Ashwin Lewis
Sleep patterns change as we age, and it is common for older adults to experience changes in the quality and duration of their sleep. While it is not unusual for seniors to take naps during the day to compensate for a lack of sleep at night, it is not considered normal for seniors to spend all day in bed. There can be many reasons for excessive sleepiness in older adults, including depression, medication side effects, and sleep disorders. In later-stage dementia, it is common for patients to sleep a lot during the day and night. If you are concerned about an older adult in your life who is sleeping constantly, it is important to consult a doctor to rule out any underlying health problems.
| Characteristics | Values |
|---|---|
| Sleep becomes | More fragmented and lighter |
| There is a decrease in rapid-eye-movement (REM) sleep | |
| There is a reduction in the amount of slow-wave sleep | |
| There is a compensatory increase in the lighter stages of sleep | |
| Sleep efficiency and total sleep time | Reduced with age |
| Circadian rhythms | Change with age, leading to disrupted sleep patterns |
| Sleep disturbances | Can become chronic sleep issues if not addressed |
| Sleep issues | Can contribute to health concerns, reducing quality of life |
| Excessive sleepiness | Could be a symptom of oncoming health issues |
| Depression | Can cause excessive fatigue |
| Medication | May have undesirable side effects, such as excessive sleepiness |
| Dementia | Can cause sleep difficulties, particularly in the later stages |
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What You'll Learn
Sleep patterns change with age, becoming more fragmented and lighter
Older adults may experience changes in the quality and duration of their sleep due to these changes in their body's internal clock. They may also have to get up during the night to use the bathroom, and aches and pains can make it difficult to get comfortable and sleep soundly. All of these factors can contribute to excessive daytime sleepiness, which can lead to intentional and unintentional napping. It's important to note that while napping during the day can compensate for a lack of sleep at night, it is not normal for seniors to spend all day in bed or dozing in front of the TV instead of engaging in their daily activities. If you notice that an elderly loved one is sleeping much more than usual during the day, it may be a good idea to encourage them to see a doctor to rule out any underlying health problems that could be causing their excessive tiredness.
In addition to changes in the body's internal clock, the prevalence of mental and physical health conditions increases with age, which can further disrupt sleep patterns. For example, depression can cause anyone, regardless of age, to lose interest in activities they once enjoyed and feel excessively tired. Similarly, elderly individuals managing multiple health conditions may be taking various medications with side effects that include excessive sleepiness. Seeking medical attention, therapy, and support from family and friends can help address depression in older adults.
It's worth noting that sleep disturbances can become chronic if not addressed. Therefore, improving sleep hygiene and developing healthy habits can encourage better sleep in older adults. Additionally, family caregivers and home care staff can assist seniors with dementia by establishing a strict sleep schedule at night, allowing for regulated naps during the day, and providing engaging, therapeutic activities to stimulate them during their waking hours. While sleeping more is a common feature of later-stage dementia, caregivers may find it distressing and worry that something is wrong. In such cases, seeking advice from a doctor or dementia specialist is recommended.
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Circadian rhythms change, causing disrupted sleep patterns
Circadian rhythms are 24-hour cycles that influence when people get hungry, when the body releases certain hormones, and when a person feels sleepy or alert. These rhythms are controlled by the body's internal clock, which is located in a part of the brain called the hypothalamus. As people age, their circadian rhythms change, often leading to disrupted sleep patterns.
Research has shown that circadian rhythms shift throughout our lifespan, peaking in lateness during adolescence and then gradually shifting back as we age. Starting at age 60 to 65, circadian rhythms tend to get earlier, a change known as a phase advance. This shift can cause sleep problems in older adults, as it affects their mental and physical tasks. Older adults may also have more trouble adapting to new sleep rhythms, so changes to their sleep schedule may be more challenging to manage.
The exact reasons for the shift in circadian rhythms with age are not fully understood, but it is believed to be a combination of biological and environmental factors. One theory suggests that certain clock genes may lose their rhythm and be replaced by other genes that function slightly differently. Another factor may be the eyes' changing ability to let in light as we age, particularly short-wave light, which plays a critical role in regulating the circadian rhythm.
