Aging and Sleep: Prevent Disease by Getting More Zzzs

Aug 01, 2023
Fact Checked
Learn about the relationship between age and sleep to understand what’s normal—and what’s not.

As we age, our sleep patterns change, but our ability to sleep shouldn’t. Your brain needs sleep to regulate your body, restore energy, and repair damage. Without a healthy amount of sleep, you’re left vulnerable to health conditions that accelerate aging and make it difficult to safely age in place.

Fast facts

How sleep works in the brain

Did you know your entire sleep pattern is run by a small yet powerful structure in your brain? The suprachiasmatic nucleus (SCN) is a dense bundle of cells located on both halves of your brain. Its primary purpose is to receive light from your eyes to guide behavioral patterns. This includes the circadian rhythm, which influences the timing of our sleep schedule. [5]Brain Basics: Understanding Sleep. National Institute of Neurological Disorders and Stroke. Found on the internet at https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep
When the SCN detects less sunlight, it tells the pineal gland in the brain to release a hormone called melatonin to induce sleep. [6]Zisapel, Nava. New Perspectives on the Role of Melatonin in Human Sleep, Circadian Rhythms, and Their Regulation. British Journal of Pharmacology. August 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057895/

While you rest, your brain works in shifts throughout the night to relax and restore the body, file away memories, remove toxins, and replenish energy. [7]What Happens During Sleep? National Institute of Child Health and Human Development. Found on the internet at https://www.nichd.nih.gov/health/topics/sleep/conditioninfo/what-happens
It cycles between two phases: rapid eye movement (REM) and non-REM sleep.

During non-REM sleep, your brain goes through three stages for approximately 90 minutes total: [7]What Happens During Sleep? National Institute of Child Health and Human Development. Found on the internet at https://www.nichd.nih.gov/health/topics/sleep/conditioninfo/what-happens
[5]Brain Basics: Understanding Sleep. National Institute of Neurological Disorders and Stroke. Found on the internet at https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep

Finally, you enter REM sleep. Your brain becomes active, your eyes move rapidly, and your vitals rise to near-wake levels. REM sleep is an important part of sleep for dreaming, storing memories, learning, regulating mood, and recovering the brain’s function. [7]What Happens During Sleep? National Institute of Child Health and Human Development. Found on the internet at https://www.nichd.nih.gov/health/topics/sleep/conditioninfo/what-happens
 During an eight-hour sleep, your brain cycles in and out of REM sleep four to five times. [8]Eugene, Andy R. and Masiak, Jolanta. The Neuroprotective Aspects of Sleep. MEDtube Science. November 2015. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651462/

How sleep changes as we age

According to research from the Yale School of Medicine, our sleep cycles and circadian rhythms are expected to change as we age.

It’s normal for older adults to experience less total sleep time, which is sometimes caused by more disruptions during sleep. You may also experience less time in stage three non-REM and REM sleep, influencing how the brain recovers, learns, and stores memories. Many older adults find that it takes longer to fall asleep initially, but getting back to sleep is usually not an issue. Research has found that the time it takes to return to sleep after waking is no longer than the time it takes for younger adults to get back to sleep. [9]Klerman, Elizabeth B, et al. Older People Awaken More Frequently But Fall Back Asleep at the Same Rate as Younger People. Sleep. June 2004. Found on the internet at https://academic.oup.com/sleep/article/27/4/793/2696955

As you age, you’ll find that your circadian rhythm shifts forward in time. This phenomenon is called phase advance and causes older adults to feel awake earlier in the morning and drowsy earlier in the evening than younger adults. [3]Miner, Brienne and Kryger, Meir H. Sleep in the Aging Population. Sleep Medicine Clinics. March 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300306/

Do older people need less sleep?

