Why Sleep Gets Harder After 60 and What Actually Helps

You used to fall asleep in minutes. Now you lie awake at 2 a.m. staring at the ceiling. You are not alone. Nearly half of adults over 60 report trouble sleeping, according to the National Institute on Aging.

The good news: most sleep problems after 60 are not permanent. They have specific causes, and most of those causes have fixes. Here is what is happening and what you can do about it.

Your Brain’s Sleep System Changes With Age

Sleep is controlled by two systems in your brain. The first is your circadian rhythm, your internal clock. The second is sleep pressure, the tiredness that builds the longer you stay awake.

Both systems shift as you age:

Your internal clock moves earlier. This is why many older adults feel sleepy at 8 p.m. and wide awake at 4 a.m. The brain produces melatonin (the sleep hormone) earlier in the evening.
Deep sleep decreases. Adults over 60 spend about 10 to 15 percent of their night in deep sleep, compared to 20 to 25 percent for younger adults. Less deep sleep means lighter sleep and more awakenings.
Sleep becomes more fragmented. Older adults wake up three to four times per night on average. Brief awakenings are normal at any age, but they become longer and harder to recover from after 60.

These changes are biological, not a disease. But other factors often make them worse.

Common Causes That Doctors Miss

Many sleep problems in older adults have fixable causes that get overlooked:

Medications. More than 40 percent of adults over 65 take five or more prescription drugs. Many of these disrupt sleep:

Beta-blockers (for blood pressure) suppress melatonin production.
SSRIs (for depression) can cause insomnia or vivid dreams.
Diuretics (for blood pressure or heart failure) cause nighttime bathroom trips.
Corticosteroids (for inflammation) are stimulating and disrupt sleep cycles.

Ask your pharmacist to review all your medications for sleep side effects. Sometimes a dose change or different timing (morning instead of evening) makes a big difference.

Sleep apnea. About 25 percent of adults over 65 have obstructive sleep apnea, where the airway collapses during sleep. Many cases go undiagnosed because people think snoring is just part of aging. Signs include loud snoring, gasping or choking during sleep, morning headaches, and daytime exhaustion. A home sleep test can diagnose it.

Pain. Chronic pain from arthritis, back problems, or neuropathy is the number one sleep disruptor in older adults. Treating the pain often fixes the sleep. Talk to your doctor about timing pain medication so it peaks during sleeping hours.

Restless legs syndrome. That crawling, tingling feeling in your legs at bedtime affects about 10 percent of older adults. It is linked to low iron levels in some cases. A simple blood test can check your ferritin level.

What Actually Helps: Proven Strategies

Cognitive Behavioral Therapy for Insomnia (CBT-I)

This is the gold standard treatment for chronic insomnia. The American College of Physicians recommends CBT-I as the first treatment, before any medication.

CBT-I is a structured program, usually four to eight sessions, that retrains your sleep habits. It includes:

Sleep restriction: Spending less time in bed so the time you do spend there is actual sleep.
Stimulus control: Using the bed only for sleep and intimacy. No reading, no TV, no scrolling.
Relaxation techniques: Progressive muscle relaxation, deep breathing, or guided imagery.
Cognitive restructuring: Changing anxious thoughts about sleep (“I will never fall asleep”) into realistic ones.

Studies show CBT-I works for 70 to 80 percent of people, and the results last long after treatment ends. Many therapists offer it over video calls. Medicare covers it when provided by a licensed therapist.

Fix Your Sleep Environment

Small changes to your bedroom can make a measurable difference:

Temperature: Keep the room between 65 and 68 degrees Fahrenheit. Your body needs to cool down to fall asleep. A room that is too warm is the most common environmental sleep disruptor.
Light: Total darkness matters more as you age because your eyes become more sensitive to light. Use blackout curtains or a sleep mask. Cover LED lights on electronics with tape.
Noise: A white noise machine or fan can mask sounds that wake you. Earplugs work too, but make sure you can still hear a smoke alarm.
Mattress: If yours is more than eight years old, it may be causing pain. You do not need to spend thousands. Consumer Reports rates several mattresses under $1,000 that score well for support and comfort.

Set a Consistent Schedule

Your circadian rhythm responds to routine. Go to bed and wake up at the same time every day, including weekends. This is the single most effective habit for better sleep.

If you tend to fall asleep early (say, 8 p.m.) and wake too early (4 a.m.), try bright light therapy in the evening. Sitting near a 10,000-lux light box for 30 minutes around 6 to 7 p.m. can shift your clock later. Ask your doctor before starting this if you have eye conditions.

Be Strategic About Naps

Naps are not the enemy, but timing matters. Keep naps:

Before 2 p.m.
Under 30 minutes
In a chair, not in bed (to keep your brain’s association between bed and nighttime sleep)

A 20-minute nap between noon and 2 p.m. can boost afternoon alertness without hurting nighttime sleep.

Watch What You Eat and Drink

Caffeine stays in your system for eight to ten hours. That afternoon coffee at 2 p.m. is still half-strength at 10 p.m. Cut off caffeine by noon.
Alcohol may help you fall asleep but wrecks sleep quality. It suppresses REM sleep and causes early morning awakenings. Limit alcohol to one drink, at least three hours before bed.
Large meals before bed cause acid reflux and discomfort. Eat dinner at least three hours before bedtime. A small snack is fine.
Fluids: Stop drinking large amounts two hours before bed to reduce bathroom trips.

What About Sleep Medications?

Prescription sleep drugs (like zolpidem, eszopiclone, and benzodiazepines) carry real risks for older adults:

Falls. The risk of a nighttime fall doubles with sleep medication use.
Cognitive effects. Long-term use is linked to memory problems and may increase dementia risk (research is ongoing).
Dependence. Your body builds tolerance, requiring higher doses for the same effect.

The American Geriatrics Society lists most sleep medications on its “Beers Criteria” list of drugs that older adults should avoid or use with caution.

Melatonin is a safer option for short-term use. Most people take too much. Research shows 0.5 to 1 mg is effective, yet stores sell 5 to 10 mg tablets. Start with the lowest dose, taken 30 to 60 minutes before your target bedtime.

When to See a Sleep Specialist

Talk to your doctor or ask for a sleep specialist referral if:

You snore loudly and feel tired during the day despite spending enough time in bed.
You have trouble sleeping three or more nights per week for more than three months.
You fall asleep during activities like driving, eating, or talking.
You have restless or jerky leg movements at night.
Sleep problems are affecting your mood, memory, or ability to function.

A sleep study (which can often be done at home) can identify specific disorders that need targeted treatment.

The Bottom Line

Sleep changes after 60 are real, but poor sleep is not something you just have to accept. Start with good sleep habits and a consistent schedule. If that is not enough, ask your doctor about CBT-I. It works better than pills and has no side effects. Save medication as a last resort, and if you use it, use the lowest dose for the shortest time.

Good sleep is not a luxury. It protects your heart, your memory, and your mood. It is worth the effort to get it right.

Reported by Dr. James Patterson with additional research from the SeniorDaily editorial team. For corrections or updates, please contact us.

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