Sleep After 50: Why It Changes, What Helps, and What to Do About Insomnia

How much you need, and what changes

The National Institute on Aging (NIA) says older adults need about the same amount of sleep as all adults: seven to nine hours a night. What changes is quality. As you age you tend to go to bed earlier and wake earlier, sleep is lighter, and you wake more often during the night.

That’s common and not automatically a problem. It becomes one when it leaves you tired in the day or you can’t get back to sleep. Illness, pain, mood, medicines and caffeine all get in the way, and it helps to know which apply to you.

The habits that matter most

NIA lists these. They’re things to try, not a treatment, and results vary from person to person. Pick the two or three that fit your life.

• Keep a steady schedule. Go to bed and get up at the same time every day, weekends included. A regular wake time is the most useful anchor.
• Build a wind-down routine: reading, soft music or a warm bath, a little before bed.
• Make the bedroom comfortable, not too hot or cold, and dark and quiet.
• Move during the day. Regular exercise helps, but not within three hours of bedtime.
• Skip late-afternoon and evening naps. If you nap, keep it short and early.
• Cut caffeine after midday and go easy on alcohol, which may make you drowsy at first but tends to break up sleep later in the night.
• Keep screens such as the TV, phone and tablet out of the bedroom.
• Avoid large meals and large amounts of liquid in the two to three hours before bed.

If you lie awake: what actually works

Almost everyone has bad nights. Insomnia is different: trouble falling or staying asleep at least three nights a week. NIA calls it chronic when it lasts more than three months, and says it’s the most common sleep problem in adults 60 and older.

For chronic insomnia, the best-supported first treatment isn’t a pill. The American College of Physicians recommends that all adults with chronic insomnia receive cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment. That’s a strong recommendation based on moderate-quality evidence. CBT-I is a structured program, delivered over several weeks, that works on the habits and thoughts that keep insomnia going. Typical pieces include:

• A fixed wake time and a limited time in bed, so your sleep consolidates instead of spreading thin.
• Using the bed for sleep only. If you’re awake and frustrated, get up, do something quiet in dim light, and go back when you feel sleepy.
• Challenging the worries that keep you wired, such as “I’ll be useless tomorrow if I don’t sleep now.”
• Relaxation techniques you can practice.

NIA says sleep medicines may help in the short term but carry risks and shouldn’t be used long term. Older adults are more sensitive to side effects such as next-day drowsiness and confusion. Talk with your doctor before starting any medicine or supplement for sleep, and ask whether CBT-I is available. Many programs are offered online or through your health plan.

Keep a sleep diary

If you have trouble sleeping, NIA suggests keeping a diary for a couple of weeks. Note when you go to bed, when you wake in the night and when you get up, and whether you had caffeine or alcohol or exercised that day. The patterns often point to a fix, and they make a doctor’s visit much more useful. The free Two-Week Sleep Diary does the averages for you and keeps everything in your browser.

When sleep is a doctor’s question

NIA notes that sleep disorders become more common with age. They’re treatable, and worth raising early if any of these sound like you:

• You’re always sleepy in the day, or you struggle to get enough sleep at night.
• You have trouble falling or staying asleep at least three nights a week.
• You snore loudly, or someone notices you pause your breathing while asleep. NIA says snoring can be a sign of sleep apnea, though not everyone who snores has it.
• You feel tingling or crawling in your legs at night that eases when you move.

One practical note: many night-time falls happen on the way to the bathroom. NIA suggests a lamp that’s easy to reach, a nightlight in the hallway and bathroom, and removing rugs and cords you could trip over. The free Home Safety Checklist covers the rest of the path.