Daytime Napping: Elders And Their Sleep Patterns Explained

As people age, their sleep patterns change. Older people tend to sleep more lightly and wake up more frequently during the night due to achy joints or the need to use the bathroom. Many compensate for this lost sleep by taking a nap during the day. This is normal.

However, it becomes a problem when an older person spends most of the day dozing instead of engaging in life. People with dementia are especially prone to this type of daytime sleeping.

Boredom, depression, chronic pain, nutritional deficiencies, and medication can be underlying causes of excessive daytime sleeping. Medication can be a problem, with atypical (second-generation) antipsychotics being notoriously bad for elderly patients.

If an older person is sleeping all day, it's important to determine the cause. A doctor can help rule out depression, pain, vitamin deficiencies, or medication as the root of the problem.

Sleep disorders and dementia: People with dementia often sleep a lot during the day. This can be due to breathing issues, confusion, nightmares, hallucinations, and acting out dreams

Sleep disturbances are common in people with dementia, and these can manifest as sleeping a lot during the day. This can be due to a variety of factors, including breathing issues, confusion, nightmares, hallucinations, and acting out dreams.

Breathing Issues

Obstructive sleep apnea (OSA) is a common condition in people with dementia, especially Alzheimer's disease. OSA occurs when the muscles in the throat relax during sleep, blocking the airways and causing hypoxia (lack of oxygen in the brain). This results in fragmented sleep and can lead to cognitive issues, such as problems with focus, decision-making, and motor movements.

Confusion

People with dementia often experience a shift in their sleep-wake cycle, feeling sleepy during the day and awake at night. This is known as a circadian rhythm problem and is associated with changes in the brain, specifically the hypothalamic suprachiasmatic nucleus, which regulates circadian rhythms.

Nightmares

Some medications and polypharmacy can interfere with sleep and cause nightmares. Medication schedules should be adjusted to prevent sleep problems. Anticholinergic medications, for example, have been linked to an increased risk of Alzheimer's disease and can cause nightmares.

Hallucinations

Dementia, particularly dementia with Lewy bodies, is associated with hallucinations. Visual hallucinations are the most common type, but hallucinations can also involve other senses, such as hearing, smell, touch, and taste. Hallucinations can be distressing and lead to fear and confusion.

Acting Out Dreams

Acting out dreams while sleeping, known as REM sleep behavior disorder (RBD), is a strong predictor of dementia with Lewy bodies in men. This disorder is caused by a loss of the normal muscle paralysis that occurs during REM sleep, allowing people to physically act out their dreams, sometimes violently. RBD can appear decades before a diagnosis of dementia with Lewy bodies.

Depression: Depression is not a normal part of ageing and can cause excessive fatigue

Depression is not a normal part of ageing. While it is true that older people may experience a decline in their energy levels, depression is a serious mental health issue that requires attention and should not be dismissed as a normal part of getting older.

Depression can be triggered by a variety of factors, such as boredom, a loss of purpose, medication changes, the death of loved ones, inability to engage in activities they once enjoyed, family difficulties, loneliness, and other challenges. It is a condition that can be effectively treated with medical attention, therapy, and support from loved ones.

Older adults may experience a decrease in their quality of sleep, which can lead to excessive daytime sleepiness. This can be caused by various factors, including changes in their body's internal clock, hormonal changes, and decreased production of melatonin with age. Additionally, older individuals often suffer from multiple medical conditions, such as pain, osteoarthritis, chronic obstructive pulmonary disease, congestive heart failure, and nocturia, which can disrupt their sleep. The side effects of medications used to treat these conditions can also contribute to sleep disturbances.

It is important to note that excessive daytime sleepiness in older adults may be a symptom of underlying health issues, such as sleep apnea, cognitive impairment, or cardiovascular problems. Therefore, if you notice your elderly loved one sleeping a lot during the day, it is crucial to consult a doctor to identify any potential health concerns and ensure they receive proper care.

Medication: Elders may be managing multiple health conditions with different medications, which may have undesirable side effects like sleepiness

Medication can be a significant factor in elders sleeping a lot during the day. Elders often have to manage multiple health conditions, and polypharmacy is increasingly common among older adults. The average senior takes between four and five separate medications, and almost 40% of adults over the age of 65 take five or more medications.

