Herbie Murray
As people age, they tend to experience changes in the quality and duration of their sleep. Older people may sleep more lightly, wake up more frequently, and experience a decline in the quality of their sleep. This can lead to excessive daytime sleepiness, with seniors taking restorative naps during the day to compensate for lost sleep at night. While increased sleep can be a normal part of aging, it can also be a sign of underlying health issues, such as depression, dementia, or other terminal illnesses. In some cases, excessive sleepiness may be a side effect of medications or a result of changes in the body's internal clock and circadian rhythms. It is important to consult a doctor if you notice significant changes in a loved one's sleep patterns to rule out any potential health concerns.
| Characteristics | Values |
|---|---|
| Sleep duration | Older adults tend to sleep longer than younger adults. |
| Sleep quality | The quality of sleep tends to deteriorate with age, with older adults experiencing less deep or "slow-wave" sleep. |
| Sleep architecture | Older adults spend more time in the earlier, lighter stages of sleep and less time in the later, deeper stages, leading to more frequent waking during the night. |
| Circadian rhythms | The body's circadian rhythms shift with age, causing older adults to get tired earlier in the afternoon and wake up earlier in the morning. |
| Sleep disorders | Older adults are more prone to sleep disorders such as REM sleep behavior disorder (RBD) and restless legs syndrome (RLS). |
| Medication | Older adults often take multiple medications that can interact and cause side effects such as excessive sleepiness. |
| Depression | Depression and low mood are associated with increased sleep and can affect older adults. |
| Dementia | Dementia, especially in the later stages, can cause significant sleep disturbances and increased daytime sleeping. |
| Palliative care | Increased sleeping can be an early sign of the final stage of life in older persons, indicating the need for palliative care. |
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What You'll Learn
Sleep and dementia
While the exact underlying causes of dementia are unknown, experts have identified a link between sleep and dementia. Research suggests that both poor sleep and dementia influence each other.
Sleep deprivation and dementia
A long-term study by Harvard Medical School found that individuals who slept under five hours per night were twice as likely to develop dementia compared to those who slept six to eight hours per night. Another study of 8,000 participants found a 30% increase in dementia risk associated with sleeping six hours or less at ages 50, 60, and 70, compared to a normal sleep duration of seven hours.
Sleep as a symptom of dementia
It is common for people with dementia to experience sleep problems, particularly in the earlier stages of the disease. Dementia can cause changes in the brain that affect our internal "clock", which helps our body recognize when it is time to sleep. As dementia progresses, individuals spend less time in the later stages of sleep, which are essential for cognitive function and overall health, and more time in the earlier stages.
Additionally, certain types of dementia can impact sleep patterns. For example, people with dementia caused by Lewy body disease, such as Parkinson's disease, often experience daytime sleepiness but have restless nights due to confusion, nightmares, and hallucinations.
Managing sleep problems in dementia
If a person with dementia is experiencing sleep deprivation, their doctor may suggest several interventions:
- Sleep medications
- Pain relief at bedtime
- Maintaining a constant temperature in the bedroom
- Using nightlights to softly light the room
- Avoiding caffeine, alcohol, and screen time before bed
- Encouraging exercise, such as one or two walks per day
- Stimulus control therapy, which involves eliminating all in-bed activities other than sleep
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Medication side effects
While increased sleep in older people is sometimes attributed to the progression of dementia, medication side effects can also be a factor. Older adults are at a higher risk of experiencing the medical and psychiatric effects of insomnia, and sleep medication use is on the rise in this demographic.
Sleeping pills and other sleep aids can have unpleasant and potentially dangerous side effects for older people. For example, over-the-counter (OTC) sleep aids often contain antihistamines, which can cause drowsiness the next day, negatively impacting driving ability and increasing the risk of accidents. Other side effects of OTC sleep aids include constipation, diarrhoea, muscle weakness, digestive problems, worsened snoring, and sleep apnea.
Sleeping pills can also cause a "hangover effect", with people feeling drowsy and experiencing muddled thinking and dizziness the next day. Additionally, the body can become dependent on sleeping pills, and insomnia may return worse than before if an individual stops taking them. This is known as rebound insomnia.
The FDA has issued a warning about the risk of complex sleep behaviours associated with sleeping pills, including sleepwalking and sleep-driving, which can result in serious injuries.
Older adults are advised to try non-drug treatments first, as there may be safer ways to improve sleep. For example, a study found that CBT-I was effective in older adults with chronic insomnia disorder and carried fewer risks than medication. Exercise is also recommended, with regular physical activity helping people attain sleep quicker and stay asleep longer.
When medication is necessary, doctors must carefully consider the patient's other prescriptions to prevent negative drug interactions. Benzodiazepines and non-benzodiazepines, for instance, can increase the risk of falling and carry a high risk of tolerance, dependence, and withdrawal.
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Depression and mental health
While increased sleep is a common feature of ageing, it can also be a symptom of depression or dementia. Depression is not a normal part of ageing, but it is common in older adults and is often under-recognised, under-diagnosed, and under-treated. Older adults are also more likely to succeed in suicide attempts, and depression increases the risk of suicide. Therefore, it is important to be aware of the signs of depression and seek help if you or someone you know may be depressed.
Depression can be caused by changes in the brain that affect mood, or it can be triggered by a major life event, such as a concerning medical diagnosis or the death of a loved one. Those who care for loved ones with a serious illness or disability are also at risk of depression. Symptoms of depression include low mood, lack of motivation, withdrawal, and memory problems. In older adults, depression may also be accompanied by a loss of self-sufficiency, as they may no longer be able to dress themselves, drive, read, or lead an active life, leading to a loss of identity.
