How Aging Affects Men’s Sleep: What Changes and What to Expect

Sleep plays a critical role in health at every stage of life, but as men age, changes in sleep patterns, quality, and duration become increasingly common. These changes are part of the natural aging process, influenced by shifts in hormones, circadian rhythms, lifestyle, and health status. While not all sleep disturbances are inevitable, understanding how aging affects sleep can help men navigate these changes and take steps to improve rest and overall well-being.

1. Sleep Architecture Changes with Age

One of the most noticeable changes in sleep as men age is in sleep architecture—the structure and stages of sleep throughout the night.

• Less Deep Sleep: Young men typically get a healthy amount of slow-wave sleep (also known as deep sleep), which is the most restorative phase. As men age, the amount of deep sleep declines significantly. By the time they reach their 60s or 70s, some men may have little to no slow-wave sleep.

• More Light Sleep: Aging men spend more time in lighter stages of sleep (N1 and N2), which are more easily disrupted by noise, movement, or internal discomforts such as the need to urinate.

• Reduced REM Sleep: There may also be a modest decline in REM (rapid eye movement) sleep, the stage associated with dreaming, memory consolidation, and emotional processing.

As a result, older men often report feeling less refreshed after a full night’s sleep—even if the total duration hasn’t changed significantly.

2. Shorter Sleep Duration and More Nighttime Awakenings

While the commonly recommended 7–8 hours of sleep still applies to men 65 years old and older, many aging men find it harder to sleep that long.

• Frequent Awakenings: It becomes more common to wake up multiple times per night, sometimes without any clear cause. These awakenings may last longer or be harder to recover from.

• Difficulty Falling Back Asleep: Waking in the early morning hours and being unable to return to sleep—known as sleep maintenance insomnia—is particularly common in older adults.

• Earlier Sleep and Wake Times: Older men often experience a shift in their circadian rhythm that causes them to become sleepy earlier in the evening and wake earlier in the morning. This phenomenon, known as advanced sleep phase syndrome, may feel frustrating if social or family schedules don’t align with it.

3. Hormonal Changes Affect Sleep Quality

Testosterone levels decline gradually with age, and this drop in testosterone has been linked to:

• Lighter sleep and more nighttime awakenings

• Reduced slow-wave (deep) sleep

• Increased risk for sleep disorders, including sleep apnea

Low testosterone may also contribute to daytime fatigue, mood changes, and reduced physical energy—all of which can further impact sleep quality and consistency.

While testosterone replacement therapy (TRT) may improve some symptoms in certain cases, it is not generally recommended as a treatment for sleep issues alone due to potential risks and side effects.

4. Increased Risk of Sleep Disorders

Several sleep disorders become more common as men age, and they often go underdiagnosed.

a. Obstructive Sleep Apnea (OSA)

• OSA is a condition where breathing repeatedly stops and starts during sleep due to airway blockage.

• Aging men, especially those who are overweight or have larger neck circumferences, are at higher risk.

• Symptoms include snoring, gasping for air, dry mouth, teeth grinding (bruxism), frequent urination at night (nocturia), nocturnal heartburn, palpitations, morning headaches, unrefreshing sleep, excessive daytime sleepiness/fatigue, and cognitive or mood complaints.

• Untreated sleep apnea increases the risk of high blood pressure (hypertension), diabetes, atrial fibrillation, heart disease, stroke, and cognitive decline (dementia).

b. Insomnia

• Insomnia can affect both falling asleep and staying asleep.

• It may be caused or worsened by medical conditions, medications, or psychological stressors.

• Chronic insomnia affects up to 30% of older adults, and men are less likely than women to seek treatment.

c. Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD)

• These conditions involve involuntary leg movements or sensations that interfere with sleep.

• They are more common in older adults and can lead to fragmented, poor-quality sleep.

5. Medical Conditions and Medications

As men age, they are more likely to have chronic health conditions that interfere with sleep, such as:

• Prostate enlargement (BPH), which leads to frequent nighttime urination (nocturia)

• Arthritis, causing pain that disrupts sleep

• Diabetes, which can cause night sweats or neuropathy

• Heart disease or lung conditions, which may lead to breathing issues during sleep

Additionally, medications taken for these conditions may have side effects that interfere with sleep. For example:

• Beta-blockers (for blood pressure) may cause insomnia or nightmares.

• Decongestants, steroids, or certain antidepressants can also disrupt sleep patterns.

6. Mental Health and Sleep

Aging can bring emotional challenges—such as retirement adjustment, loss of loved ones, or loneliness—which may contribute to anxiety or depression. These conditions are strongly linked with sleep disturbances, including early-morning waking or trouble falling asleep.

Unfortunately, older men are often less likely to discuss mental health concerns with healthcare providers, which can delay diagnosis and treatment of both emotional distress and the sleep problems it causes.

7. What Older Men Can Do to Improve Sleep

While age-related changes in sleep are natural, many sleep issues are treatable or manageable. Practical strategies include:

• Maintain a consistent sleep schedule, even on weekends.

• Avoid caffeine and alcohol late in the day.

• Limit screen time in the hour before bed.

