Gina Johnson
Sleep patterns change with age, and it is common for older adults to experience changes in the quality and duration of their sleep. Sleep disorders in older adults can involve any disrupted sleep pattern, including problems falling or staying asleep, sleeping too much, or abnormal behaviours with sleep. For instance, people with dementia, especially those in the later stages, can often spend a lot of time sleeping, which can be distressing for their loved ones. If you are concerned about an elderly person in your life who is sleeping too much, it is important to consult a medical professional for advice.
| Characteristics | Values |
|---|---|
| Circadian Rhythm Changes | The body's internal clock, located in the hypothalamus, shifts forward in time as people age, causing them to get tired earlier in the afternoon and wake up earlier in the morning. |
| Sleep-Wake Cycle Disruptions | Older adults may experience problems falling or staying asleep, too much sleep, or abnormal sleep behaviours. |
| Lifestyle Changes | Retirement, loss of independence, and social isolation can contribute to stress and anxiety, impacting sleep quality. |
| Sleep Architecture Changes | Older adults may wake up more frequently during the night, experiencing changes in their sleep structure. |
| Light Exposure | Reduced exposure to bright light, especially in institutionalized elderly patients, is associated with nighttime sleep fragmentation and circadian rhythm disorders. |
| Dementia | People with dementia, especially in the later stages, tend to sleep more during the day and night, possibly due to increased exhaustion from simple tasks. |
| Treatment Options | Bright light therapy, physical activity, social interaction, and medication can help regulate sleep-wake cycles and treat specific sleep disorders. |
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What You'll Learn
Sleep disorders in elderly people with dementia
Sleep disturbances are common in older adults, and these changes are often related to lifestyle and body changes that come with ageing. For instance, retirement can lead to a less structured sleep-wake schedule, and significant life changes can increase stress and anxiety, contributing to sleep issues. As people age, their body's circadian rhythms shift, causing them to get tired earlier in the afternoon and wake up earlier in the morning. This shift is known as a "phase advance".
Older adults with dementia often experience sleep disorders, with approximately one-quarter of adults with dementia suffering from some form of sleep disruption. People with dementia, especially in the later stages, tend to sleep a lot during the day and at night. This increased sleep is a common feature of later-stage dementia as the person's brain becomes more extensively damaged, making even simple tasks exhausting.
There are various sleep disorders that specifically affect older people with dementia. These include sleep-disordered breathing, such as obstructive sleep apnoea, which is more common in people with Alzheimer's disease and vascular dementia. Obstructive sleep apnoea causes the airway to collapse or narrow during sleep, resulting in loud snoring and impaired breathing.
Additionally, people with dementia may experience periodic limb movement disorder, which causes them to unconsciously move their limbs, often their legs and feet, during sleep. This disorder can be caused by certain drugs, such as antidepressants, allergy medications, anti-sickness drugs, and antipsychotics. Restless legs syndrome is also common in people with dementia, particularly those with Lewy bodies or Parkinson's disease dementia. While the cause of this condition is not well understood, treatments include physical activity, massage, acupuncture, and medication.
The treatment of sleep disturbances in older adults with dementia should be guided by the specific sleep disorder present. For example, sleep-disordered breathing can be treated with continuous positive airway pressure, while restless legs syndrome may be treated with a dopamine agonist. Bright light therapy is also beneficial for circadian rhythm disturbances, as light is the strongest cue for circadian entrainment. Maintaining regular physical activity and social interaction can also promote a healthier sleep-wake cycle.
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Circadian rhythm sleep disorders
As people age, their bodies' circadian rhythms shift forward in time, causing them to get tired earlier in the afternoon and wake up earlier in the morning. This is known as a "phase advance". In addition to ageing, circadian rhythm sleep disorders can be caused by genes, medical conditions, lifestyle changes, and environmental factors such as light exposure.
The risk factors for developing circadian rhythm sleep disorders include ageing, genetic predisposition, and medical conditions such as dementia or Alzheimer's disease. Lifestyle changes, such as retirement or institutionalization, can also contribute to the development of these disorders. For example, retirement can lead to a less structured sleep-wake schedule, while institutionalization can result in reduced exposure to bright light, which is a crucial zeitgeber (cue) for regulating sleep-wake cycles.
There are several types of circadian rhythm sleep disorders, including advanced or delayed sleep-wake phase disorder, irregular or non-24-hour sleep-wake rhythm disorder, shift work disorder, and jet lag disorder. Advanced sleep-wake phase disorder involves difficulty staying awake in the early evening and early awakening in the morning, while delayed sleep-wake phase disorder is characterized by falling asleep and waking up later than desired. Non-24-hour sleep-wake rhythm disorder results in bedtimes and wake times gradually shifting later each day, leading to daytime sleepiness. Shift work disorder affects those with variable or overnight work schedules, resulting in disrupted sleep, insomnia, and extreme tiredness. Jet lag disorder occurs when travelling across multiple time zones, causing the sleep-wake cycle to fall out of sync with the local time.
Treatment for circadian rhythm sleep disorders aims to strengthen and entrain the sleep-wake cycle. Bright light therapy is commonly used, as light exposure is the strongest cue for regulating the circadian rhythm. Evening light exposure can delay circadian rhythms, while morning light exposure can advance them. Physical activity and social interaction can also promote a healthier sleep-wake cycle. Medications are sometimes prescribed, but their use should be carefully considered due to the potential for increased sleep disturbances and daytime sleepiness.
