Sleep After 60: How Sleep Changes With Age, and What Helps

Last updated: October 2026

Sleep changes with age in predictable ways: a meta-analysis of 65 studies covering 3,577 healthy people found total sleep time, sleep efficiency, and deep sleep all decline through adulthood, while time awake during the night rises (Ohayon et al., 2004). Activity helps, since in a review of 14 studies in adults 60 and over, all but one physical activity program improved at least one sleep outcome (Vanderlinden et al., 2020). Below is what changes, what helps, how sleep position shifts with age, and where pillow height comes in.

Key takeaways

Across 65 studies of 3,577 healthy people, total sleep, sleep efficiency, and deep sleep declined with age (Ohayon et al., 2004).
In 14 studies of adults 60 and over, all but one activity program improved at least one sleep outcome (Vanderlinden et al., 2020).
A Pillowise fitting takes three measurements (shoulder width, neck circumference and neck length) and adds sleeping position and bed type to choose from seven sizes.

How does sleep change with age?

A meta-analysis pooled 65 studies that recorded sleep in a lab or with activity monitors in 3,577 healthy people aged 5 to 102 (Ohayon et al., 2004).

Through adulthood, total sleep time, sleep efficiency, the share of deep slow wave sleep, and the share of REM sleep all declined with age. Time to fall asleep, the share of lighter sleep stages, and time awake after first falling asleep all increased.

These are averages for healthy people, not predictions for any one person.

What changes after 60?

In the same analysis, most sleep measures stopped changing much after age 60. Sleep efficiency, the share of time in bed actually spent asleep, was the one measure that kept declining (Ohayon et al., 2004).

That gives a useful frame for older patients: more time awake in bed is common with age, and it is worth asking about rather than assuming.

Can activity help older adults sleep?

A systematic review looked at 14 physical activity programs in generally healthy adults 60 and over, with average ages from 64 to 76 (Vanderlinden et al., 2020).

All but one study found at least one significant improvement in sleep. Effect sizes ranged from 0.34 to 1.55, and programs of moderate intensity three times a week for 12 weeks to 6 months showed the most improvements. Tai chi, Baduanjin, and yoga were common program types.

Eight of the 14 studies had no control group, so the evidence is encouraging rather than settled.

Does sleep position change with age?

In motion-sensor recordings of 664 working adults, time spent sleeping on the side increased with age and with body mass index (Skarpsno et al., 2017).

Side sleeping puts the shoulder between the head and the mattress. That makes pillow height a more personal question as people age.

What does pillow height change?

In a radiographic study of 16 adults, raising the pillow from 0 to 10 to 20 cm increased T1 slope and C2-7 Cobb angle while neck tilt decreased (Kim et al., 2015). A crossover study of 10 healthy participants paired with finite element modeling measured how heights from 110 to 170 mm shift pressure across the head and neck (Ren et al., 2016).

In a pilot EMG study of 15 adults lying on their side, the height matched to shoulder width produced the lowest neck and shoulder muscle activity (Jiao et al., 2025).

Why do generic pillows miss?

A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009). No single optimal pillow height can be specified, because it depends on four variables that differ from person to person: cervical alignment, body dimension, contact pressure, and muscle activity (Lei et al., 2021).

What we measure

Pillowise is a fitted cervical pillow that licensed healthcare providers measure and dispense, made in seven sizes.

Our sleep specialists take three measurements: shoulder width, neck circumference, and neck length. Combined with sleeping position and bed type, an algorithm identifies the best-fitting pillow from seven sizes.

Shoulder width is the measurement the EMG study found mattered most. A height matched to it produced the lowest neck and shoulder muscle activity during side sleeping (Jiao et al., 2025), and body dimension is what drives the individual optimum (Tian et al., 2025).

A systematic review of 11 studies covering 309 participants identified a 7 to 11 cm unloaded central height among the parameters supporting spinal alignment and sleep comfort (Radwan et al., 2021). The size is chosen from those three measurements plus sleeping position and bed type, rather than from a single stock height.

Pillowise pillows are made from premium Dutch memory foam and certified to OEKO-TEX Standard 100, meaning every component has been tested against the standard's limits for harmful substances.

Scope

The aging studies measured sleep and activity, not pillows, and the pillow height studies enrolled mostly young adults. No study has tested whether a fitted pillow changes sleep in older adults, and we make no such claim. The most recent systematic review found no clear advantage for any pillow type in chronic neck pain (Ghosh et al., 2025).

For providers

Older patients often accept poor sleep as part of aging. Asking how long they spend awake in bed, and how active they are, opens a conversation the research supports.

