From early awakenings to lighter sleep, ageing changes how we rest. A neurologist explains when disturbed sleep is normal, when it points to disease, and what to do to rest better Sleep often becomes lighter and more fragmented with age, but it can be fixed, say doctors. Lighter sleep, more night-time waking, or early-morning awakenings, many people notice their sleep deteriorating with age. While some of this is part of ageing, experts warn that persistent poor sleep can point to medical issues and is often more treatable than people realize. e older adults struggling with sleep issues and assuming it’s just age,” says Dr Kapil Kumar Singhal, Director of Neurology at Mediante Hospital, Noida. “Ageing does affect the brain’s sleep centers and body clock, but not all poor sleep is normal, and ignoring red flags can mean missing treatable conditions. The body’s internal clock, or circadian rhythm, is controlled by a brain structure called the suprachiasmatic nucleus,” explains Dr Singhal. “With age, this clock weakens and tends to run faster, pushing sleep earlier in the evening and wake-up times earlier in the morning. Add to that shrinking brain cells, reduced melatonin production, and changes in sleep-regulating centers, and the result is lighter, more fragmented sleep and less time spent in deep, restorative stages. As slow-wave sleep declines with age, memory suffers first. Connections in the hippocampus, which is the brain’s memory hub, weaken, increasing forgetfulness and long-term dementia risk. Metabolic health takes a hit too. Less deep sleep raises blood sugar levels and insulin resistance, increasing the risk of type 2 diabetes. Chronic inflammation rises, pushing up the likelihood of heart disease, stroke and Alzheimer’s. Trouble starts when awakenings become frequent, prolonged or exhausting. “If someone is awake for more than 30 minutes most nights, has four or more awakenings, and this causes daytime fatigue or poor concentration for over three months, it meets criteria for insomnia Women face a steeper sleep challenge. “Women are about 1.5 to two times more vulnerable to insomnia after menopause,” says Dr Singhal. Falling oestrogen and progesterone levels trigger hot flashes, night sweats and repeated awakenings, cutting into deep sleep. Hormone replacement therapy (HRT) can help, but selectively. “In women with significant vasomotor symptoms, HRT can reduce night awakenings by nearly 50 per cent,” he says. “But it’s not a universal solution and should be used short-term in carefully selected patients.”
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