To maintain mental health, older adults should stay physically active and eat a healthy, balanced diet. This can help reduce the risk of illnesses that can bring on depression and manage chronic conditions that increase the risk of depression, such as limitations in movement and social isolation. It is also important for older adults to stay socially connected, as loneliness can intensify feelings of depression. Friends and family members can help by inviting their loved ones out for activities they used to enjoy, such as walks or art classes, and scheduling regular social activities. Group outings, visits, and trips to senior or community centres can help combat isolation and provide mental stimulation.
If you or someone you know is experiencing symptoms of depression, it is important to see a doctor, who can rule out any medical conditions that may be causing the depression through a physical exam, learning about your health and personal history, and lab tests. If no medical condition is found, the doctor may suggest a psychological evaluation and refer you to a mental health professional for psychotherapy, counselling, or "talk therapy". Treatment for depression can include medication to balance chemicals in the brain, such as serotonin, or therapies such as cognitive-behavioural therapy (CBT) and interpersonal therapy (IPT).
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Sleep architecture and quality
As people age, they experience changes in their sleep architecture and quality. Sleep architecture refers to the cyclical progression through the different stages of sleep, and older adults tend to spend more time in the initial, lighter stages of sleep and less time in the latter, deeper stages. This shift contributes to older individuals waking up more frequently during the night and experiencing more fragmented and less restful sleep.
The quality of sleep gradually declines as people age, with a decrease in the amount of deep or "slow-wave" sleep, which is essential for maintaining a healthy and refreshed brain. Older adults may experience a reduction in total sleep time, sleeping less than younger adults. This deterioration in sleep quality and quantity can lead to excessive daytime sleepiness, with older adults taking restorative naps during the day to compensate for lost sleep.
Several factors contribute to the changes in sleep architecture and quality among older adults. One factor is the shift in the body's circadian rhythms, known as a phase advance, which causes older individuals to feel tired earlier in the afternoon and wake up earlier in the morning. Additionally, older adults may experience more sleep disruptions due to achy joints, the need to use the restroom, or various health conditions.
Medications also play a significant role in sleep quality among older adults, as they often take multiple drugs that can interact and produce side effects such as drowsiness. Certain medications for conditions like anxiety, depression, insomnia, and chronic pain are known to cause excessive sleepiness. It is important for older adults and their caregivers to be aware of these side effects and discuss alternative treatments or dosage adjustments with their physicians.
Furthermore, older adults may experience sleep disorders such as REM sleep behavior disorder (RBD), where individuals physically act out their dreams, sometimes violently. Additionally, conditions like depression and dementia can significantly impact sleep patterns, with individuals experiencing sleep issues and fatigue.
To improve sleep architecture and quality, older adults can focus on sleep hygiene and develop habits that promote better sleep. This includes maintaining a regular sleep schedule, reducing bedroom distractions, and incorporating relaxing activities before bed, such as a warm bath or reading. Exercise has also been shown to improve sleep quality, with older adults who exercise regularly reporting better sleep and improved overall health.
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End-of-life care
Caring for a loved one through the final stage of life is never easy. End-of-life symptoms in older adults can vary, and each person will progress at their own pace, which could be significantly fast or slow.
Emotional and Mental Symptoms
Some of the earliest signs of end-of-life symptoms have to do with a sense of resignation. This may involve a low mood, lack of motivation, and withdrawal. The person may spend more time reminiscing about their childhood and earlier life experiences. End-of-life anxiety and depression are not uncommon, and the person may experience a growing fear or worry for themselves or for those who will be left behind.
Physical Symptoms
Loss of appetite, general weakness, and increasing fatigue become noticeable. Older adults will likely sleep more than they’re awake. Their breathing may sound noisy or 'rattling', and they may have fewer bowel movements. Their urine may become more concentrated and darker in colour, and both bladder and bowel functions may get harder to control. Heart rate, body temperature, and blood pressure begin to drop, and with reduced circulation, the hands, arms, feet, and legs start to feel cool to the touch. The skin may turn dark blue, purple, or appear mottled.
Providing Comfort
- Use a humidifier to aid breathing.
- Apply lip balm and alcohol-free lotion to soothe dry skin.
- Help them stay hydrated with ice chips or by applying a wet washcloth to the lips.
- Change their positioning every few hours to prevent bedsores.
- Provide comfy bedding and refresh it as necessary.
- Prepare soft foods, but don’t force the person to eat.
- Use low lighting and block out loud or distracting sounds.
- Let them sleep when they want to.
- Put gloves or socks on the person to keep them warm.
- Cover them with a blanket or duvet.
- Gently massage their hands or feet.
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Frequently asked questions
As people approach the end of their lives, they may experience a decline in their health, which can cause them to sleep more. However, increased sleep is not always a sign of imminent death. It is important to consult a doctor if you notice significant changes in sleep patterns, as this could indicate underlying health issues.
There are several reasons why older adults may sleep more than younger adults. Firstly, the quality of sleep tends to deteriorate with age, resulting in more fragmented and less restful sleep. Older adults experience a shift in their body's circadian rhythms, causing them to get tired earlier in the afternoon and wake up earlier in the morning. Additionally, older people are more susceptible to various health conditions, such as depression, dementia, and chronic pain, which can impact their sleep. The medications used to treat these conditions may also have side effects, including drowsiness.
Older adults can take several steps to improve their sleep quality. Maintaining a regular sleep schedule and a relaxing bedtime routine can help. Reducing distractions in the bedroom, such as televisions and smartphones, is also beneficial. Regular exercise can improve both sleep quality and duration. In cases of insomnia, cognitive behavioral therapy (CBT) has been shown to be an effective treatment for both younger and older adults.
