Sleep in later life: a practical guide to better rest at every age

Poor sleep is one of those things that older adults are often told to simply accept. You wake earlier. You wake in the night. You feel less rested. That's just how it is after a certain age.

But the evidence tells a more hopeful story. Yes, sleep does change as we age. But the idea that older adults need less sleep, or that long-term insomnia is an unavoidable part of later life, is not supported by the research. We still need 7 to 9 hours throughout adulthood. And when older adults struggle to get them, the causes can almost always be found, and usually put right.

How sleep changes as we get older

Several things about sleep do genuinely change with age. Understanding what changes, and what doesn't, is the starting point for putting it right.

What doesn't change is the amount of sleep the body needs. Adults of all ages need 7 to 9 hours. Many older adults are short of sleep, not because they need less, but because something is stopping them getting what they need.

Why good sleep matters in later life

Sleep is not idle time. It is when the body repairs itself, stores memories, balances hormones and, crucially, clears the brain of harmful proteins that build up while we are awake. Long-term poor sleep affects almost every part of the body.

Brain health and dementia

This link was covered in Issue 4, but it is worth restating here. During sleep, the brain's glymphatic system flushes out beta-amyloid and tau proteins, the same proteins linked to Alzheimer's disease. Regularly poor sleep is linked to a 30% higher risk of dementia in later life. For older adults already noticing changes in memory or thinking, tackling poor sleep is one of the most important and most overlooked steps available.

Cardiovascular health

Regularly sleeping under 7 hours is linked to much higher risks of high blood pressure, heart disease and stroke. Poor sleep raises cortisol and inflammation, upsets blood pressure control, and blocks the heart-and-vessel repair that normally happens during rest.

Falls and physical safety

Poor sleep harms balance, reaction time and concentration, all of which are already under pressure in later life. Sedating sleeping medicines (covered below) add to this risk. A lack of sleep is a risk factor for falls in older adults in its own right.

Mood and mental health

Insomnia and depression work both ways. Poor sleep raises the risk of depression, and depression in turn makes sleep harder. This can become a cycle that feeds itself, especially after bereavement, retirement or other big life changes common in later life.

What causes poor sleep in later life

Poor sleep in older adults is almost never simply down to ageing. In the vast majority of cases there is a specific cause that can be found, and most causes can be treated.

Pain and physical discomfort

Long-term pain, from arthritis, back problems, restless legs or other conditions, is one of the most common and most undertreated causes of poor sleep in later life. Pain often gets worse at night, making it harder to fall asleep and stay asleep. Better pain management, including a medication review with a GP, can improve sleep quickly and dramatically.

Nocturia: waking to use the bathroom

Waking to pass urine at night affects up to 80% of older adults and is one of the most common reasons sleep is broken up. It has several causes: a smaller bladder capacity, an overactive bladder, an enlarged prostate in men, some medicines (particularly diuretics), and drinking too much in the evening. Many causes can be treated, so a GP appointment is the right first step.

Medication side effects

Many commonly prescribed medications disrupt sleep. Beta blockers (used for blood pressure and heart disease) can cause nightmares and insomnia. Diuretics cause nocturia. Steroids cause arousal. Some antidepressants affect sleep architecture. Decongestants act as stimulants. Anyone taking multiple medications who experiences sleep problems should request a medication review specifically focused on sleep effects.

Sleep apnoea

Obstructive sleep apnoea, in which breathing repeatedly stops and starts during sleep, is common in older adults and often goes undiagnosed. Signs include loud snoring, waking with a dry mouth or headache, unexplained daytime sleepiness, and being told you stop breathing during sleep. Sleep apnoea raises the risk of heart disease and is linked to cognitive decline. Treatment, usually a CPAP device worn at night, can transform sleep quality.

Anxiety, depression, and psychological factors

Worry, rumination, and low mood are powerful disruptors of sleep. Following bereavement, retirement, or significant life changes, anxiety about the future, grief, or the loss of purpose that structured daily life can make falling and staying asleep very difficult. These are best addressed through talking support rather than sleeping medication.

