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  • Updated 08.01.2023
  • Released 04.07.2020
  • Expires For CME 08.01.2026

Sleep and aging



This article aims to focus on aspects the authors consider relevant for clinical practice and future research directions and not to give a complete review of all aspects of sleep and aging. As the world population ages, the aging population is rapidly changing. The “feminization of aging” implies a more in-depth attention to sex and gender differences. Additionally, there are important differences among younger-old and older-old persons, with sex specificities. New lifestyles, work, and familial and social habits can greatly alter circadian rhythms, even in elderly persons.

In the last 2 decades, sleep deficiency and hypersomnolence have become important concerns of everyday life. These problems have a “human impact” (44), a relatively new concept that is a synthesis between health and social impact. This concept can apply to environmental and climate problems and can be used to develop programs and human health and welfare decisions.

Moreover, new environmental problems interfere with sleep and aging, such as reduced daytime exposure to sunlight and more light pollution in our towns at night. These phenomena are attracting growing interest from sleep and public health researchers worldwide.

In aging, “subjective” and “objective” sleep characteristics show several differences between men and women. Such aspects need to be deeply investigated for tailoring diagnostic and therapeutic interventions according to sex and gender. Studies have focused on the relationship between sleep and the preclinical phases of neurodegenerative diseases and dementia. Sleep disturbances may be present at the earliest stages of neurodegeneration or neuroinflammation: growing epidemiological data have demonstrated that sleep disturbances can be considered a risk factor for dementia. Greater attention to sleep since midlife and among older adults can offer new opportunities for multidomain interventions to prevent neurodegenerative disorders and other chronic conditions.

Key points

• The aging population is rapidly changing: there are new difficulties in defining old persons as a homogeneous group and in assessing related sleep and sleep-wake rhythm characteristics and disorders.

• Sleep and circadian sleep-wake rhythms change in older adults.

• A new research agenda on excessive daytime sleepiness, sleep deficiency, environmental problems, work and family demands interfering with sleep habits, and the global impact on older adults is discussed.

• The relevance of the timing of risk factors for growing epidemiological data on sleep, aging, and cognitive decline is reviewed.

• Sex differences in some aspects of sleep among older adults are discussed; unmet needs regarding gender differences are proposed as a future, relevant direction of sleep research.

Historical note and terminology

Since the late 1990s, many researchers have demonstrated that sleep characteristics, sleep, and sleep-wake rhythm disturbances are important in the aging process. They cannot be considered a mere and inevitable consequence of aging, as persons aged 65 years and over are a heterogeneous group. Increasing sleep debt in middle and advanced age and excessive daytime sleepiness are under new investigation and should be emphasized and deeply elucidated for specific interventions.

In aging, insomnia or drowsiness, collectively referred to as sleep complaints, are frequent and associated with relevant concurrent morbidities. Primary sleep disturbances are highly prevalent in older adults (84; 118). In the elderly, sleep disturbances can share unconventional presentations among older adults with possible delays in their assessment and management. Sleep disturbances are frequent in several forms of dementia and in mild cognitive impairment, with percentages exceeding 40%, and two or more disturbances are often present in the same patient (49). Dementia research has shown that brain pathological alterations can precede the clinical onset of cognitive decline by several decades. In 2011, the diagnostic criteria for Alzheimer disease introduced a preclinical phase of the disease defined by specific biomarkers (76). Growing evidence demonstrates that sleep disturbances can be considered an independent risk factor for neurodegeneration in a bidirectional or circular relationship (59; 52).

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