Sleeping Seniors: Is It Normal Or A Concern?

As people age, they tend to sleep more lightly and wake up during the night due to achy joints or the need to use the restroom. Many seniors compensate for this lost sleep by taking a nap during the day. This is normal. However, daytime sleepiness in the elderly becomes a problem when a person spends most of their time dozing instead of engaging in life. If you want an older adult to stay awake more during the day and sleep better at night, you need to find out the underlying reason for their excessive napping.

There are several reasons why an elderly person might sleep all the time:

- Boredom and lack of engagement: As people age, they may develop chronic health conditions and experience age-related changes that prevent them from doing the things they enjoy. Elders may not be clinically depressed, but with no schedule to keep and not much to look forward to in their lives, they slide into the habit of napping throughout most of the day.

- Polypharmacy: Older individuals metabolise medications differently to their younger counterparts, meaning they are more susceptible to adverse effects like drowsiness and dizziness.

- Depression and low energy: Sleep issues and fatigue may indicate changes in a loved one's mental health.

- Alzheimer’s disease or other forms of dementia: Dementia patients often experience issues with circadian rhythms and temporal awareness, making it difficult for them to sleep through the night and keep a normal schedule.

- Serious medical conditions: Excessive sleeping in individuals with one or more serious medical conditions can indicate that their health has deteriorated.

Boredom and lack of engagement

Boredom and a lack of engagement can have serious repercussions on the mental and physical health of seniors. As people age, they may develop chronic health conditions and experience age-related changes that prevent them from doing the things they once enjoyed. This can take a serious toll on their quality of life, leaving them incredibly bored and fatigued.

Seniors who are bored may not be clinically depressed, but they can experience similar symptoms such as frustration, restlessness, dissatisfaction, and low mood. Boredom can also lead to unhealthy behaviours such as overeating, smoking, and excessive alcohol consumption, which can further exacerbate existing health conditions.

To combat boredom in seniors, it is important to encourage regular social interaction and engagement in meaningful activities. This can include joining senior groups or classes, participating in local events, trying new hobbies, volunteering, or accessing virtual activities and classes online.

• Social Connection: Encourage regular communication with loved ones and friends. Joining senior groups, participating in community events, or taking part in virtual activities can also help foster social connections and reduce loneliness.
• Mental Stimulation: Provide opportunities for mental stimulation through activities such as reading, learning a new skill or hobby, playing games, or participating in virtual classes. These activities can help keep the mind active and support cognitive health.
• Variety and Novelty: Introduce variety and novelty into daily routines. Trying new activities or exploring new places can stimulate the brain and promote neuroplasticity, which refers to the brain's ability to adapt and reorganise itself.
• Physical Activity: Encourage regular physical activity such as walking, cycling, swimming, or participating in sports. Physical activity can improve cardiovascular health, muscle tone, balance, and overall physical well-being. It can also help reduce the risk of chronic conditions associated with a sedentary lifestyle.
• Creative Outlets: Encourage seniors to engage in creative activities such as painting, writing, or learning a new skill. Creative outlets can provide a sense of accomplishment and improve mental well-being.
• Purpose and Fulfillment: Help seniors find a sense of purpose and fulfillment through activities such as volunteering, joining a club, or taking a class. These activities can provide social interaction and personal growth, leading to improved self-esteem and overall mental health.
• Routine: Establish a daily or weekly routine that includes a variety of scheduled activities. A structured routine can provide a sense of purpose and make it easier for seniors to stay engaged and active.
• In-Home Caregivers: In-home caregivers can play a crucial role in keeping seniors engaged and active. They can assist in organising daily activities, ensuring a balanced routine that includes physical exercise, mental stimulation, and social interaction.

By addressing boredom and lack of engagement in seniors, we can help improve their overall quality of life, mental health, and physical well-being. It is important to tailor activities to the individual's interests and abilities, ensuring they remain active, socially connected, and mentally stimulated as they age.

Polypharmacy

The use of multiple medications can also increase the risk of drug-drug interactions, where one medication affects another, and drug-disease interactions, where taking a medication for one health problem makes another health problem worse. Polypharmacy can also create a burden for patients and their families, who need to understand the purpose of multiple prescriptions, manage refills, and be aware of potential side effects.

To manage polypharmacy, it is recommended to have regular check-ups and medication reviews with a healthcare practitioner. This can help identify potentially unnecessary medications and reduce the risk of adverse effects and financial hardship. It is also important to consider the patient's goals and priorities regarding their health and well-being.

Additionally, older adults are at a higher risk of sleep disorders, which can further impact their health and quality of life. Sleep apnea, for example, can cause breathing pauses during sleep, leading to fragmented sleep and oxygen level issues in the body. This can result in headaches, daytime sleepiness, and cognitive issues. Other sleep disorders, such as insomnia and restless leg syndrome, can also contribute to excessive daytime sleepiness in older adults.

