This post is part of our Vital 8 Healthy Aging Series — a blog series exploring the key areas of health that shape how well we age, and what we can do about them today.
Vital 8 Healthy Aging Series — Part 5
Author: Kara Welke, OTD, OTR/L, CLT and Jada Welke, OTD, OTR/L
– Part 1: How Strong Is Your Body Battery?
– Part 2: The Missing Checkup: Why We Test Everything Except the Brain
– Part 3: The Core of Everything: Why Pelvic Floor Health Belongs in Every Aging Conversation
– Part 4: Beyond Standing on One Foot: Why Most Balance Training Is Not Enough
We use the phrase “sleeping like a baby” to describe the best sleep imaginable — deep, restorative, uninterrupted. But why do we accept that this kind of sleep should stop being possible as we get older?
You spend roughly one-third of your life asleep. During that time, your body clears toxic waste from your brain, regulates hormones that control hunger and weight, repairs tissue, consolidates memories, and resets your immune system.
Yet almost no one is assessing sleep as part of routine health care. Your doctor checks blood pressure, cholesterol, blood sugar, and heart rate at every visit. But sleep — which directly influences every single one of those numbers — rarely gets more than a passing question.
A national survey found that approximately 30% of people with sleep problems reported their doctor never asks about sleep. Sleep disorders cost the U.S. an estimated $411 billion per year, and people with diagnosed sleep disorders spend nearly $7,000 more per year on health care.
And the damage starts long before age 65. Sleep problems in your 40s and 50s are not just an inconvenience — they are silently contributing to conditions that will not show up for decades. That is why the Vital 8 Framework includes sleep as a core domain and why assessment should begin in midlife, not after problems become severe.
Your Brain Cleans Itself During Deep Sleep — And Only During Deep Sleep
The brain has its own waste-clearance system called the glymphatic system. During deep sleep, cerebrospinal fluid flushes out toxic proteins — including beta-amyloid and tau, the proteins that build up in Alzheimer’s disease.
A 2025 study in Cell identified the exact mechanism: rhythmic fluctuations in norepinephrine during deep sleep drive waves of blood vessel contraction that pump fluid through the brain like a washing machine. During wakefulness, this system is largely shut down.
A study in JAMA Neurology found that people who lost deep sleep over time had significantly higher rates of dementia — and the decline in deep sleep often began years before any cognitive symptoms appeared.
If you read Part 2 of this series on cognitive health, this connection should sound familiar. Poor sleep accelerates cognitive decline, and cognitive decline worsens sleep. Catching sleep problems early — in midlife — is one of the most powerful ways to protect your brain for the decades ahead.
Poor Sleep Does Not Just Make You Tired — It Makes You Sick
Research now links insufficient or disrupted sleep to virtually every major chronic disease:
Can poor sleep cause diabetes? Yes. Poor sleep quality is associated with a 40% increased risk of type 2 diabetes. Sleep restriction impairs insulin sensitivity within just days — even in healthy adults. The American Diabetes Association’s 2026 Standards of Care now formally recognize sleep as a diabetes risk factor.
Can poor sleep cause weight gain? Yes — even if you are eating well. Sleep deprivation suppresses leptin (fullness) and increases ghrelin (hunger), driving cravings for high-calorie foods. Research confirms a causal link between short sleep and obesity.
Can poor sleep cause heart disease? Yes. Both short sleep and insomnia are linked to hypertension, coronary heart disease, stroke, and atrial fibrillation. The American Heart Association now includes sleep as an essential cardiovascular health metric.
Can poor sleep weaken your immune system? Yes. Even short-term sleep loss activates inflammatory pathways and impairs vaccine responses, triggering the kind of chronic inflammation linked to diabetes, atherosclerosis, and neurodegeneration.
How many people are being treated for these conditions while the underlying sleep problem has never been assessed?
→ Think your sleep might be affecting your health? The Vital 8 Assessment evaluates sleep alongside 7 other domains that influence how well you age. Call us at (218) 230-2171 or you may book online to get started.
