sleepiness is greater than that in late afternoon and evening in more mature adolescents than in younger subjects. With increasing age, the total time spent sleeping decreases, as does REM sleep. However, if bedtime is fixed, the duration of REM sleep remains constant (Carskadon, 1982; Carskadon et al., 1983).

Adults

Sleep architecture continues to change with age across adulthood. Two major attributes of age-related sleep changes are earlier wake time and reduced sleep consolidation (Dijk et al., 2000). A hallmark change with age is a tendency toward earlier bedtimes and wake times. Older adults (approximately ages 65 to 75) typically awaken 1.33 hours earlier, and go to bed 1.07 hours earlier, than younger adults (approximately ages 20 to 30) (Duffy et al., 1998). There are no conclusive studies that demonstrate why older adults experience earlier wake times, despite decreased sleep efficiency, but one hypothesis may be an advanced circadian pacemaker that accompanies age (Dijk et al., 2000). It is unclear if this is due to older adults experiencing an increased sensitivity to light (Dijk et al., 2000; Ancoli-Israel, 2005). Nonetheless, the consequences of an advanced circadian rhythm are a 1-hour advance in body temperature increase in the early morning and misaligned melatonin and cortisol secretion rhythms with the circadian clock (Dijk et al., 2000).

Younger adults may experience brief awakenings, but they are usually minor and occur close to an REM sleep transition; thus, sleep remains relatively consolidated. Arousal occurring mostly from REM sleep in young adults suggests that there is a protective mechanism to keep from awakening during NREM sleep; however, this protective effect appears to also decline with age (Dijk, 1998). As an individual ages (between the ages of 20 to 60), SWS declines at a rate of about 2 percent per decade (Figure 2-6) (Dijk et al., 1989; Astrom and Trojaborg, 1992; Landolt et al., 1996; Ancoli-Israel, 2005). Because arousal thresholds are typically highest during SWS, and because SWS declines with age, older adults experience more frequent awakenings during a sleep episode. Another important variable may be an age-related reduction both in homeostatic sleep pressure and circadian pacemaker effectiveness during the night (Dijk et al., 2000).

Gender Differences

Although there have been few systematic studies, there appear to be gender-based differences in sleep and circadian rhythms. Available evidence is strongest in adults; however, gender differences have also been observed in infancy (Bach et al., 2000; Moss and Robson, 1970; Hoppenbrouwers et



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