Age-related sleep deterioration affects substantial portions of older populations, with insomnia occurring in 20-40% and obstructive sleep apnea exceeding 30% prevalence among adults over 65. Normal aging reduces slow-wave and REM sleep while increasing sleep fragmentation, but these pathological disorders represent distinct threats beyond typical changes. The implications extend far beyond nighttime discomfort. Chronic sleep disturbances create cascading health risks including accelerated cognitive decline, cardiovascular disease, increased fall risk, frailty development, and elevated mortality rates. This positions sleep as a critical modifiable factor in healthy aging trajectories. The review highlights cognitive-behavioral therapy as first-line insomnia treatment, while emerging dual orexin receptor antagonists offer promising alternatives with improved safety profiles compared to traditional sedatives. For sleep apnea, CPAP therapy remains standard care despite ongoing adherence challenges that limit real-world effectiveness. This comprehensive analysis reinforces sleep's role as a cornerstone of successful aging, distinguishable from inevitable decline. The research gaps identified—particularly longitudinal studies in the oldest-old and equity-focused investigations across diverse populations—suggest current interventions may not adequately serve all aging demographics.