What changes occur in sleep architecture as you age and how can they be managed?

From the Guidelines

Sleep architecture changes significantly with age, and managing these changes is crucial to prevent negative impacts on morbidity, mortality, and quality of life. As people age, they experience decreased total sleep time, reduced deep sleep (slow-wave sleep), increased sleep fragmentation, and more frequent nighttime awakenings 1. These changes can be managed through:

• Consistent sleep schedules
• Regular exercise (preferably 3-5 hours before bedtime)
• Limiting caffeine and alcohol
• Creating a comfortable sleep environment
• Practicing relaxation techniques like meditation For those experiencing persistent sleep issues, cognitive behavioral therapy for insomnia (CBT-I) is highly effective and should be considered before medication 1. If medication is necessary, short-term options include melatonin (0.5-5mg taken 1-2 hours before bedtime), or prescription medications like trazodone (25-100mg) or low-dose doxepin (3-6mg) 1. These age-related changes occur due to neurological alterations in the brain's sleep-regulating centers and hormonal shifts, particularly decreased melatonin production 1. Managing sleep hygiene is especially important for older adults as poor sleep quality can impact cognitive function, mood, and physical health 1. Most people can achieve significant improvements through behavioral modifications alone, though persistent problems should be discussed with a healthcare provider to rule out sleep disorders like sleep apnea 1.

From the Research

Changes in Sleep Architecture with Age

• Sleep patterns change with aging, including advanced sleep timing, shortened nocturnal sleep duration, increased frequency of daytime naps, and increased number of nocturnal awakenings 2
• The amount and pattern of sleep-related hormone secretion also change with age 2
• Slow wave sleep, which is essential for restorative sleep, decreases with age, particularly in elderly men 3
• REM sleep also diminishes with increasing age, with most REM sleep occurring at the beginning of the night in elderly individuals 3

Effects of Aging on Sleep Stages

• Core sleep, which is the essential part of sleep, remains relatively intact with aging, while optional sleep is more altered 3
• The ultradian NREM-REM cycle rhythm shows a monophasic trend with aging, suggesting a diminished adaptive function of aged sleep 3
• Deep sleep, which is important for cognitive function, is decreased with age, particularly during the inactive period 4
• Increased deep sleep during the active period is correlated with impaired cognitive function in aged individuals 4

Age and Gender Dependency of Sleep

• Sleep architecture is dependent on both age and gender, with significant changes occurring in women and men 5
• The physiological network of sleep changes with age, with a significant overall weakening of the network with age, particularly in non-REM sleep stages 5
• Gender differences are also observed in the network dynamics, with higher link strengths found in women for some links in different frequency bands 5

Functional Consequences of Age-Related Sleep Disruption

• Age-related sleep disruption has functional consequences, including memory impairment 6
• The underlying neural mechanisms of age-related sleep disruption are complex and multifactorial, involving changes in sleep quantity and quality, as well as alterations in sleep-related hormone secretion 2, 6