Many people notice that sleep changes in their 60s and 70s. Bedtime drifts earlier, waking at 5 a.m. becomes routine, and a full night without getting up becomes rare. Some of that is normal aging. Some of it is a treatable sleep problem that deserves attention.

This article covers what changes, what does not, and when poor sleep is worth bringing to your doctor. For the basics of how much sleep adults need, see are you getting enough sleep.

What changes with age, and what does not

According to the National Institute on Aging, older adults need about the same amount of sleep as all adults: seven to nine hours a night. What changes is the timing. Older people tend to go to sleep earlier and wake earlier than they did when they were younger.

NIA also notes that sleep disorders become more common with age, including insomnia, sleep apnea and movement disorders such as restless legs syndrome. Illness, medicines, pain and mood can all disturb sleep. Feeling tired every day is not simply a part of getting older.

The National Heart, Lung, and Blood Institute links ongoing sleep deficiency to a higher risk of heart disease, high blood pressure, diabetes, kidney disease, obesity, depression and stroke. NHLBI adds that sleep deficiency is linked to a higher chance of injury, and that in older adults it may be linked to a higher chance of falls and broken bones.

Sleep is also one of the easier areas to improve. Unlike many risk factors, it responds to changes in routine within weeks, and the main treatments carry little risk.

Insomnia

NIA calls insomnia the most common sleep problem in adults 60 and older. People with insomnia have trouble falling asleep or staying asleep at least three nights a week, and it becomes chronic when it lasts more than three months.

The first-line treatment is not a pill. The American College of Physicians recommends cognitive behavioral therapy for insomnia, or CBT-I, as the initial treatment for chronic insomnia in adults. CBT-I is a structured program that adjusts sleep timing, habits and the thoughts that keep people awake. It can be done with a trained clinician and, increasingly, through guided programs.

Sleep medicines may help in the short term, but NIA notes that they carry risks and should not be used long term. In older adults, some sleep aids, including some sold over the counter, can cause next-day grogginess, confusion and falls. Our article on medication reviews for older adults explains why every sleep aid belongs on your medicine list.

Sleep apnea

In obstructive sleep apnea, the airway repeatedly narrows or closes during sleep. NHLBI lists common signs including loud snoring, pauses in breathing that a partner notices, gasping or choking at night, morning headaches and daytime sleepiness. Untreated sleep apnea is linked to high blood pressure and other heart problems, according to NHLBI.

Sleep apnea is diagnosed with a sleep study, which may be done at home or in a sleep center. If your bed partner has commented on your snoring or breathing, or your blood pressure is hard to control, mention it at your next visit.

Medicines and other conditions

Many common medicines can affect sleep, from some blood pressure pills and diuretics taken late in the day to decongestants and steroids. Pain from arthritis, heartburn, and the urge to urinate at night can all break up sleep. NIA lists illness, medications, mental health and pain among the factors that make a good night harder for older adults.

This is where a medicine review earns its keep. Sometimes moving a dose earlier in the day, or treating the underlying problem, does more than any sleep aid.

Habits that help

  • Keep a regular schedule, including on weekends.
  • Get morning light and daytime activity. Both help set your body clock.
  • Limit late naps to keep sleep pressure for the night.
  • Watch caffeine and alcohol. NIA suggests avoiding caffeine late in the day and avoiding alcohol, even small amounts. See alcohol after 50.
  • Avoid large meals and lots of fluid in the two to three hours before bed, as NIA suggests.
  • Keep a sleep diary for two weeks before your appointment. It makes the conversation far more useful.

When to talk with your doctor

Bring up sleep if you feel unrefreshed most mornings, fall asleep unintentionally during the day, snore loudly with pauses in breathing, get up to urinate many times a night, or rely on a sleep aid most nights. Some of these point to conditions an internist checks for directly, from heart failure to prostate enlargement to blood sugar problems.

At Legacy Medical, visits are unhurried, so there is time to go through a sleep diary and your medicine list together, and Dr. Shtern can coordinate a sleep study or a referral when one is needed. Many follow-ups work well by video visit. To start, book a complimentary meet and greet.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.