As side sleeping becomes more common with age, ask which position the patient holds longest and what they sleep on.

A fitted pillow extends the work of the visit into the hours between visits, alongside the exercise, manual therapy, and other care the provider is already delivering.

Common questions

Is it normal to sleep less as you get older?

Some change is expected. Across 65 studies of healthy people, total sleep time, sleep efficiency, and deep sleep declined through adulthood, and after 60 sleep efficiency was the measure that kept falling (Ohayon et al., 2004).

Does exercise help older adults sleep?

The evidence is encouraging. In 14 studies of adults 60 and over, all but one activity program improved at least one sleep outcome, with moderate-intensity programs three times a week showing the most improvements (Vanderlinden et al., 2020).

Do older adults sleep on their side more?

In motion-sensor recordings of 664 working adults, time on the side increased with age and body mass index (Skarpsno et al., 2017).

Is a contoured pillow from a store enough?

Not reliably. A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009), and no single optimal height can be specified because it depends on four variables that differ from person to person (Lei et al., 2021). A contour helps only if its height matches the person using it. That is what the fitting settles, in a provider's office.

Find a Pillowise provider or become one

Pillowise pillows are clinically measured and dispensed exclusively through licensed healthcare providers as part of broader sleep, posture, and recovery education.

To locate a Pillowise provider near you, visit: Find a Reseller

Licensed healthcare providers interested in offering Pillowise may register here: Become a Reseller

References

Ghosh, S. K., Goyal, M., & Goyal, K. S. (2025). Effect of pillow on pain, disability and sleep quality in patients with chronic neck pain: A systematic review. Rehabilitación, 59(3), 100922. https://doi.org/10.1016/j.rh.2025.100922

Gordon, S. J., Grimmer-Somers, K., & Trott, P. (2009). Pillow use: The behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy, 14(6), 671-678. https://doi.org/10.1016/j.math.2009.02.006

Jiao, R., Xiao, W., Wang, M., Yu, S., & Li, H. (2025). The impact of pillow height on neck muscle activity: A pilot study. Sleep and Breathing, 29(1), 40. https://doi.org/10.1007/s11325-024-03219-6

Kim, H. C., Jun, H. S., Kim, J. H., Ahn, J. H., Chang, I. B., Song, J. H., & Oh, J. K. (2015). The effect of different pillow heights on the parameters of cervicothoracic spine segments. Korean Journal of Spine, 12(3), 135-138. https://doi.org/10.14245/kjs.2015.12.3.135

Lei, J.-X., Yang, P.-F., Yang, A.-L., Gong, Y.-F., Shang, P., & Yuan, X.-C. (2021). Ergonomic consideration in pillow height determinants and evaluation. Healthcare, 9(10), 1333. https://doi.org/10.3390/healthcare9101333

Ohayon, M. M., Carskadon, M. A., Guilleminault, C., & Vitiello, M. V. (2004). Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: Developing normative sleep values across the human lifespan. Sleep, 27(7), 1255-1273. https://doi.org/10.1093/sleep/27.7.1255

Radwan, A., Ashton, N., Gates, T., Kilmer, A., & VanFleet, M. (2021). Effect of different pillow designs on promoting sleep comfort, quality, & spinal alignment: A systematic review. European Journal of Integrative Medicine, 42, 101269. https://doi.org/10.1016/j.eujim.2020.101269

Ren, S., Wong, D. W.-C., Yang, H., Zhou, Y., Lin, J., & Zhang, M. (2016). Effect of pillow height on the biomechanics of the head-neck complex: Investigation of the cranio-cervical pressure and cervical spine alignment. PeerJ, 4, e2397. https://doi.org/10.7717/peerj.2397

Skarpsno, E. S., Mork, P. J., Nilsen, T. I. L., & Holtermann, A. (2017). Sleep positions and nocturnal body movements based on free-living accelerometer recordings: Association with demographics, lifestyle, and insomnia symptoms. Nature and Science of Sleep, 9, 267-275. https://doi.org/10.2147/NSS.S145777

Tian, S., Yao, C., Wang, Y., Cao, X., Sun, Y., Wang, L., & Fan, Y. (2025). The individualized optimal pillow height and neck support design for side sleepers. Medical and Biological Engineering and Computing, 63(2), 535-544. https://doi.org/10.1007/s11517-024-03204-x

Vanderlinden, J., Boen, F., & van Uffelen, J. G. Z. (2020). Effects of physical activity programs on sleep outcomes in older adults: A systematic review. International Journal of Behavioral Nutrition and Physical Activity, 17, 11. https://doi.org/10.1186/s12966-020-0913-3