Many of these medications can have sleepiness as a side effect. For example, the following types of drugs can cause fatigue or drowsiness:

• Allergy medications (antihistamines)
• Antidepressants, particularly tricyclics
• Anxiety medications, such as benzodiazepines
• Blood pressure medications, especially beta-blockers
• Gut medications
• Muscle relaxants
• Opioid pain medications
• Seizure or epilepsy medications (anticonvulsants)
• Antipsychotics
• Antinausea medications
• Cancer treatment medications
• High cholesterol medications, such as statins and fibrates
• Heart medications, such as beta-blockers, calcium channel blockers, diuretics, and renin inhibitors
• Proton pump inhibitors (PPIs)

It is important to note that the sedating effect of some medications, such as tricyclic antidepressants, tends to wear off within the first few weeks. Additionally, the side effect of drowsiness may go away over time as the body adjusts to the medication.

If an elder is experiencing sleepiness as a side effect of their medication, it is recommended that they do not stop taking the medication but instead consult their doctor. The doctor may suggest taking the medication at a different time, such as in the evening or before bed, or prescribe a different medication.

Chronic pain: Aches and pains can make it difficult to get comfortable and result in poor sleep quality

Sleep and pain have a bidirectional relationship, with sleep loss often causing heightened sensitivity to pain. This relationship is particularly evident in those with chronic pain, who may experience a self-perpetuating cycle of pain, insomnia, and depression or anxiety.

The Impact of Chronic Pain on Sleep

Chronic pain can affect sleep in different ways, depending on the nature of the pain. Some conditions may flare up at night or be aggravated by certain sleeping positions. Others may cause persistent pain that does not ease at night. Those with chronic pain may also experience frequent nighttime wakings, which can lead to less restful sleep and next-day tiredness.

The Impact of Sleep on Chronic Pain

Poor sleep can increase pain sensitivity and make it harder to cope with pain. Sleep loss can also cause inflammation in the immune system, which may further exacerbate pain. Additionally, sleep problems have been identified as a risk factor for developing musculoskeletal pain.

Coping Strategies for Better Sleep

• Make sleep a priority and develop a healthy relationship with it.
• Practice deep breathing, mindfulness techniques, or guided imagery to reconceptualize pain.
• Follow good sleep hygiene practices, such as getting enough sunlight, exercising early in the day, and maintaining a healthy diet.
• Avoid stimulants like screens, caffeine, or alcohol close to bedtime.
• Establish a bedtime routine and stick to a consistent sleep schedule.
• If you can't fall asleep, get up and go to another room, and distract yourself until you feel sleepy again.

Lifestyle changes: Retirement, loss of independence, and social isolation can cause stress and anxiety, contributing to sleep issues

Retirement, loss of independence, and social isolation can cause stress and anxiety, which can contribute to sleep issues in older adults. Here are some ways in which these lifestyle changes can impact sleep:

Retirement

Retirement often leads to a less structured sleep-wake schedule, which can disrupt an older adult's sleep patterns. Without the routine of a work schedule, retirees may find it challenging to maintain a consistent sleep routine, leading to sleep disturbances.

Loss of Independence

Loss of independence, such as the need for assisted living or reduced mobility, can impact an older adult's sleep. For example, older adults living in nursing homes experience extremely fragmented sleep due to environmental factors such as noise, light exposure, and a lack of physical activity. Additionally, the use of sedative-hypnotic medications, which are commonly prescribed to older adults, can have adverse effects on sleep quality and may increase the risk of falls.

Social Isolation

Social isolation and loneliness are associated with higher risks of various physical and mental health conditions, including sleep problems. Older adults who live alone or feel lonely may experience increased sleep disturbances and reduced sleep quality. Social isolation can also lead to a sense of boredom and a lack of purpose, triggering depression and further contributing to sleep issues.

It is important to note that social isolation and loneliness are distinct but related concepts. Social isolation refers to having little or no social interaction with others, while loneliness is the subjective feeling of being alone or separated from others. Addressing these issues through social engagement and support from family and friends can help improve sleep quality in older adults.

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