The disruption of circadian rhythms can have significant implications for older adults. Older adults spend less time in deep sleep, leading to sleep disruptions and daytime sleepiness. This can result in excessive daytime napping, further disrupting their sleep at night. Additionally, poor sleep can contribute to various health concerns, reducing the overall quality of life for older individuals.
While it is normal for older adults to experience changes in their sleep patterns, severe alterations in circadian rhythms may be an early indicator of Alzheimer's disease or other disorders. Therefore, addressing sleep issues and improving sleep hygiene and habits are crucial for maintaining the health and well-being of older adults.
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Dementia causes sleep difficulties, especially in later stages
While ageing is accompanied by a variety of sleep complaints and disorders, dementia is known to cause sleep difficulties, especially in the later stages. People with dementia often spend a lot of time sleeping during the day and at night. This can be distressing for family and friends, who may worry that something is wrong.
Dementia can cause disruptions to the body's internal clock, which is located in the hypothalamus region of the brain. This internal clock controls the body's 24-hour daily cycles, or circadian rhythms, which influence when a person feels sleepy or alert. A person with dementia may experience a shift in their sleep-wake cycle, feeling sleepy during the day and awake at night. This disruption to the body clock can also affect the production of melatonin, a sleep hormone that helps people feel sleepy when it gets dark. As dementia progresses, the brain may produce less melatonin, making it harder for people with dementia to fall asleep at night.
Additionally, people with dementia may experience other health conditions that disrupt their sleep, such as pain or urinary problems that require frequent trips to the toilet. They may also experience sleep disorders such as insomnia, which is linked to a higher risk of dementia, or obstructive sleep apnea (OSA), which can further increase the risk of dementia. REM behaviour disorder (RBD) is also common in people with dementia, especially those with Parkinson's disease or Lewy body dementia.
The relationship between sleep and dementia is complex, and it is unclear which comes first. However, it is known that a lack of sleep can lead to the build-up of plaque-like substances and changes in brain areas related to Alzheimer's disease. Poor sleep may also worsen the symptoms of dementia, making it more challenging for those with dementia to communicate, eat, or understand their surroundings.
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Depression in elderly people can cause excessive fatigue
Sleep patterns change as people age. Older adults tend to experience changes in the quality and duration of their sleep. Circadian rhythms change, often leading to disrupted sleep patterns. Sleep disturbances can decrease sleep quality and quantity and become chronic sleep issues if not addressed.
It is normal for a 102-year-old to sleep more than younger adults. However, if you notice that an elderly person is sleeping constantly, it could be a sign of an underlying issue. For example, people with dementia, especially in the later stages, can often spend a lot of time sleeping. This can be distressing for family and friends, who may worry that something is wrong. Sleeping more and more is a common feature of later-stage dementia. As the disease progresses, the person with dementia may find it exhausting to do simple tasks like communicating or eating.
Depression is a widespread problem among older adults and can be hard to recognize. It is a mental health condition and a mood disorder in which feelings of sadness, loss, anger, or frustration are present nearly every day for at least two weeks. They often interfere with daily life. Symptoms of depression in older adults may be ignored or confused with other conditions common in older adults. For example, common symptoms of depression, such as fatigue, appetite loss, and trouble sleeping, can also be part of the aging process or a physical illness.
In addition, older adults are more likely to experience several conditions simultaneously. Social isolation and loneliness, which affect about a quarter of older people, are key risk factors for mental health conditions in later life. As people age, they often find themselves spending more time alone, and studies show that loneliness and social isolation are associated with a higher risk of depression. Other risk factors for depression in older adults include a loss of independence, divorce or widowhood, and physical illness.
If you think an older adult is experiencing depression, they should make an appointment with their doctor or another healthcare provider. Certain medications or medical conditions can sometimes cause symptoms of depression. A doctor can rule out these possibilities through a physical exam, learning about the patient's health and personal history, and lab tests. If no medical condition is causing the depression, the doctor may suggest a psychological evaluation and refer the patient to a mental health professional. Treatment options for depression include psychotherapy, counseling, medication, and electroconvulsive therapy (ECT).