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Sleep-wake cycle disruption
The human body's internal clock, located in the hypothalamus region of the brain, typically runs on a sleep-wake cycle of slightly over 24 hours. This internal clock, or suprachiasmatic nucleus (SCN), is influenced by external cues such as daylight, meal times, and physical activity. When these cues are weak or disrupted, it can lead to sleep-wake cycle issues. For example, elderly individuals, especially those in institutional settings, often receive insufficient bright light exposure, which is crucial for entraining the circadian rhythm.
Age-related changes, such as retirement, loss of independence, and social isolation, can also contribute to sleep-wake cycle disruptions. These lifestyle changes can increase stress and anxiety, impacting sleep patterns. Additionally, as people age, their body's circadian rhythms tend to shift forward, resulting in earlier sleep and wake times.
Neurodegenerative diseases, such as Alzheimer's and dementia, are commonly associated with sleep-wake disturbances in older adults. Patients with these conditions may experience insomnia, excessive daytime sleepiness, sudden sleep attacks, and REM behavior disorders. Structural changes in the SCN or alterations in how SCN cells communicate can lead to these disruptions.
To address sleep-wake cycle disruptions, treatments such as bright light therapy, sleep restriction therapy, and medications are often employed. Maintaining regular physical activity and social interaction can also help promote a more robust sleep-wake cycle.
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Lifestyle changes affecting sleep
As people age, they experience various lifestyle changes that can impact their sleep. These changes can be related to retirement, loss of independence, social isolation, and biological factors. Here are some lifestyle changes that can affect the sleep of elderly individuals:
Retirement and Reduced Social Activity: Retirement often leads to a less structured sleep-wake schedule. With more free time, older adults may adopt irregular sleep patterns, take frequent naps, and have more opportunities to sleep during the day. This can disrupt their circadian rhythms and contribute to sleep disturbances.
Loss of Independence and Social Isolation: Significant life changes, such as losing independence or experiencing social isolation, can increase stress and anxiety, negatively impacting sleep quality. Social isolation can also reduce exposure to light, which is crucial for regulating circadian rhythms.
Biological and Health Factors: Aging is associated with a decrease in the production of hormones like melatonin, which is crucial for regulating sleep. Additionally, older adults may experience more health conditions, such as heart disease, diabetes, arthritis, or chronic pain, which can contribute to sleep disruptions.
Changes in Sleep Patterns: As people age, their sleep patterns tend to change. They may find it harder to fall asleep, wake up more frequently during the night, and experience an earlier wake-up time. The transition between sleep and waking up can be more abrupt, and older adults may spend less time in deep sleep.
Increased Napping: Older adults may nap more frequently due to biological and lifestyle changes. However, excessive napping during the day can lead to excessive daytime sleepiness (EDS), which is associated with depression, pain, nocturia (nighttime urination), and other health conditions.
To improve sleep quality, older adults can make lifestyle changes such as maintaining a consistent sleep schedule, avoiding stimulants like caffeine, engaging in regular physical activity, and minimizing exposure to bright light before bed. It is also important to consult a healthcare provider to address any underlying health conditions that may be impacting sleep.
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Sleep medication side effects
Sleep medication can have a variety of side effects, particularly in older adults. Firstly, it is important to note that sleep medication is not recommended for children, and older adults should try non-drug treatments first, as there may be safer ways to improve sleep.
Sleeping pills can cause a range of side effects, including constipation, diarrhoea, muscle weakness, digestive problems, and worsening snoring and sleep apnea. They can also cause a hangover effect, with people feeling drowsy, confused, and dizzy the next day, impacting their ability to complete daily tasks. This can be particularly dangerous for older adults, increasing the risk of falls and hip fractures.
Sleeping pills can also cause parasomnia, a disruptive sleep disorder where people may walk, eat, make phone calls, or even drive while still mostly asleep. This can be dangerous, and parasomnias are difficult to detect once the medication takes effect.
Additionally, sleeping pills can cause memory issues, balance problems, dry mouth, difficulty urinating, decreased sexual drive, and potential weight gain. They can also lead to dependence, with long-term users struggling to sleep without them. Abruptly stopping the medication can cause withdrawal symptoms and worsen insomnia, known as rebound insomnia.
For older adults, poor sleep quality can be related to lifestyle changes that come with aging, such as retirement, loss of independence, and social isolation, which can increase stress and anxiety. Aging also affects the body's internal clock, located in the hypothalamus, influencing when a person feels sleepy or alert. Bright light therapy can be an effective treatment for shifts in the circadian rhythm.
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Frequently asked questions
It is common for older adults to experience changes in the quality and duration of their sleep. This can be due to lifestyle changes, such as retirement, or changes in their body's internal clock.
If your elderly relative is sleeping more and more, it could be a sign of later-stage dementia. It is common for people with dementia to sleep a lot during the day and night as they progress through the stages of the disease.
If you are concerned about your elderly relative's sleep patterns, you should seek advice from a medical professional. They may recommend treatments such as bright light therapy or sleep restriction therapy to improve their sleep-wake cycle.
There are several things you can do to improve your elderly relative's sleep hygiene, including maintaining a consistent sleep schedule, avoiding naps, limiting screen time before bed, and creating a quiet and comfortable sleeping environment.
Sleeping pills can lead to dependence and may make sleep problems worse over time if not used properly. They can also cause side effects, such as severe allergic reactions and dangerous sleep-related behaviors, such as sleep-driving. It is important to discuss the risks and benefits of sleeping pills with a medical professional before use.
