symptoms are more persistent, other treatments are available too.
What are your experiences of sleep conditions? Have you noticed changes to your sleeping patterns as you’ve aged? We’d love to hear from you. Join the conversation on the Rest Less community forum, or leave a comment below.