Depression and low energy

Depression can cause low energy for a variety of reasons. It could be that a person is not sleeping well, either too little or too much. They may be eating junk food because they have no desire to cook healthy food. They may be smoking or drinking more to cope. Depression can also lead to social isolation and withdrawal, meaning a person no longer exercises. Even the medication used to treat depression can deplete energy levels.

There are several ways to improve depression and energy levels. Firstly, it's important to rule out any other conditions that may be causing low energy. If medication is being taken, it may be a case of adjusting dosages or changing the type of drug. Sometimes, taking antidepressants at a different time of day can improve sleep, which will, in turn, improve daytime energy levels.

It's also important for people experiencing depression to get up and get dressed in the morning. Showering and cleaning teeth can be an energizing way to start the day. Completing a morning ritual can be exhausting for someone with depression, but it will get the body moving and will give the person energy to get through the day.

Eating a healthy, balanced diet is important for maintaining normal health and energy levels, but this can be a difficult task for someone with depression. Eating smaller portions, little and often, can help. If nothing appeals, try some favorite foods from childhood. Once a person starts eating properly, their energy levels will rise, and their body will be able to start healing.

Even gentle exercise will encourage blood and oxygen to flow to the brain, aiding mental health. Endorphins released during exercise are well-known mood enhancers. Activities like tai chi, qi gong, yoga, and Pilates focus on breathing and can be calming for people with depression.

It's important to rest, too, so take time out to listen to music, read, or watch TV. A short nap can restore energy levels, but it's important not to go back to bed—separate sleep from rest.

Dementia

Seniors with dementia often experience changes in their sleep patterns, with many sleeping more during the day and at night. This is more common in the later stages of the disease as the damage to their brain becomes more extensive, and they become weaker and frailer. As a result, they may find simple tasks exhausting, leading to increased daytime sleep.

Additionally, the type of dementia can also influence sleep. For example, those with dementia caused by Lewy bodies or Parkinson's disease often experience sleep disturbances at night and sleep more during the day.

Medications can also contribute to sleepiness, including some antipsychotics, antidepressants, antihistamines, and sleeping pills. Sleeping disorders unrelated to dementia, such as sleep apnoea, can also play a role.

While sleeping more is generally not a cause for concern in the later stages of dementia, sudden changes in sleep patterns or excessive sleeping may indicate an underlying issue, such as an infection or medication side effects, and should be discussed with a doctor.

Terminal illness

Insomnia is a common problem, where patients have difficulty falling or staying asleep, or don't feel rested after sleeping. This can lead to excessive daytime sleepiness, which in turn can cause unintentional napping. Insomnia may be caused by various factors, including depression, psychological distress, medical conditions, medications, and circadian rhythm disturbances.

Disorders of the sleep-wake cycle can occur when a patient's sleep is disrupted by a noisy environment, distressing symptoms, or worries. This can lead to reduced activity during the day and contribute to a cycle of disturbed sleep.

Excessive daytime sleepiness is characterised by difficulty staying awake during the day and is different from the tiredness and fatigue commonly experienced by those with a terminal illness.

There are several factors that can contribute to sleep problems in patients with terminal illnesses:

• Restless leg syndrome, a common condition of the nervous system
• Bladder or bowel symptoms
• Anxiety, worries, spiritual concerns, and distress
• Reduced activity during the day
• Medication, such as steroids and some antidepressants
• Respiratory problems, such as breathlessness, cough, or obstructive sleep apnoea
• Consumption of caffeine, nicotine, or alcohol
• Withdrawal from medicines or substances, such as nicotine or alcohol
• Uncontrolled symptoms, such as sweating and itch
• Environmental conditions, such as noise and light levels, and visitors staying late

Practical steps can be taken to encourage good quality sleep for patients with terminal illnesses:

• Encourage a regular sleep schedule, including avoiding naps during the day
• Encourage physical activity during the day, if possible
• Ensure the patient is comfortable and that pain and other symptoms are well-controlled
• Ask visitors not to stay too late, as the patient may find it tiring
• Set up a quiet, calm, and comfortable sleeping environment, using earplugs and eye masks if necessary
• Avoid electronic devices before bed
• Encourage relaxation techniques, such as listening to music or deep breathing
• Avoid caffeine, nicotine, or alcohol before bed
• Suggest sleep apps or podcasts designed to aid sleep
• Offer emotional support and relaxation therapies, such as aromatherapy, massage, or hypnotherapy
• Review medications that may be contributing to sleep problems
• Arrange further assessment or prescribe appropriate medications

Towards the end of life, patients may become more drowsy and sleep more. They may withdraw and spend more time sleeping, answering questions slowly or not at all, and showing less interest in their surroundings. They may still be able to hear, so family members are encouraged to continue talking to them.

Frequently asked questions