Sleep plays a fundamental role in maintaining overall health and well-being throughout the lifespan, with its importance becoming increasingly pronounced as individuals age. Healthy aging, often referred to as “resilient” or “successful” aging, is a multidimensional concept characterized by the maintenance of physical, cognitive, and social functioning, along with the preservation of psychological well-being in older adults. Active aging, a complementary concept, emphasizes the continued participation of older individuals in social, economic, cultural, spiritual, and civic activities, regardless of physical capacity.
The World Health Organization (WHO) has broadened the definition of aging to include social and environmental determinants, defining active aging as the process of optimizing opportunities for health, participation, and security to enhance quality of life as people age. This aligns with the broader framework of healthy aging, which the WHO defines as maintaining functional ability to enable well-being in older age. Recognizing the growing importance of this issue, the WHO declared 2020–2030 the Decade of Healthy Ageing, focusing on fostering environments that promote both active and healthy aging.
Changes in Sleep Patterns with Aging
Aging is inevitably associated with changes in sleep patterns and architecture. These changes include more fragmented sleep, decreased total sleep time (TST), and alterations in sleep architecture characterized by reduced slow-wave sleep (SWS) and diminished rapid eye movement (REM) sleep. Such changes are influenced by physiological, psychological, and environmental variables and might reflect progressive modifications in brain structure accompanying the aging process. Emerging evidence indicates that insufficient or disrupted sleep can adversely affect cognitive function through multiple converging biological pathways, including altered prefrontal cortex activation, systemic inflammatory and oxidative stress cascades, and disturbances in neuronal plasticity and cellular homeostasis.
Furthermore, recent studies suggest that the association between sleep and aging is not linear. A large-scale investigation on 13,569 participants in the US focusing on “phenotypic aging” provided compelling evidence that sleep duration exerts a strong influence on healthy aging, showing that both short and long sleep durations are associated with accelerated aging. This U-shaped relationship between sleep duration and phenotypic aging increases the complexity of the interplay between sleep and aging.
Prevalence and Impact of Sleep Disorders
Sleep disturbances are prevalent among older adults, with conditions such as insomnia, sleep apnea, restless legs syndrome, REM sleep parasomnias, and periodic limb movement disorder becoming more common with aging. These disorders not only contribute to subjective complaints of poor sleep quality but may also exacerbate age-related declines in cognitive function, increase the risk of chronic medical conditions such as arterial hypertension, metabolic disorders, and diabetes, and impair the quality of life and well-being in older individuals.
Despite the recognition of the interplay between sleep and healthy aging, the complex relationships between sleep parameters and various domains of healthy aging outcomes are still largely poorly understood. Specifically, considering the increasing burden of neurodegenerative diseases in the general population and its societal and economic impacts, understanding the complex role that sleep may play as a protective factor is crucial in contemporary society.
Research Methodology and Findings
Existing reviews have predominantly focused on pathological sleep conditions in relation to aging, thereby overlooking the complex spectrum of physiological sleep changes that accompany the aging process. A scoping review of the literature represents an appropriate methodological approach to collating and evaluating the available body of scholarly evidence. This review aims to examine the current state of knowledge regarding the associations between sleep parameters, including sleep duration, continuity, architecture, and quality, and multiple dimensions of healthy aging, such as physical health, cognitive function, psychological well-being, and social engagement.
The review reveals consistent findings of an advanced sleep phase in older adults across different cultures, with earlier bedtimes and wake-up times. This pattern is linked to various factors, including gender, with women tending to wake up earlier. A reciprocal relationship between sleep duration and sleep quality was also suggested, where poor sleepers presented with later sleep-onset. Noteworthy, the relationship between sleep duration and healthy aging outcomes indicates a U-shaped association, where both shorter and longer sleep durations can be detrimental, suggesting an optimal range conducive to healthy aging.
Sleep continuity and efficiency are found to decrease with age, with more pronounced effects in women. The impact of aging on sleep architecture is evident in the reduction of SWS and alterations in REM sleep, with potential implications for cognitive functions. The role of gender in these changes is also highlighted, with differences in REM sleep patterns and SWS between men and women.
Implications and Future Directions
The findings of this scoping review hold significant implications for clinicians, public health stakeholders, and older individuals themselves. For healthcare providers, awareness of the physiological yet heterogeneous nature of sleep changes in aging is essential for distinguishing normal variations from early signs of pathological decline, particularly in cognitive and affective domains. Integrating objective assessments such as polysomnography (PSG) or actigraphy with validated subjective tools could enhance diagnostic precision and guide individualized sleep management plans.
For public health professionals, promoting these approaches through education, prevention, and accessibility programs could represent a sustainable and cost-effective strategy. Community-based initiatives encouraging regular sleep–wake schedules, exposure to natural light, and moderate physical activity may help maintain circadian stability and overall well-being. Furthermore, embedding sleep optimization within broader multimodal interventions, targeting mental health, cognitive preservation, and chronic disease prevention, could foster a comprehensive framework for active and functional aging.
Finally, for aging individuals, increasing self-awareness of sleep behaviors and adopting lifestyle modifications, including daily exercise, cognitive stimulation, and structured relaxation routines, can mitigate age-related sleep disruptions and preserve well-being. Digital self-monitoring tools and technology-assisted feedback may further improve adherence and empower older adults to actively manage their sleep health.
Overall, this review underscores the critical importance of sleep in the context of healthy aging, calling for a comprehensive approach to understanding and addressing sleep-related issues in older adults. Future high-quality, community-based research, leveraging longitudinal frameworks and employing multidisciplinary approaches that coherently combine and integrate insights from sleep science, gerontology, psychology, and technology, is needed to eventually develop comprehensive assessments and holistic interventions that address the multifaceted nature of sleep in aging.
