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Why is it so hard to sleep? (sleep and the aging process)

Sleep patterns change as people age. Over the years, I have had multiple patients concerned about sleep problems. This blog post will explore the relationship between aging and sleep issues, including causes, symptoms, and treatments.

As we age, sleep patterns naturally change. Older adults tend to have more difficulty falling asleep and staying asleep throughout the night, resulting in less time spent in deep sleep. Sleep changes can lead to feeling more tired during the day and an increased risk of developing sleep disorders like insomnia and sleep apnea.

Older adults tend to spend less time in rapid eye movement (REM) sleep, the sleep stage associated with dreaming, leading to a less restful night's sleep.

Common Causes of Sleep Problems Factors that can contribute to sleep issues in older adults include:

Changes in Circadian Rhythms

Circadian rhythms are the natural, internal processes that regulate our sleep-wake cycles. As we age, our circadian rhythms shift, making it harder to fall asleep and wake up at the desired times. Older adults tend to produce less of the hormone melatonin, which helps regulate circadian Rhythms.

Medical Problems

Certain medical conditions more common in older adults can also contribute to sleep issues. For example, arthritis, chronic pain, heart disease, lung disease, and urinary problems can make it harder to fall asleep and stay asleep throughout the night.


Many medications commonly prescribed to older adults can have side effects that impact sleep. For example, some antidepressants can cause insomnia, while diuretics can lead to frequent urination during the night.

Lifestyle Factors

Lifestyle factors such as caffeine intake, alcohol consumption, and tobacco use can all contribute to sleep problems in older adults. Also, poor sleep habits like staying up late or using electronics before bed can make it harder to fall asleep.

Common Symptoms of Sleep Issues in Older Adults include:

  1. Difficulty falling asleep

  2. Waking up frequently during the night

  3. Feeling tired during the day

  4. Irritability or mood changes

  5. Trouble concentrating

  6. Memory problems

  7. Waking up too early in the morning

  8. Nighttime leg cramps

  9. Sleep apnea

  10. Insomnia

Treatment Options to Manage Sleep Problems in Aging

Several treatments can help manage sleep problems in older adults. These include:

Sleep Hygiene

Sleep hygiene habits such as avoiding caffeine and alcohol before bed, establishing a regular sleep schedule, and creating a comfortable sleep environment can improve the quality and quantity of sleep.


Some Medications can help manage sleep problems in older adults. For example, sleep aids like melatonin, other over-the-counter sleep aids, or benzodiazepines can help promote sleep. However, since there are risks with sleep aids, it is always important to discuss them with your doctor before taking any over-the-counter sleep aid. For example, over-the-counter sleep aids can cause memory issues, confusion, increased risk of falls, vision problems, dry mouth, etc.

A word about melatonin, our body produces melatonin naturally. As we age, our body produces less melatonin, making it more difficult to fall asleep. This supplement can be purchased over the counter. For my patients who have difficulty falling asleep, I recommend they take 1-3mg about 4 hours before sleep to mimic the body's natural pattern of melatonin secretion. Some melatonin supplements can take 30 minutes to 2 hours before they take effect. Usually, melatonin is secreted soon after the onset of darkness, then peaks around 2 and 4 am, gradually falling during the second half of the night. There is even a prescription formulation that is much more potent. Talking with your doctor before starting this supplement is important to ensure you take it safely.

Behavioral Therapy

Behavioral therapy, such as cognitive-behavioral therapy for insomnia (CBT-I), can be very effective. This therapy focuses on changing negative thought patterns and behaviors that can contribute to insomnia and other sleep issues.

Medical Treatment

If an underlying medical problem contributes to sleep issues, treating that condition may help improve sleep. For example, treating arthritis and chronic pain with medication or physical therapy may enhance sleep quality and reduce sleep disruptions. Proper management of bladder issues, heart disease, and lung disease can also improve sleep.

Sleep apnea treatment

I cannot stress enough how important it is to treat sleep apnea. Treatment of sleep apnea can help improve the quality of sleep. It may also help prevent dementia and improve heart and lung disease. Older adults are at risk of developing sleep apnea; it is important to talk to your doctor about your risk of having or developing it and seek proper treatment.

Lifestyle Changes

Regular exercise, a healthy diet, and quitting smoking can improve sleep. Data suggests that exercise improves sleep quality and duration. At the same time, a healthy diet can help regulate hormones and promote healthy sleep.


Sleep issues are common in older adults and can lead to various health issues, including increased risk of falls, cognitive decline, and overall decreased quality of life. Understanding the causes and symptoms causing sleep problems can help you get a more restful night's sleep. Older adults can improve their sleep quality and health by seeking appropriate medical treatments and lifestyle changes. Learn more on aging-related topics at


  1. National Institute on Aging. (2021). Aging and Sleep. Retrieved from

  2. American Academy of Sleep Medicine. (2014). Sleep in Older Adults. Retrieved from

  3. National Sleep Foundation. (2021). Aging and Sleep. Retrieved from

  4. National Institute of Neurological Disorders and Stroke. (2020). Brain Basics: Understanding Sleep. Retrieved from

  5. American Geriatrics Society. (2015). Sleep Disorders in Older Adults Fact Sheet. Retrieved from

  6. Morin, C. M., & Benca, R. (2012). Chronic insomnia. The Lancet, 379(9821), 1129-1141.

  7. National Sleep Foundation. (2021). Sleep Hygiene. Retrieved from

  8. Buysse, D. J. (2014). Insomnia. JAMA, 312(7), 697-706.

  9. National Heart, Lung, and Blood Institute. (2021). Sleep Apnea. Retrieved from

  10. National Institute on Aging. (2021). Healthy Sleep Habits. Retrieved from


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