Mechanisms of Heat-Induced Sleep Disruption in Aging: A Narrative Review

Rising global temperatures and more frequent heat waves pose a growing threat to public health, particularly among older adults. Age-related declines in thermoregulatory capacity such as reduced sweating, impaired vasodilation, and diminished hypothalamic responsiveness make it more difficult to cope with elevated nighttime temperatures. These thermal challenges disrupt sleep by prolonging sleep onset, fragmenting slow-wave and REM sleep, and suppressing melatonin secretion. Importantly, sex-related differences in thermoregulatory aging-particularly menopause-associated vasomotor instability in women and testosterone-related autonomic changes in men-further modulate individual vulnerability to heat-induced sleep disruption. Beyond sleep, heat-induced stress affects metabolic, cardiovascular, and immune systems, promoting insulin resistance, endothelial dysfunction, sympathetic overactivation, and chronic inflammation. Socioeconomic disparities, urban heat island exposure, and differential access to cooling infrastructure function as critical environmental modifiers that amplify biological vulnerability, particularly in disadvantaged older populations. This narrative review aims to synthesize current knowledge on the specific thermoregulatory mechanisms of sleep disruption induced by heat stress in older adults. Understanding these interactions is crucial for developing effective interventions, including environmental cooling, circadian-aligned behaviors, and targeted public health strategies, to mitigate the compounded risks of heat exposure and preserve healthy sleep in aging populations. However, many proposed mechanistic pathways are primarily derived from animal models, and controlled human studies specifically targeting heat-exposed older adults remain scarce.