No, older people don’t need less sleep. Seven hours of sleep is adequate for most older adults, but changes in sleep patterns can influence whether they get their recommended seven hours. [3]Miner, Brienne and Kryger, Meir H. Sleep in the Aging Population. Sleep Medicine Clinics. March 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300306/

The impacts of sleep quality on health

What happens if I don't sleep enough graphic

Poor sleep affects physical, mental, and emotional health. Older adults who report sleep complaints (like insomnia ⓘA disorder where you have trouble falling asleep or staying asleep.) also report increased pain levels, impaired physical function, and a higher risk of falls, to name a few. [3]Miner, Brienne and Kryger, Meir H. Sleep in the Aging Population. Sleep Medicine Clinics. March 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300306/ [19]Drake, Christopher, et al. Caffeine Effects on Sleep Taken 0, 3, or 6 Hours before Going to Bed. Journal of Clinical Sleep Medicine. November 2013. Found on the internet at https://jcsm.aasm.org/doi/10.5664/jcsm.3170

Sleep and physiological aging

A 2021 study summarized research findings that link sleep deficiency with accelerated aging and disease onset, including heart issues and cancer.

As we age, our body tissues naturally experience damage. Our immune system has an inflammatory response to remove these damaged cells. This process occurs more as we age, but if we can’t remove the damage efficiently, it accumulates and promotes a chronic state of inflammation. The abnormal accumulation of damaged cells and inflammation as we age is called inflammageing. [1]Carroll, Judith E. and Prather, Aric A. Sleep and Biological Aging: A Short Review. Current Opinion in Endocrine and Metabolic Research. June 2021. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658028/ [11]Ferrucci, Luigi and Fabbri, Elisa. Inflammageing: Chronic Inflammation in Ageing, Cardiovascular Disease, and Frailty. Nature Reviews Cardiology. September 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146930/

Sleep regulates the immune system and its inflammatory response, which is important in removing damaged cells. Those with sleep deficiency have a higher risk of inflammageing. Adults who reported six hours or less of sleep nightly show more accumulation of tissue damage than those who got the recommended seven hours of sleep. [23]Carroll, Judith E., et al. Partial Sleep Deprivation Activates the DNA Damage Response (DDR) and the Senescence-Associated Secretory Phenotype (SASP) in Aged Adult Humans. Brain, Behavior, Immunity. January 2016. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679552/
One study showed genetic damage in older adults after only one night of four-hour sleep, which remained despite the participants getting enough rest the following night. [22]Miaskowski, Christine, et al. A Biopsychosocial Model of Chronic Pain for Older Adults. Pain Medicine. September 2020. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/31846035/

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Disordered breathing during sleep, often seen in those with obstructive sleep apnea, is also known to accelerate cell damage and aging by limiting the oxygen supply needed to restore and repair brain tissues. [10]Li, Xiaoyu, et al. Association Between Sleep Disordered Breathing and Epigenetic Age Acceleration: Evidence from the Multi-Ethnic Study of Atherosclerosis. eBioMedicine. December 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6921369/ If you experience disturbed sleep due to loud snoring, gasping, or long pauses in breathing, book an appointment with your doctor. Ask if a continuous positive airway pressure (CPAP) machine is appropriate to improve oxygen flow during the night and promote better breathing.

Sleep and depression

Sleep and depression have a two-way relationship. A review of relevant studies showed that sleep disturbance is a major symptom of depression. But disturbed sleep, particularly during your mood-balancing REM sleep, can also be the cause of depression. [12]Fang, Hong, et al. Depression in Sleep Disturbance: A Review on a Bidirectional Relationship, Mechanisms and Treatment. Journal of Cellular and Molecular Medicine. February 2019. Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1111/jcmm.14170
Naturally occurring age-related changes to sleep patterns leave older adults vulnerable since they spend less time in REM sleep. [3]Miner, Brienne and Kryger, Meir H. Sleep in the Aging Population. Sleep Medicine Clinics. March 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300306/

Researchers have agreed on the relationship between sleep and depression, but there’s no consensus on how the two are linked or how to best treat both issues. There is some evidence specific to older adults, though. Research has found that older adults with depression and insomnia benefitted from cognitive behavioral therapy for insomnia (CBT-I) ⓘA type of talk therapy centered on making positive changes in both thinking and behavior., with significantly fewer symptoms at the 20-week follow-up visit. [13]Sadler, Paul, et al. Cognitive Behavior Therapy for Older Adults with Insomnia and Depression: A Randomized Controlled Trial in Community Mental Health Services. Sleep Research Society. August 2018. Found on the internet at https://academic.oup.com/sleep/article/41/8/zsy104/5003056?login=false

