Seven Key Insights from the Integrative Practitioner Digital Summit on Aging and Longevity

3. Sleep Changes with Age

Older adults don’t have a reduced sleep need, rather they have an impaired ability to generate the sleep they do need, according to Catherine Darley, ND, a naturopathic sleep doctor in Seattle, W.A., who presented a session, “Sleep – Essential Anti-Aging Medicine”.

“As you're talking with your older patients and they’re describing getting less sleep, you may want to, as part of your therapeutic goals, work on getting them the sleep that they previously got,” said Darley.

Sleep fragmentation with age can be seen at both a micro and macro level, Darley said. Macro changes include advanced sleep timing, decreased sleep duration, and longer time taken to fall asleep.

As people age, the prevalence of brief sleep awakenings increases due to conditions like sleep apnea or restless leg syndrome, said Darley. In addition, older patients are more likely to be woken up by external stimuli like neighborhood noises or their sleep environment being too warm or too cold. This, Darley said, is because slow wave sleep, also known as deep sleep, reduces with age.

 “Less slow wave sleep, shorter and fewer sleep cycles, and increased time awake at night all result in a sensation of less restorative sleep for elders,” said Darley.

At a micro level, there are several changes concerning electroencephalogram (EEG), or electrical activity in the brain which can help better understand the elderly's sleep experience, Darley explained. In elders, EEG patterns have shown that, relative to young people, slow wave sleep is reduced by 75 to 80 percent in the prefrontal cortex and in the first non-rapid eye movement (NREM) cycle.

“We think that part of the change in the slow wave EEG patterns is that aging diminishes the synchronized neuronal en masse firing that gives rise to sleep oscillations,” said Darley.

Other EEG changes include a decrease towards the end of the night in sleep spindles, which are a characteristic of stage 2 sleep and associated with learning and memory. Also, sleep drive, which builds throughout the day and motivates sleep, was shown to decrease in older people.

To screen patients for sleep regulatory changes, Darley noted several risk factors to discuss with patients, among them, presence of sleep disorders, medication use, obesity, nocturnal urinary frequency, and chronic pain.