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Medication side effects can cause excessive sleepiness
It is normal for older adults to experience changes in the quality and duration of their sleep. As people age, their circadian rhythms change, often leading to disrupted sleep patterns. Older adults tend to experience more fragmented sleep, with an increase in the number of arousals and awakenings. There is also a reduction in the amount of slow-wave sleep and rapid-eye-movement (REM) sleep. These changes can lead to excessive daytime sleepiness, which can be worrying for caregivers, friends, and family.
Medication side effects are a common cause of excessive sleepiness in older adults. Many prescription and over-the-counter medications can lead to fatigue and drowsiness. Here are some types of medications that can cause excessive sleepiness:
Allergy Medications (Antihistamines): Antihistamines are commonly used to treat allergies, but they can also be found in sleeping pills. Some antihistamines that may cause sleepiness include brompheniramine, diphenhydramine, hydroxyzine, and meclizine.
Antidepressants: Tricyclic antidepressants, such as amitriptyline, doxepin, imipramine, and trimipramine, are known to cause drowsiness and fatigue. Trazodone, an older antidepressant, can also cause sleepiness in a significant number of people.
Gut Medications: Drugs that control nausea, vomiting, or treat diarrhea can have a sedating effect. These medications work on the nerves in the brain and spine, leading to relaxation and tiredness.
Muscle Relaxants: Muscle relaxants, such as carisoprodol and cyclobenzaprine, work on the nervous system to relax the muscles. However, their impact on the nervous system can also cause fatigue and sleepiness.
Opioid Pain Medications: Opioids mimic the body's natural endorphins to control pain. Common opioids like fentanyl, oxycodone, morphine, and hydrocodone can cause significant drowsiness as a side effect. Tramadol is another pain medication that can cause drowsiness, although it is less potent than other opioids.
If you or your loved one is experiencing excessive sleepiness due to medication side effects, there are several strategies to consider:
- Exercise and Stretching: Engaging in light physical activities, such as walking or stretching, can help boost energy levels and counteract the sedating effects of medications.
- Deep Breathing: Practicing deep breathing techniques can promote relaxation without increasing fatigue.
- Caffeine Consumption: A moderate amount of caffeine, such as a cup of coffee or tea, can help combat drowsiness. However, it is important to be mindful of the diuretic effects of caffeine, especially in older adults.
- Non-Drowsy Alternatives: Consult your doctor or pharmacist to explore "non-drowsy" versions of over-the-counter medications or alternative prescriptions that are less likely to cause sleepiness.
- Adjust Dosage or Timing: Discuss with your healthcare provider the possibility of adjusting the dosage or timing of your medication. Sometimes, taking a lower dose or shifting the medication time to bedtime can help reduce daytime sleepiness.
- Address Sleep Hygiene: Maintaining healthy sleep habits and routines can improve overall sleep quality. This may include limiting substances that cause tiredness, such as alcohol, and establishing a consistent sleep schedule.
- Contact Healthcare Provider: If excessive sleepiness interferes with daily activities or safety, contact your healthcare provider. They may recommend adjusting the dose or changing the medication to resolve the drowsiness.
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Frequently asked questions
While it is common for older adults to experience changes in the quality and duration of their sleep, it is not normal for seniors to spend all day in bed. Excessive sleepiness during the day could be a sign of underlying health problems.
There could be many reasons for this, including depression, medication side effects, sleep disorders, or dementia.
Depression can cause anyone, young or old, to lose the desire to engage in activities they used to enjoy. Other signs to look out for include extreme boredom, a loss of a sense of purpose, and loneliness.
All forms of dementia cause sleep difficulties, especially in the later stages of the disease. A person with dementia may find it exhausting to do simple tasks such as communicating or eating. They may also experience damage to their brain, making it hard for them to understand what is going on around them.
If you are concerned about your relative's sleep habits, it is important to consult a doctor to rule out any underlying health problems. In the meantime, make sure they are getting the personal hygiene, hydration, medications, and nutrition they need.