• Keep the bedroom cool, quiet, and dark.

• Get morning sunlight exposure, which helps regulate circadian rhythms.

• Stay physically active, but avoid vigorous exercise close to bedtime.

• Treat underlying health conditions that may disrupt sleep.

If sleep problems persist, men should not hesitate to talk to a healthcare provider or a sleep specialist. Simple interventions—like adjusting medication timing, using a CPAP machine for sleep apnea, or trying cognitive behavioral therapy for insomnia (CBT-I)—can lead to significant improvements in sleep and overall quality of life.

Final Thoughts

Sleep changes are a normal part of aging, but they don’t have to mean sleepless nights. By understanding the factors that affect sleep in older men—from hormone levels and medical conditions to lifestyle habits—it's possible to take proactive steps toward better rest. And with good sleep comes improved memory, mood, energy, and long-term health.

This article was created using OpenAI’s ChatGPT on September 19, 2025 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

What Causes Early Morning Awakenings?

By Brandon Peters, MD

There is something disappointing about waking up earlier than is necessary. It may be nice to doze in and out of sleep in the early morning hours, but it is especially upsetting if you cannot fall back asleep. What might cause someone to wake up before the alarm clock goes off? There are specific conditions, including a fair number of sleep and mood disorders, which might cause early morning awakenings.  By understanding these potential causes, you may be able to find a treatment that will keep you asleep until your desired wake time.

The Role of Insomnia

The most important cause of difficulty staying asleep near morning is insomnia. Insomnia is defined as difficulty falling or staying asleep or sleep that is simply not refreshing. These awakenings may occur throughout the night, but they tend to be more frequent in the second half of the night. This is due to a diminishing ability to sleep toward the morning hours.

The ability to sleep is linked to two processes, one called the homeostatic sleep drive and the other being the circadian rhythm (which will be discussed more later). The homeostatic sleep drive is the gradual desire for sleep that builds the longer a person stays awake. It relates to the gradual accumulation of a chemical within the brain called adenosine. This “sleepiness signal” eventually helps to initiate sleep. During sleep, it is cleared away, so that midway through the night, the desire for sleep is depleted. By morning, it should be completely gone.

If a person awakes in the night, especially if this awakening occurs toward morning, the ability to return to sleep will be compromised due to the lower levels of adenosine. Sleep may be greatly delayed, fragmented, or disrupted in insomnia, but awakenings near morning can be especially troublesome.

Anxiety and Depression May Provoke Awakenings

Any of the mood disorders, most notably anxiety and depression, can provoke awakenings. These typically occur in the several hours before the intended awakening. For example, if the alarm is set for 6 AM, someone with depression may start waking at 4 AM for no good reason. How can this be addressed?

As with insomnia, it is important to address the underlying contributing factors that lead to these awakenings. In the setting of psychiatric distress, these problems can persist. It is therefore necessary to treat any coexisting depression or anxiety. This may require the use of medications or counseling with the assistance of a psychologist or psychiatrist. Studies have shown that both, used in combination, are the most effective. Insomnia is especially well-treated with cognitive behavioral therapy for insomnia (CBTi).

It is clear that sleep can undermine mood. Conversely, mood problems can greatly affect sleep. By working on both issues together, the complexity of this relationship can be unraveled.

The Unexpected Influence of Sleep Apnea

It may seem peculiar to imagine that a breathing disorder such as obstructive sleep apnea may contribute to early morning awakenings. To better understand this relationship, it is necessary to carefully consider the structure of sleep.

It is artificial (but useful) to divide the night in half when considering the stages of sleep. In the first half of the night, slow-wave sleep more frequently occurs, especially among young people. In the second half, rapid eye movement (REM) sleep makes a more frequent appearance. Though the cycles of sleep occur regularly through the night, REM sleep becomes more prolonged towards morning. Therefore, we are more likely to awaken from it near morning and recall the vivid dreams that are associated with the state.

Sleep apnea is also more likely to occur during REM sleep. The muscles of the body are actively paralyzed during this stage, so that we are unable to act our dreams out. (If this does not occur, a condition called REM behavior disorder may result.) Muscles lining the upper airway are also paralyzed. This makes the airway more collapsible and when collapse occurs, it manifests as disrupted breathing and sleep apnea. Sleep apnea is often worsened during REM for this reason.

Therefore, morning awakenings may occur in the setting of sleep apnea that is worsened during the periods of REM that become more frequent and prolonged towards morning.

Morning Larks, Circadian Rhythms, and How Sleep Changes in Aging

The last major contributor to early morning awakenings is the class of conditions that are collectively known as circadian rhythm disorders. These include the natural tendency to wake early in the morning (so-called early birds or morning larks), advanced sleep phase syndrome, and natural changes that occur in sleep ability as we get older.

There are some who are just naturally morning people. They may prefer to fall asleep earlier (such as at 9 PM) and wake earlier (by 5 or 6 AM). This may be a lifelong preference. It isn’t necessarily abnormal, but it may lead to morning awakenings. If a sufficient amount of sleep is obtained before getting up for the day, then there is no reason to give it a second thought.

