From business-standard.com
From early awakenings to lighter sleep, ageing changes how we rest. A neurologist explains when disturbed sleep is normal, when it points to disease, and what to do to rest better
Lighter sleep, more night-time waking, or early-morning awakenings, many people notice their sleep deteriorating with age. While some of this is part of ageing, experts warn that persistent poor sleep can point to medical issues and is often more treatable than people realise.
“As a neurologist, I often see older adults struggling with sleep issues and assuming it’s just age,” says Dr Kapil Kumar Singhal, Director of Neurology at Medanta Hospital, Noida. “Ageing does affect the brain’s sleep centres and body clock, but not all poor sleep is normal, and ignoring red flags can mean missing treatable conditions.”
What biological changes occur in the ageing brain that affect sleep quality?
According to Dr Singhal, ageing does not shrink your need for sleep, it shrinks your brain’s ability to produce good sleep.
“The body’s internal clock, or circadian rhythm, is controlled by a brain structure called the suprachiasmatic nucleus,” explains Dr Singhal. “With age, this clock weakens and tends to run faster, pushing sleep earlier in the evening and wake-up times earlier in the morning.”
Add to that shrinking brain cells, reduced melatonin production, and changes in sleep-regulating centres, and the result is lighter, more fragmented sleep and less time spent in deep, restorative stages.
“The requirement remains the same, about seven to nine hours, but the brain struggles to deliver it without interruptions,” Dr Singhal says.
Why does losing deep sleep matter for memory, immunity and long-term health?
Dr Singhal explains that deep sleep, also called slow-wave sleep, is where the real repair work happens in the brain.
“This stage clears toxic waste from the brain, consolidates memories, regulates hormones and supports immunity,” says Dr Singhal.
As slow-wave sleep declines with age, memory suffers first. Connections in the hippocampus, which is the brain’s memory hub, weaken, increasing forgetfulness and long-term dementia risk.
Metabolic health takes a hit too. Less deep sleep raises blood sugar levels and insulin resistance, increasing the risk of type 2 diabetes. Chronic inflammation rises, pushing up the likelihood of heart disease, stroke and Alzheimer’s.
“This is not a benign change,” Dr Singhal warns. “Studies show that every one per cent yearly drop in deep sleep can raise dementia risk by nearly 27 per cent. Early intervention matters.”
How much night-time waking is normal among older adults?
Some broken sleep after midlife is expected. But there are limits.
“After 50, one to three brief awakenings a night, say under five minutes, is considered physiological,” says Dr Singhal. “That adds up to roughly 20–30 minutes of wake time after sleep onset.”
Trouble starts when awakenings become frequent, prolonged or exhausting. “If someone is awake for more than 30 minutes most nights, has four or more awakenings, and this causes daytime fatigue or poor concentration for over three months, it meets criteria for insomnia,” he explains.
Dr Singhal warns about certain patterns and recommends immediate medical attention.
“Sudden insomnia with daytime sleepiness raises suspicion of sleep apnoea,” says Dr Singhal. “Acting out dreams can be an early sign of Parkinson’s. Confusion during night awakenings may signal cognitive decline.”
Other red flags include leg discomfort at night (restless legs syndrome), persistent early-morning waking with anxiety (depression), and sleep tied closely to pain or breathlessness.
“Nearly half of so-called ‘age-related insomnia’ is actually driven by arthritis, medications like diuretics, or chronic diseases such as heart failure,” he notes. “Blaming age alone leads to missed diagnoses.”
Is age-related insomnia really about ageing or about poor health?
“Chronic inflammation and metabolic disorders disrupt the brain’s sleep signals,” Dr Singhal explains. “Conditions like diabetes, obesity and heart disease fragment sleep and worsen deep sleep loss.”
The relationship is bidirectional. Poor sleep fuels inflammation and raises diabetes risk by 30–50 per cent, and those conditions, in turn, further damage sleep.
“Insomnia is frequently a symptom of underlying ill-health rather than ageing itself,” he says.
Why are women more vulnerable, and does hormone therapy help?
Women face a steeper sleep challenge. “Women are about 1.5 to two times more vulnerable to insomnia after menopause,” says Dr Singhal. Falling oestrogen and progesterone levels trigger hot flashes, night sweats and repeated awakenings, cutting into deep sleep.
Hormone replacement therapy (HRT) can help, but selectively. “In women with significant vasomotor symptoms, HRT can reduce night awakenings by nearly 50 per cent,” he says. “But it’s not a universal solution and should be used short-term in carefully selected patients.”
Men aren’t spared either. Declining testosterone during andropause worsens sleep apnoea and night-time awakenings.
What lifestyle changes can improve sleep among older adults?
“Regular exercise, consistent sleep schedules and cognitive behavioural therapy for insomnia can reduce awakenings by 50–70 per cent,” says Dr Singhal.
Morning sunlight is especially potent. “Thirty minutes of morning light helps reset the ageing body clock,” he explains.
Other non-negotiables include early, light dinners; limiting caffeine; and avoiding alcohol, which disrupts sleep more severely with age than in youth.
“These changes fix the circadian and metabolic roots of poor sleep,” he adds.
Can sleep aids like melatonin help in old age?
“Melatonin can help older adults who have low natural levels,” says Dr Singhal. “The effective dose is usually 0.5 to 3 mg, taken one to two hours before bedtime.”
However, Dr Singhal warns that long-term or unsupervised use can suppress the body’s own production. He further says that popular herbs like valerian and ashwagandha carry no strong proof for treating sleep disorders. “They are safer than sleeping pills, but lifestyle changes work better.”
Why are sleeping pills risky?
According to Dr Singhal, sedatives are particularly dangerous in older adults. “They slow brain signals, increasing dizziness and doubling fall risk,” Dr Singhal explains. “They impair memory and raise dementia risk by 50–80 per cent. Dependence is common because older bodies clear drugs more slowly.”
Short-term use, say one to two weeks, may be justified during acute crises like bereavement.
Dr Singhal stresses that good functional sleep means feeling rested and alert during the day, even if one wakes up at night. “Ageing changes sleep,” Dr Singhal says, “but suffering through bad sleep is not a requirement of growing older.”
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