Sleep and dementia

“Disrupted sleep could increase the risk for neurodegenerative brain diseases,” warned Ann Kriebel-Gasparro, DNP, president-elect of the Gerontological Advanced Practice Nurses Association. Research has connected disturbed sleep and sleep-disordered breathing (like sleep apnea) with a higher risk for different types of dementia, a neurodegenerative condition that permanently impacts memory, thinking, and physical function. [14]Ward, Stephanie A. and Pase, Matthew P. Advances in Pathophysiology and Neuroimaging: Implications for Sleep and Dementia. Respirology. November 2019. Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13728 Unfortunately, there is no cure for dementia, but there are disease management strategies.

Kriebel-Gasparro explained that sleep disturbance can increase beta-amyloid, a protein that accumulates in the brains of people with Alzheimer’s disease and other forms of dementia. Without adequate sleep, your body can’t keep up with beta-amyloid protein removal, triggering disease onset. Neurodegenerative damage can start young. Middle-aged adults who sleep less than six hours per night show changes in the brain that have been linked to declining brain health and medical conditions, like dementia or stroke. [2]Yaffe, Kristine, et al. Sleep Duration and White Matter Quality in Middle-Aged Adults. Sleep. September 2016. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989263/

Like sleep and depression, sleep and dementia also have a two-way relationship. The same research series stated that altered sleep patterns are a hallmark sign of dementia, possibly due to changes in parts of the brain that control the circadian rhythm. This cyclical relationship is difficult to manage, but understanding it is the first step to developing the right treatment. [14]Ward, Stephanie A. and Pase, Matthew P. Advances in Pathophysiology and Neuroimaging: Implications for Sleep and Dementia. Respirology. November 2019. Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13728

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Daytime drowsiness is not normal among older adults

Daytime drowsiness and excessive sleep is not a normal part of aging, but it is common. Excessive sleep is generally defined as 10 or more hours of sleep per day or night. Research showed a 23% prevalence of excessive sleepiness among older adults (average age of 84), and many cases of daytime sleepiness are associated with frequent sleep disturbances during the night. Unfortunately, too much sleep is linked to many of the same health conditions as too little sleep, like heart issues and increased falls risk. [25]Miner, Brienne, et al. The Epidemiology of Patient-Reported Hypersomnia in Persons with Advanced Age. Journal of the American Geriatrics Society. August 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898735/ rnrnThe bottom line? Aim for quality, not quantity of sleep.

Common issues impacting sleep in older adults

In an academic review on sleep disorders, three studies reported a prevalence rate between 21.3% and 34% among adults older than 60. [15]Gulia, Kamalesh K. and Kumar, Velayudhan Mohan. Sleep Disorders in the Elderly: A Growing Challenge. Psychogeriatrics. May 2018. Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1111/psyg.12319 Both old and newer research shows that many factors contribute to disordered sleep, and some are more common as we age: [15]Gulia, Kamalesh K. and Kumar, Velayudhan Mohan. Sleep Disorders in the Elderly: A Growing Challenge. Psychogeriatrics. May 2018. Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1111/psyg.12319 [16]Burns, Angus C., et al. Time Spent in Outdoor Light is Associated With Mood, Sleep, and Circadian Rhythm-Related Outcomes: A Cross-Sectional and Longitudinal Study in Over 400,000 UK Biobank Participants. Journal of Affective Disorders. December 2021. Found on the internet at https://www.sciencedirect.com/science/article/abs/pii/S0165032721008612 [17]Suzuki, Keisuke, et al. Sleep Disorders in the Elderly: Diagnosis and Management. Journal of General and Family Medicine. April 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689397/

Many of these factors are controllable. Kriebel-Gasparro highlighted multiple ways daytime habits can contribute to nocturia, for example. Taking diuretic medications or fluids before bedtime (alcohol, tea, coffee) can have you running to the bathroom throughout the night. Take diuretic medications first thing in the morning, not in the evening, unless otherwise prescribed. And be sure to limit fluid intake, especially diuretic beverages like the ones listed above, in the evening.

“Other medications that can keep us awake include some antidepressants, like Prozac or Celexa, and cold medications, like Sudafed,” Kriebel-Gasparro said. “Of course, checking in with your health care provider, especially a geriatrician or geriatric nurse practitioner, to discuss any problems with sleep and strategies is essential for health.”