Loss of structure and routine

Work gives a powerful daily anchor: a regular wake time, activity for body and mind through the day, and a clear line between busy time and rest. Retirement removes that structure. Without something to replace it, sleep-wake rhythms can drift, daytime inactivity rises, and the natural build-up of pressure for sleep weakens.

The sleeping pill problem

Important: NICE guidance says sleeping pills (benzodiazepines and z-drugs such as zopiclone and zolpidem) should be avoided where possible in older adults because of serious risks. These include dependency, a higher risk of falls, and problems with memory and thinking. Despite this, older adults are among the groups most often prescribed these medicines.

The British Geriatrics Society flagged this in 2025 as an ongoing concern. Sleeping pills can give short-term relief, but they treat a symptom, the difficulty sleeping, rather than its cause. They also carry serious risks in older adults that are often played down.

Why sleeping pills are particularly risky in older adults

• Falls. Sedating medicines are a leading cause of falls in older adults. The next-day drowsiness that reduces night-time waking also harms balance, reaction time and coordination the following morning and day.

• Dependency. Benzodiazepines and z-drugs can cause physical and psychological dependency relatively quickly. Stopping them can cause rebound insomnia worse than the original problem.

• Effects on memory and thinking. Sleeping pills, particularly benzodiazepines, are linked to poorer memory, confusion and cloudy thinking. In people already noticing changes in memory, this is a real concern.

• Poorer sleep quality. Sleeping pills change the structure of sleep, cutting time in the restorative deep stages even as they reduce the feeling of being awake. The sleep they produce is not the same quality as natural sleep.

If you are currently taking sleeping pills and want to cut down or stop, always do so with GP guidance, because stopping suddenly can cause problems. A gradual reduction plan, ideally alongside CBT-I support, is the approach backed by evidence.

What actually works

CBT-I: the most effective treatment for chronic insomnia

CBT-I (cognitive behavioural therapy for insomnia) is the NICE-recommended first treatment for long-term insomnia, recommended ahead of medication. It is a structured 6 to 8 week programme that tackles the thought patterns and habits that keep insomnia going, including the worry about sleep that often feeds itself.

Studies show CBT-I works better than sleeping pills and, importantly, brings lasting improvements after treatment ends rather than dependency. Evidence suggests it may work even better in people over 65 than in younger adults. Ways to access it include:

• Sleepio, a NICE-recommended digital CBT-I programme and the first digital treatment to receive NICE recommendation. Check whether it is available through your GP practice or local NHS trust.

• NHS Talking Therapies. Many NHS Talking Therapies (formerly IAPT) services include sleep support. Self-refer at nhs.uk/service-search/mental-health or ask your GP.

• GP referral. Ask your GP specifically about access to CBT-I. In some areas this is available through community mental health teams.

Sleep hygiene: what it means and what actually helps

"Sleep hygiene" is the term for the habits and surroundings that support good sleep. It is often dismissed as obvious, but the evidence is clear that keeping to these habits improves sleep, especially alongside CBT-I.

• Keep a regular sleep and wake time. This is the single most effective sleep habit. Go to bed and wake up at the same time every day, including weekends. It steadies the body clock and shortens the time it takes to fall asleep.

• Use the bed only for sleep. Avoid reading, watching television, or using devices in bed. This trains the brain to associate the bedroom with sleeping rather than wakefulness and stimulation.

• Get up if you can't sleep. If you are awake for more than around 20 minutes, get up and do something calm (read, listen to quiet music) in another room until you feel sleepy. Lying awake in bed increases the association between bed and wakefulness.

• Limit caffeine after midday. Caffeine takes around 5 to 7 hours to halve in the body. An afternoon cup of coffee is still working away at 10pm.

• Reduce or avoid evening alcohol. Alcohol aids falling asleep but significantly worsens sleep quality and duration. It reduces time in deep sleep and increases early morning waking.