Poor Sleep Is Not a Normal Part of Aging — Stop Accepting It
This may be the most important section of this entire post.
One of the most damaging misconceptions is that poor sleep just happens as you get older. That waking up multiple times a night is inevitable. That needing a daily nap means your body just needs more rest now.
It does not.
Research shows that abnormal sleep habits in older adults are often mistaken as typical aging and go unaddressed, allowing problems to worsen. Nearly half of adults over 60 have difficulty initiating and maintaining sleep. But “common” does not mean “normal” — and it does not mean untreatable.
What about napping? Brief naps can be protective. But needing a daily nap to get through the day often signals that nighttime sleep is inadequate. Research shows excessive napping is associated with increased mortality risk. If you cannot function without a nap, that is a signal worth investigating — not accepting.
The real problem is timing. By the time most people seek help for sleep — typically well past 65 — the damage has been accumulating for decades. Sleep problems in midlife contribute to cognitive decline, metabolic disease, cardiovascular risk, and functional loss that become much harder to reverse later. Waiting until retirement age to address sleep is like waiting until your engine seizes to check the oil.
The goal should be the same at 70 as it is at 30: restorative, consistent sleep that leaves you refreshed and ready for the day. Sleeping like a baby should not be something you give up. It should be something you protect — starting now.
Effective Treatments Exist — Without the Risks of Medication
Sleep medications carry real risks, particularly for older adults. Research has linked sleep medication use to a 48% increase in dementia risk. Many also increase fall risk, impair cognition, and cause daytime drowsiness.
The good news: non-pharmacological interventions often work better than medications — without the side effects.
A 2026 systematic review of 34 randomized controlled trials found that cognitive behavioral therapy for insomnia (CBT-I) was the most effective non-drug intervention for sleep quality in older adults. CBT-I addresses the thoughts, behaviors, and routines that perpetuate poor sleep.
Other evidence-based approaches include exercise programs, structured sleep routines, environmental modifications, and addressing the underlying factors disrupting sleep — pain, medications, mood, nutrition, pelvic floor issues, and activity levels. These are interventions occupational and physical therapists deliver every day.
Why Sleep Cannot Be Fixed in Isolation
Sleep may be the most interconnected domain of all — which is exactly why assessing it alone is not enough:
– Sleep and cognition: Deep sleep consolidates memories and clears toxic proteins. Disrupted sleep accelerates cognitive decline ([Part 2]).
– Sleep and balance: Fatigue impairs reaction time and postural control — the reactive balance that prevents real-world falls ([Part 4]).
– Sleep and strength: Growth hormone is released during deep sleep. Chronic sleep loss promotes muscle loss and reduces the physical reserve from [Part 1].
– Sleep and pelvic floor: Nighttime bathroom trips fragment sleep. Treating pelvic floor dysfunction reduces nocturia and improves sleep ([Part 3]).
– Sleep and mood: Poor sleep is both a cause and symptom of depression. Addressing sleep often improves mood before other interventions begin.
– Sleep and medications: Many common medications disrupt sleep. A comprehensive review can reveal culprits hiding in plain sight.
– Sleep and nutrition: Meal timing, caffeine, alcohol, and nutritional deficiencies all influence sleep — and poor sleep drives cravings, creating a cycle.
A sleep problem is rarely just a sleep problem. And fixing sleep often improves conditions that seemed completely unrelated.
→ Sleep connects to everything. The Vital 8 assesses all 8 domains together — so nothing gets missed. Call us at (218) 230-2171 or you may book online to schedule your assessment.
Why Sleep Is a Core Domain of the Vital 8
The Vital 8 Framework was built on one principle supported by decades of research: multi-component assessment and intervention produces better outcomes than addressing any single area alone.
Sleep is one of eight core domains assessed in the Vital 8 — alongside strength, cognition, balance, mood, medications, nutrition, and home safety. The sleep assessment uses a validated, multidimensional measure that evaluates far more than hours slept — it captures consistency, satisfaction, daytime alertness, timing, efficiency, and duration.
