Ageing Res Rev. 2026 Mar 11:103101. doi: 10.1016/j.arr.2026.103101. Online ahead of print.
ABSTRACT
Population aging accelerates globally, increasing sleep-related complaints among older adults. These disorders substantially impact cognitive function, physical health, and quality of life. This narrative review examines age-related changes in sleep architecture, alterations in circadian rhythm, common sleep disorders, and modifiable behavioral factors in older populations. We searched PubMed, Web of Science, and Google Scholar through December 2025 for studies involving adults aged ≥65 years focusing on sleep patterns, architecture, circadian rhythms, and disorders. Normal aging involves reduced slow-wave and REM sleep, decreased sleep efficiency, increased fragmentation, and circadian amplitude dampening. However, pathological sleep disorders affect substantial proportions: insomnia (20-40%), obstructive sleep apnea (>30%), restless legs syndrome, and REM sleep behavior disorder. Chronic sleep disturbances are associated with elevated risks of cognitive decline, cardiovascular disease, falls, frailty, and mortality. Evidence supports cognitive-behavioral therapy as a first-line insomnia treatment. Emerging dual orexin receptor antagonists show promise with favorable safety profiles. Continuous positive airway pressure remains the standard of care for obstructive sleep apnea, though adherence challenges persist. Sleep may represent a modifiable healthy aging determinant. Distinguishing normal age-related changes from pathological disorders can enable appropriate management. Future priorities include longitudinal studies in the oldest-old, investigations of circadian mechanisms, implementation of behavioral interventions, and equity-focused research across diverse populations.
PMID:41825783 | DOI:10.1016/j.arr.2026.103101