Sleep is a cornerstone of health, influencing well-being across all stages of life. Its significance becomes particularly pronounced as individuals age, intertwining with the concept of healthy aging—a multidimensional approach that emphasizes physical, cognitive, and social functioning, along with psychological well-being. This comprehensive review explores the complex relationship between sleep and healthy aging, shedding light on the intricate dynamics that influence aging trajectories.
Healthy aging, often synonymous with “successful” or “resilient” aging, involves maintaining functionality in older age. The World Health Organization (WHO) has expanded this definition to include optimizing opportunities for health, participation, and security. In recognition of its growing importance, the WHO has declared 2020–2030 as the Decade of Healthy Ageing, emphasizing environments that promote both active and healthy aging.
Understanding Sleep Changes with Age
Aging inevitably brings changes in sleep patterns and architecture. Older adults often experience fragmented sleep, reduced total sleep time, and alterations in sleep architecture, such as diminished slow-wave and REM sleep. These changes are influenced by a myriad of factors, including physiological, psychological, and environmental variables. Moreover, they may reflect progressive brain structure modifications accompanying aging, impacting physical and cognitive health.
Research highlights that insufficient or disrupted sleep can adversely affect cognitive function through biological pathways, including altered prefrontal cortex activation and systemic inflammatory responses. These mechanisms may accelerate neurocognitive decline, positioning sleep as a potential target for preserving brain health and functional aging.
Non-Linear Associations and Sleep Disorders
The relationship between sleep and aging is not linear. A large-scale study involving 13,569 US participants revealed that both short and long sleep durations are linked to accelerated aging. This U-shaped relationship suggests that optimal sleep duration is crucial for healthy aging. Additionally, sleep disturbances like insomnia, sleep apnea, and restless legs syndrome become more prevalent with age, exacerbating cognitive decline and increasing the risk of chronic conditions.
Despite the recognition of sleep’s role in healthy aging, the complex relationships between sleep parameters and aging outcomes remain underexplored. Existing reviews often focus on pathological sleep conditions, overlooking the physiological changes that accompany aging. This scoping review aims to fill these gaps, offering a comprehensive understanding of how sleep influences healthy aging across various populations.
Methodology and Key Findings
The review utilized the Arksey and O’Malley framework, a recognized tool for scoping reviews, to map key concepts and evidence. A thorough literature search across major databases identified 7,694 items, with 20 studies meeting the inclusion criteria. These studies explored sleep parameters like duration, continuity, architecture, and quality, alongside dimensions of healthy aging such as physical health, cognitive function, and social engagement.
Findings indicate an advanced sleep phase in older adults, characterized by earlier bedtimes and wake-up times. Gender differences emerged, with women tending to wake up earlier. A reciprocal relationship between sleep duration and quality was suggested, where poor sleepers had later sleep onset. The U-shaped association between sleep duration and healthy aging was confirmed, highlighting the importance of optimal sleep duration.
Sleep Architecture and Daytime Napping
Age-related changes in sleep architecture include reduced slow-wave sleep and alterations in REM sleep, with implications for cognitive functions. Gender differences were noted, with men spending more time in REM sleep than women. Daytime napping, prevalent among older adults, was found to improve sleep quality and efficiency, although excessive napping was linked to reduced odds of successful aging.
Chronotype and circadian rhythms also shift with age, leading to earlier sleep and wake times. Subjective sleep quality, often poorer in older adults, correlates with successful aging. The review highlights discrepancies between subjective and objective sleep measures, suggesting the need for careful consideration in sleep research.
Implications and Future Directions
This scoping review underscores the critical importance of sleep in healthy aging, revealing gaps in current literature and pointing to areas for future research. Longitudinal studies tracking sleep patterns over time are needed to understand the trajectory of sleep changes with aging. Additionally, the biological mechanisms linking sleep changes with aging processes require further exploration.
Gender-specific research is essential to address mixed findings on sleep patterns and architecture. Cultural and ethnic considerations should also be explored, as societal differences may influence sleep patterns and aging outcomes. The review calls for the development of sensitive assessment tools to capture sleep quality accurately in older adults.
For clinicians and public health stakeholders, these findings highlight the need for integrating sleep assessments into aging care. Behavioral and lifestyle interventions, alongside community-based initiatives, could promote healthy sleep habits and support active aging. For older individuals, self-awareness and lifestyle modifications, supported by digital tools, can mitigate age-related sleep disruptions and preserve well-being.
In conclusion, this review emphasizes the multifaceted nature of sleep in aging, advocating for a comprehensive approach to understanding and addressing sleep-related issues in older adults. By advancing research and translating findings into actionable interventions, we can promote optimal sleep and aging outcomes, enhancing the quality of life for older populations.