As we get older, our ability to maintain a continuous, uninterrupted period of sleep diminishes. The “machinery” of sleep (whatever we might conceive this to be) isn’t working as well as it used to. Sleep may become more fragmented. There may be more time spent awake in the transition to falling asleep and during the night. Slow-wave sleep diminishes. The total sleep time may be reduced. As part of this, early morning awakenings may occur.

In some cases, a condition called advanced sleep phase syndrome may become apparent. In this circadian rhythm disorder, the onset and offset of sleep moves forward by several hours. If it is disruptive to social life, it may be treated with the use of properly timed melatonin and light exposure at night.

If you suffer from morning awakenings, you should reflect on your situation and consider what might be contributing to the occurrence. If there is evidence for mood disorders, these should be addressed by a doctor. When a clear explanation cannot be identified, it may be useful to speak with a sleep specialist who may be able to provide additional insight. 

What Factors Make Sleep Apnea Worse?

By Brandon Peters, MD

Though your anatomy may predispose you to having obstructive sleep apnea, there are other factors that might actually make the condition worse. Some of these potential contributors are within your control and others are not. What makes sleep apnea worse and what can you do about it?

Starts with Your Anatomy

The most important cause of sleep apnea is the structure of your airway’s anatomy. There are a number of components that have a role: nose, tonsils, palate, tongue, and jaw. These structures develop based on your genetics. Just like we share a familial resemblance with our parents and siblings, so too the internal structures are similarly arranged. Unfortunately, this foundation is largely out of your control, but there are other factors that might make sleep apnea worse. Some of these additional considerations include:

Sleep Position

Some people’s sleep apnea is significantly worsened by sleep position. A sleep study might show that sleeping on your back, in the supine position, leads to increased breathing disruption. This occurs because the soft tissues of the airway, including the soft palate and tongue, can fall backwards and block the passage of air. Gravity contributes and lying on your back will make this occurrence more likely. In some individuals, the use of positional therapy to stay sleeping on your sides can be very helpful.

REM Sleep

It is natural to transition through various sleep stages throughout the night. The majority of sleep consists of non-REM sleep. However, about every 90 minutes REM sleep occurs. Rapid eye movements occur along with paralysis of muscles. This state is characterized by intense, vivid dreaming, much like watching a movie. In order to prevent the acting out of these dreams, the body is actively paralyzed. The muscles of the airway are also paralyzed. This tube becomes floppy and collapsible. As a result, sleep apnea often worsens during REM sleep. This may cause an increased number of events or more severe drops in oxygen levels as measured by oximetry. As REM sleep is an integral part of quality sleep, this particular risk factor cannot be avoided.

Alcohol

Counter to the tradition of having a nightcap, it is clear that alcohol negatively affects sleep. Although it may make you feel sleepy, as it wears off it leads to sleep fragmentation and insomnia. In addition, as a muscle relaxant, it can make the upper airway more collapsible. This risk factor is within your control. It is best to avoid alcohol before bedtime. As a rule of thumb, allow one hour to elapse for each alcoholic beverage you consume before going to bed. This will help to minimize the effects of alcohol on your chance of experiencing sleep apnea.

Menopause

Okay, so this one obviously only applies to women. However, it is a significant risk factor to consider. Younger women are protected by the hormones progesterone and estrogen which maintain the patency of the airway. The incidence of sleep apnea among women before the onset of menopause is thus lower. When these hormones are lost, the incidence increases among women to equal that of men. Surgical menopause, a phrase used to describe the state after which hysterectomy and removal of the ovaries has occurred, conveys a similar risk of sleep apnea. Women who take hormone replacement therapy are found to have an intermediate risk of sleep apnea.

Prescription Medications

How might medications affect sleep apnea? In general, there are three classes of medications that are potentially problematic: benzodiazepines, opiates, and barbiturates. Benzodiazepines are often prescribed for anxiety, seizures, and were previously often used for insomnia. They also act as muscle relaxants and this can affect the airway and lead to sleep apnea. Opiates are narcotic medications that are used to control pain. They can contribute to central sleep apnea, characterized by shallow or irregular breathing. In addition, barbiturates are used for sedation and seizure control and these can likewise affect breathing. If you are concerned that your medications may be increasing your risk of sleep apnea, you should speak with your prescribing doctor.

Aging

Finally, aging itself may make your sleep apnea. Just as you lose muscle tone in your arms and legs, you similarly may lose muscle tone within your airway. This may compromise its ability to stay open. There isn’t much to be done about this particular risk factor. The good news is that the incidence of sleep apnea appears to level off at the age of 60. If you are going to develop sleep apnea, it seems, you will develop it by then.

Regardless of the issue that might be making your sleep apnea worse, there are still effective treatment options available including the use of an oral appliance or continuous positive airway pressure (CPAP). Discuss the risks you face with your sleep specialist and find the right solution for you.

Sources:

Kryger, MH et al. "Principles and Practice of Sleep Medicine." Elsevier. 5th edition. 2011.

The International Classification of Sleep Disorders. American Academy of Sleep Medicine. 2nd edition. 2005.