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 to healthy aging, 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 defined 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 the process of maintaining functional ability to enable well-being in older age. Recognizing the growing importance of this issue, the WHO has declared 2020–2030 the Decade of Healthy Ageing, focusing on fostering environments that promote both active and healthy aging.
Understanding Sleep Changes with Aging
While aging is inevitably associated with changes in sleep patterns and architecture, the extent to which these changes impact healthy aging outcomes remains a topic of ongoing research and debate. Advancing age is often accompanied by alterations in sleep duration, continuity, and quality, including a tendency towards 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.
These changes in sleep patterns are influenced by a myriad of factors, including physiological, psychological, and environmental variables, and might also reflect progressive modifications in brain structure that accompany the aging process. Emerging evidence indicates that insufficient or disrupted sleep can adversely affect cognitive function through multiple converging biological pathways. These include altered prefrontal cortex activation leading to impaired executive control and attention, activation of systemic inflammatory and oxidative stress cascades, and disturbances in neuronal plasticity and cellular homeostasis.
Both population-based investigations and experimental animal models have demonstrated that these mechanisms may accelerate neurocognitive decline, highlighting sleep as a potential modifiable target for preserving brain health and functional aging.
The Non-linear Relationship Between Sleep and Aging
An increasing body of scholarly literature suggests that the association between sleep and aging is not linear. For instance, a recent large-scale investigation on 13,569 participants in the US focusing on the concept of “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.
The potential influence of several endogenous (such as sex/gender) and external factors (including, above all, physical activity and exercise) can lead to a U-shaped relationship between sleep duration and phenotypic aging, increasing the complexity of such an intricate interplay. Moreover, 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 sleep 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.
Exploring the Interplay: Scoping Review Insights
Given the breadth and complexity of the research question, a scoping review of the literature represents the most appropriate methodological approach. Unlike a systematic review, which typically focuses on narrowly defined questions suitable for quantitative synthesis or meta-analysis, a scoping review can offer a rigorous and systematic 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 initial literature search yielded a pool of 7,694 items. After removing duplicates and irrelevant items, 107 results were analyzed in-depth, with 20 studies finally included in the review.
Key Findings and Implications
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.
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.
Daytime sleep and napping emerge as significant aspects of sleep in older adults. Findings suggest that napping may improve sleep quality and efficiency, though excessive daytime napping is linked to reduced odds of successful aging. Chronotype and circadian rhythms also shift with age, leading to earlier sleep and wake times, with implications for sleep propensity and circadian preferences.
Knowledge Gaps and Future Research Directions
The present scoping review on the relationship between sleep and healthy aging reveals several critical gaps in the current literature, pointing to key areas for future research. These gaps not only highlight the need for a deeper understanding of specific aspects of sleep in the context of aging but also underscore the potential for developing targeted interventions aimed at enhancing sleep quality and, by extension, promoting healthy aging outcomes.
A first limitation encountered in summarizing the reviewed evidence is the heterogeneity of the older population samples studied and the definition of healthy aging. Another relevant gap concerns longitudinal data on sleep patterns: there is a notable scarcity of studies tracking sleep patterns over time in the same individuals.
Moreover, mixed findings on gender differences in sleep patterns, continuity, and architecture indicate a gap in gender-specific research. Detailed studies focusing on the distinct sleep needs and challenges faced by older men and women are needed to tailor interventions appropriately.
Clinical and Practical Implications
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 PSG or actigraphy with validated subjective tools could enhance diagnostic precision and guide individualized sleep management plans. Beyond descriptive observation, these results should be interpreted in light of the growing body of evidence on interventions for sleep improvement in older adults.
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.
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.
