Sleep health in the older adults: Architecture, circadian changes, and common sleep disorders

Mar 13, 2026Ageing research reviews

Sleep patterns, body clock changes, and common sleep problems in older adults

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Circadian Biology on OpenScience ↗PubMed ↗DOI ↗

Abstract

Chronic sleep disturbances affect 20-40% of older adults, potentially leading to serious health risks.

Normal aging is associated with reduced slow-wave and REM sleep, decreased sleep efficiency, increased fragmentation, and dampened circadian amplitude.
Pathological sleep disorders such as insomnia, obstructive sleep apnea, restless legs syndrome, and REM sleep behavior disorder are prevalent in older populations.
Chronic sleep disturbances are linked to increased risks of cognitive decline, cardiovascular disease, falls, frailty, and mortality.
Cognitive-behavioral therapy is supported as a first-line treatment for insomnia.
Emerging dual orexin receptor antagonists may offer favorable safety profiles for treating sleep disorders.
Continuous positive airway pressure remains the standard treatment for obstructive sleep apnea, although challenges with adherence exist.

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Population aging accelerates globally, increasing sleep-related complaints among older adults. These disorders substantially impact cognitive function, physical health, and quality of life. This narrative review examines age-related changes in sleep architecture, alterations in circadian rhythm, common sleep disorders, and modifiable behavioral factors in older populations. We searched PubMed, Web of Science, and Google Scholar through December 2025 for studies involving adults aged ≥ 65 years focusing on sleep patterns, architecture, circadian rhythms, and disorders. Normal aging involves reduced slow-wave and REM sleep, decreased sleep efficiency, increased fragmentation, and circadian amplitude dampening. However, pathological sleep disorders affect substantial proportions: insomnia (20-40%), obstructive sleep apnea (>30%), restless legs syndrome, and REM sleep behavior disorder. Chronic sleep disturbances are associated with elevated risks of cognitive decline, cardiovascular disease, falls, frailty, and mortality. Evidence supports cognitive-behavioral therapy as a first-line insomnia treatment. Emerging dual orexin receptor antagonists show promise with favorable safety profiles. Continuous positive airway pressure remains the standard of care for obstructive sleep apnea, though adherence challenges persist. Sleep may represent a modifiable healthy aging determinant. Distinguishing normal age-related changes from pathological disorders can enable appropriate management. Future priorities include longitudinal studies in the oldest-old, investigations of circadian mechanisms, implementation of behavioral interventions, and equity-focused research across diverse populations.

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Sleep health in the older adults: Architecture, circadian changes, and common sleep disorders

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