Maximizing your sleep quality

If you notice negative changes in your sleep patterns, don’t wait to make changes until it impacts your daily life. Identify what triggers a bad night’s sleep and make small adjustments to your habits to prevent developing a sleep disorder.

Identify what triggers your sleep disturbance

Now that you know some of the common issues that influence sleep patterns, you have a better idea of what to look for. Kriebel-Gasparro recommended keeping a sleep diary to track your daily behavior and habits, including:

If you have a family member or caregiver at home, ask them to help you fill out your diary. They may notice louder snoring or pauses in breath, which is important to document and tell your doctor about.

Many products on the market can help you track your sleep patterns and vitals at night, like watches from Apple, Samsung, and Google, or devices such as a Fitbit or Oura Smart Ring. Some Tempur-Pedic adjustable beds pair with a mobile app to track your sleep, including when you wake up during the night, on a time-stamped dashboard. This level of tracking may not be necessary for everyone, but it can help identify difficult nights and connect them with daytime triggers, especially for those with long-term medical conditions that affect sleep quality, like sleep apnea or chronic pain.

Practice good sleep hygiene

Graphic describing strategies for better sleep

Those who practice good sleep hygiene establish daily and nightly habits that promote quality sleep. In most cases of insomnia, addressing sleep hygiene is the first approach. [17]Suzuki, Keisuke, et al. Sleep Disorders in the Elderly: Diagnosis and Management. Journal of General and Family Medicine. April 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689397/

We asked Kriebel-Gasparro about the advice she gives to her patients to improve their sleep. We also consulted the Journal of General and Family Medicine and the Sleep Hygiene Index (a clinical test that scores your sleep hygiene practices) to develop a comprehensive list of 10 sleep hygiene tips to address common causes of sleep disturbance in older adults: [17]Suzuki, Keisuke, et al. Sleep Disorders in the Elderly: Diagnosis and Management. Journal of General and Family Medicine. April 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689397/ [18]Mastin, David F., et al. Assessment of Sleep Hygiene Using the Sleep Hygiene Index. Journal of Behavioral Medicine. July 2006. Found on the internet at https://www.researchgate.net/publication/7222661_Assessment_of_Sleep_Hygiene_Using_the_Sleep_Hygiene_Index

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Are naps a good idea?

“The hours between 1 p.m. and 3 p.m. might be your ‘afternoon dip’ in energy levels,” Kriebel-Gasparro said. “Taking a nap during this time can refresh us, but it won’t make up for lost nighttime sleep.” But beware of long naps during the day, she added. “If possible, the ‘cat nap’ is ideal for refreshing energy levels; probably no more than 30 minutes,” she said.

When to talk to your doctor

It’s time to talk to your doctor when your sleep habits worsen and you notice increased difficulty falling or staying asleep. It’s especially important to talk to your doctor if you notice daytime behavior changing due to poor sleep, like altered mood, mental fogginess, or feeling physically unsteady.

If you have a sleep diary or any sleep-tracking information, remember to take it with you when you see your doctor. Kriebel-Gasparro also recommended documenting any personal or family history of depression, anxiety, bipolar disorder, previous sleep disorder diagnoses, or history of brain trauma or concussion. “It is best to be honest with your provider, as they will be able to help you better if they know your history. Everything you share will be confidential,” she said.

Download our PDF sleep health packet below to track your sleep.

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Guidance on sleep in assisted living

We asked Lisa Ridge, a licensed practical nurse and director of clinical services at Cambridge Hills Assisted Living in Pittsboro, North Carolina, about the unique challenges older adults face sleeping in assisted living homes.

“Noise is the biggest problem,” said Ridge. “Residents with dementia might make loud noises, or yell in their sleep. Staff make noise, whether conversing among themselves or interacting with other residents.” Assisted living facilities also have scheduled checks throughout the night to ensure residents are safe, but even so, “Falls happen a lot during the night,” said Ridge.