• Exercise regularly, but not too close to bedtime. Regular activity greatly improves sleep. Timing matters, though: hard exercise within 2 to 3 hours of bed can delay sleep.

• Keep the bedroom cool, dark and quiet. Around 16 to 18°C is best for sleep. Blackout curtains or an eye mask, and ear plugs if needed, can cut out disturbances.

How Abney & Baker supports sleep

Sleep links to every other pillar in our care framework. Physical pain disturbs it. Isolation and loneliness affect it. Nutrition and alcohol have a direct impact on it. And poor sleep in turn weakens strength, brain health, mood and the immune system. This is why sleep is not a separate concern. It is woven into everything else we do through our preventative home care.

Five Pillars of Living Well at Home

Sleep is linked to all Five Pillars. This matters whether you are thinking about your own sleep or helping a parent or loved one. Physical health includes strength, balance and recovery. Cognitive health includes memory and clear thinking. Nutrition and hydration matter because food, drinks and caffeine can affect sleep. Social and emotional wellbeing includes company, worry and mood. Home safety includes light, noise, temperature and a clear path to the bathroom at night.

Sleep is a barometer of how everything else is going

In our experience, changes in sleep are often one of the earliest and most reliable signs that something else is changing: pain that hasn't been mentioned, low mood that has been hidden, a medicine that isn't working as intended, or a health problem that hasn't yet been looked into.

Because Abney & Baker carers see people regularly and get to know their patterns, they are well placed to notice these shifts. A carer who knows that someone usually sleeps reasonably well, and hears them mention waking repeatedly over the past two weeks, can flag it. That opens the door to early help rather than waiting until something more serious develops.

Sleep doesn't exist on its own. It is the result of everything else, and good care supports everything else.

Sleep health checklist

Use this checklist for yourself, or go through it with a parent or loved one. Tick what is already going well. The unticked items may show a small change that could help.

Daily sleep habits

Bedroom and night-time safety

Possible causes to discuss

Using this checklist: items you can't tick in the "sleep habits" section are the easiest to act on, so start there. Items you can't tick in "potential causes to address" are worth raising with a GP, especially unmanaged pain, medication concerns, or signs of sleep apnoea.

When to see a GP

Many people with long-term sleep problems, sleeping poorly for months or years, have never mentioned it to a GP because they assume nothing can be done. That assumption is wrong in almost every case. GPs can:

• Review medicines that may be disrupting sleep and adjust or change them where appropriate

• Investigate pain, anxiety, depression, or other conditions contributing to poor sleep and initiate treatment

• Refer for sleep study to investigate suspected sleep apnoea

• Support safe tapering of sleeping pills with a structured reduction plan

• Provide access to CBT-I, either directly or through referral to NHS Talking Therapies or digital services

Bring a sleep diary to any GP appointment about sleep. Note bedtimes, wake times, how many times you woke, and your morning energy for two weeks. This gives a GP far more to work with than a general description of feeling tired.

Frequently asked questions

How much sleep does an older adult need?

Most older adults still need about 7 to 9 hours of sleep. Sleep may become lighter with age, but regularly feeling exhausted is not something you should simply accept.

Why does my older parent keep waking at night?

Pain, medicines, worry, needing the toilet or sleep apnoea can all disturb sleep. Keep a simple sleep diary for two weeks and share it with their GP.

When should sleep problems be discussed with a GP?

Speak to a GP if poor sleep lasts more than a few weeks, affects daily life, or includes loud snoring, gasping, breathlessness or unusual daytime sleepiness.

Can home care help with better sleep?

Home care can support a steady daily routine, gentle activity, regular meals, medicines and a safer night-time environment. These small changes can make restful sleep more likely.

Concerns about sleep or care at home?

Whether poor sleep is part of a wider health worry, or you're looking for care that takes a genuinely whole-person approach, we're always happy to talk.

To see how joined-up support can help with sleep and everything around it, explore our care at home services and our preventative home care. You can also get in touch for a friendly, no-obligation chat.