What genuinely changes with age
- Less slow-wave sleep. Deep sleep declines substantially from middle age onward, which makes sleep lighter and more easily disrupted.
- More fragmentation. Awakenings increase, and returning to sleep takes longer.
- Earlier timing. The circadian rhythm tends to advance, producing evening sleepiness and early-morning waking.
- Lower sleep efficiency — more time in bed for the same amount of sleep.
Total sleep need does not fall dramatically, despite the common belief. What falls is the ability to get it in one consolidated block.
Common causes of poor sleep in older adults
- Medical conditions — arthritis, heart failure, reflux, and prostate symptoms.
- Medications — beta blockers, diuretics taken late, some antidepressants, corticosteroids, and decongestants are frequent culprits. Review timing with a pharmacist or doctor; this is often the single highest-yield check.
- Sleep apnoea — prevalence rises with age and is widely under-diagnosed in older adults.
- Restless legs syndrome — also more common, and often missed.
- Less daylight and less activity, which weakens the circadian signal and reduces sleep pressure.
- Napping, which is often the response to poor sleep and the cause of worse sleep.
What works
Behavioural treatment works as well in older adults as in younger ones, and arguably better relative to the alternative, since medication carries more risk — falls, confusion, and interactions.
- CBT-I is effective in older adults and is the recommended first-line option.
- Daylight and activity. Morning outdoor light plus regular daytime movement is one of the most underused interventions available.
- Review medication timing. Ask specifically whether anything can move earlier in the day.
- Nap discipline. If you must nap, keep it under 30 minutes and before 2pm.
- Compress time in bed — see sleep restriction, adjusted cautiously and preferably with guidance.
The physical component
Older adults often carry significant background muscular effort — from pain, from reduced activity, from years of compensating for an injury. This is a genuine contributor to night-time wakefulness, and it is where Feldenkrais work is particularly well suited: it requires no strength, no floor work if that is difficult, and no range of motion you do not have. Many lessons adapt to a chair or a bed. See Feldenkrais for older adults.
When to seek assessment
- Loud snoring, gasping, or observed pauses in breathing.
- Leg discomfort relieved by movement.
- Insomnia beginning alongside low mood or loss of interest.
- Falls, confusion, or daytime sleepiness that interferes with function.