Residents who need regular assistance for self-care may be woken up often. “For residents that are incontinent ⓘThe inability to control the bowel and bladder without leakage., staff checks them and changes them if needed. This will disrupt sleep, but it is necessary to protect the integrity of the [resident’s] skin.” If noise is an issue, Ridge recommended streaming white noise ⓘNoise that resembles static and includes all of the audible sound frequencies in equal amounts; also referred to as broadband noise. through a speaker into the resident’s room to soothe and drown out other sounds.

Ridge mentioned that light is also a problem. “We turn lights down in the building, but there are lights that never shut off. If you are a person who likes to sleep in complete darkness, this will be a change,” she said. If lights are bothersome, a sleep mask may help block light from your eyes while you sleep.

For many, anxiety and change in routine can be a challenge. Ridge mentioned that medications can help, but most have side effects that can increase someone’s fall risk. “Physicians are very hesitant to order them,” she said.

If you or someone you care for lives in an assisted living facility and has trouble sleeping, talk to your doctor or a staff nurse about ways to practice sleep hygiene that is specific to your setting. You may be able to create better sleeping accommodations or participate in scheduled activities during the day that will promote sleep at night, like outdoor excursions or exercise sessions.

Practice safe sleep

According to a recent analysis of more than 10,000 older adults who have fallen, 25% reported the fall occurring in the bedroom. Unfortunately, that’s the most common place to fall in the home. [20]Moreland, Briana L., et al. A Descriptive Analysis of Location of Older Adult Falls That Resulted in Emergency Department Visits in the United States, 2015. American Journal of Lifestyle Medicine. November 2021. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8669898/

If you are planning to age in place, it’s a good idea to examine your home and make changes that will keep you safe, especially in your sleeping quarters. Here’s a list of ideas to consider:

For a full home safety checklist, visit our article Home Safety for Older Adults: A Comprehensive Guide 2023.

If you’re unsure what changes you should make in the home, consult a certified aging-in-place specialist (CAPS), who is qualified to evaluate the home and make safety recommendations. These professionals are often builders or rehabilitation specialists, much like occupational or physical therapists.

Using sleeping medications

“The general consensus is that sleeping medications should be a last resort after trying other strategies. Addressing sleep hygiene is a good first strategy,” Kriebel-Gasparro said. Cognitive behavioral therapy is another common non-pharmaceutical treatment that has shown good results among older adults. [13]Sadler, Paul, et al. Cognitive Behavior Therapy for Older Adults with Insomnia and Depression: A Randomized Controlled Trial in Community Mental Health Services. Sleep Research Society. August 2018. Found on the internet at https://academic.oup.com/sleep/article/41/8/zsy104/5003056?login=false

Melatonin is a naturally occurring hormone in the body that promotes sleep and can be taken as a supplement, but Kriebel-Gasparro recommended talking to your doctor about whether it’s safe for you to take it. “Melatonin levels go down with aging and small doses (between half a milligram to three milligrams) are best unless recommended otherwise by your doctor,” she said. “Many older adults use melatonin with good effects.” [26]Sewerynek, Ewa. Melatonin and the Cardiovascular System. Neuroendocrinology Letters. April 2022. Found on the internet at https://www.nel.edu/userfiles/articlesnew/NEL230702R10.pdf

Melatonin supplements are generally safe, but there are some health conditions that can be negatively impacted by melatonin supplements. Your doctor can advise you.

In certain populations, there are indications for sleep medications, like those diagnosed with Parkinson’s or Alzheimer’s disease, according to Kriebel-Gasparro. “This should be under the care of a physician, psychiatrist, or psychiatric nurse practitioner who can diagnose and safely prescribe medications for sleep,” she said.

If you suspect that your medication regimen is contributing to poor sleep, talk to your doctor, said Ridge. “There are certain medications that can be rearranged because they can cause a problem with your sleep patterns.”

Start sleeping better and safer

Not sure where to start? Print our Sleep Packet and start keeping your sleep diary, documenting each day honestly and completely. “If you have concerns about your sleep, be sure to speak to your provider for recommendations on lifestyle changes, medications, or supplements that can help you get quality sleep and improve your brain health,” said Kriebel-Gasparro.

Have questions about this review? Email us at reviewsteam@ncoa.org.