But the real value is in what happens next. Sleep findings are interpreted alongside every other domain. If someone sleeps poorly, the Vital 8 helps identify whether the root cause is pain, medications, mood, pelvic floor issues, environmental factors, nutritional habits, or some combination — and then provides targeted, evidence-based recommendations.
And critically, the Vital 8 is designed to begin in midlife — not after age 65. The research is clear that sleep problems, like cognitive decline, strength loss, and balance deficits, are far more modifiable when caught early. Waiting for a crisis is reactive care. The Vital 8 is proactive care.
Take the First Step
The Vital 8 Framework is a comprehensive, evidence-based healthy aging assessment developed in collaboration with the University of North Dakota Department of Geriatrics and informed by research accepted for presentation at both the Gerontological Society of America and the American Geriatrics Society.
Home Therapy Solutions is the only recognized Age-Friendly therapy practice in the Grand Forks area.
The Vital 8 Assessment is available as a private-pay wellness service for those with no current medical concerns. If the assessment identifies areas of concern, follow-up treatment may be covered by insurance.
→ Ready to find out how your sleep is affecting the rest of your health? Call us at (218) 230-2171 or you may book online to book your Vital 8 Assessment today.
Sleeping like a baby should not be something you outgrow. It should be something you fight to keep — starting today.
Frequently Asked Questions
Is poor sleep a normal part of aging?
No. While some sleep pattern changes occur with age, significant sleep disruption is not inevitable. Research shows untreated sleep problems worsen over time and contribute to cognitive decline, falls, depression, diabetes, and cardiovascular disease. Effective, non-medication treatments exist at every age.
Should I be napping every day?
Not necessarily. Brief naps can be beneficial, but needing a daily nap to function often signals inadequate nighttime sleep. Research shows excessive napping is associated with increased mortality risk. If you depend on naps, that is worth investigating.
How does sleep affect brain health?
During deep sleep, the brain’s glymphatic system flushes out toxic proteins linked to Alzheimer’s disease. This system is largely inactive during wakefulness. Loss of deep sleep is associated with significantly higher dementia rates, often years before symptoms appear.
Can poor sleep cause weight gain even if I eat well?
Yes. Sleep deprivation disrupts hunger hormones, increasing appetite and cravings for high-calorie foods independent of diet. Research confirms a causal link between short sleep and obesity.
Are sleep medications safe?
Sleep medication use has been linked to a 48% increase in dementia risk and can increase fall risk and impair cognition. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as first-line treatment and is more effective than medications in systematic reviews.
Why should I worry about sleep in my 40s or 50s?
Sleep damage accumulates over decades. Problems in midlife silently contribute to cognitive decline, metabolic disease, and cardiovascular risk that become much harder to reverse after age 65. Early assessment and intervention are far more effective than waiting for a crisis.
What is a Vital 8 Assessment?
A comprehensive healthy aging assessment covering 8 core domains — including sleep, strength, cognition, balance, mood, medications, nutrition, and home safety. Rather than looking at any one area in isolation, the Vital 8 identifies how all domains interact. It is available as a private-pay wellness service, and if concerns are identified, follow-up treatment may be covered by insurance.
About the Authors
Kara Welke, OTD, OTR/L, CLT, is the founder and CEO of Home Therapy Solutions. She developed the Vital 8 Framework to bring comprehensive, evidence-based healthy aging assessments to adults in midlife and beyond. Kara presents on aging and rehabilitation topics at local, national, and international conferences — most recently at the International Association of Gerontology and Geriatrics (IAGG)— and is actively involved in research advancing proactive approaches to healthy aging.
Jada Welke, OTD, OTR/L, co-developed the Vital 8 Framework during her doctoral capstone at the University of North Dakota. Her research on this multidimensional approach to healthy aging has been accepted for presentation at both the Gerontological Society of America (GSA) and the American Geriatrics Society (AGS) annual conferences.