Sources

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  2. Yaffe, Kristine, et al. Sleep Duration and White Matter Quality in Middle-Aged Adults. Sleep. September 2016. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989263.
  3. Miner, Brienne and Kryger, Meir H. Sleep in the Aging Population. Sleep Medicine Clinics. March 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300306.
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  7. What Happens During Sleep? National Institute of Child Health and Human Development. Found on the internet at https://www.nichd.nih.gov/health/topics/sleep/conditioninfo/what-happens.
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  10. Li, Xiaoyu, et al. Association Between Sleep Disordered Breathing and Epigenetic Age Acceleration: Evidence from the Multi-Ethnic Study of Atherosclerosis. eBioMedicine. December 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6921369.
  11. Ferrucci, Luigi and Fabbri, Elisa. Inflammageing: Chronic Inflammation in Ageing, Cardiovascular Disease, and Frailty. Nature Reviews Cardiology. September 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146930.
  12. Fang, Hong, et al. Depression in Sleep Disturbance: A Review on a Bidirectional Relationship, Mechanisms and Treatment. Journal of Cellular and Molecular Medicine. February 2019. Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1111/jcmm.14170.
  13. Sadler, Paul, et al. Cognitive Behavior Therapy for Older Adults with Insomnia and Depression: A Randomized Controlled Trial in Community Mental Health Services. Sleep Research Society. August 2018. Found on the internet at https://academic.oup.com/sleep/article/41/8/zsy104/5003056?login=false.
  14. Ward, Stephanie A. and Pase, Matthew P. Advances in Pathophysiology and Neuroimaging: Implications for Sleep and Dementia. Respirology. November 2019. Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13728.
  15. Gulia, Kamalesh K. and Kumar, Velayudhan Mohan. Sleep Disorders in the Elderly: A Growing Challenge. Psychogeriatrics. May 2018. Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1111/psyg.12319.
  16. Burns, Angus C., et al. Time Spent in Outdoor Light is Associated With Mood, Sleep, and Circadian Rhythm-Related Outcomes: A Cross-Sectional and Longitudinal Study in Over 400,000 UK Biobank Participants. Journal of Affective Disorders. December 2021. Found on the internet at https://www.sciencedirect.com/science/article/abs/pii/S0165032721008612.
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  18. Mastin, David F., et al. Assessment of Sleep Hygiene Using the Sleep Hygiene Index. Journal of Behavioral Medicine. July 2006. Found on the internet at https://www.researchgate.net/publication/7222661_Assessment_of_Sleep_Hygiene_Using_the_Sleep_Hygiene_Index.
  19. Drake, Christopher, et al. Caffeine Effects on Sleep Taken 0, 3, or 6 Hours before Going to Bed. Journal of Clinical Sleep Medicine. November 2013. Found on the internet at https://jcsm.aasm.org/doi/10.5664/jcsm.3170.
  20. Moreland, Briana L., et al. A Descriptive Analysis of Location of Older Adult Falls That Resulted in Emergency Department Visits in the United States, 2015. American Journal of Lifestyle Medicine. November 2021. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8669898.
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  23. Carroll, Judith E., et al. Partial Sleep Deprivation Activates the DNA Damage Response (DDR) and the Senescence-Associated Secretory Phenotype (SASP) in Aged Adult Humans. Brain, Behavior, Immunity. January 2016. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679552.
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  25. Miner, Brienne, et al. The Epidemiology of Patient-Reported Hypersomnia in Persons with Advanced Age. Journal of the American Geriatrics Society. August 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898735.
  26. Sewerynek, Ewa. Melatonin and the Cardiovascular System. Neuroendocrinology Letters. April 2022. Found on the internet at https://www.nel.edu/userfiles/articlesnew/NEL230702R10.pdf.
Nicole Hernandez is a writer and physical therapist who empowers people to make informed decisions about their health as a writer and clinician. She has written for NCOA, AginginPlace.org, and physical therapy clinics to educate readers on fall and injury prevention, rehabilitation, home modifications, and other clinical themes including hearing aids and medical alert systems.
Dr Chester Wu
Chester Wu Medical Reviewer
Dr. Chester Wu is board certified in Psychiatry and Sleep Medicine, training at Baylor College of Medicine and Stanford University School of Medicine, respectively. He has since established his own private practice in Houston, TX where he provides psychiatric and sleep medicine services.
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