Elderly Sleep Patterns: Understanding The Need For Prolonged Sleep

As people age, their sleep patterns change. Older people tend to sleep more lightly than when they were younger, and they often wake up during the night due to achy joints or the need to use the restroom. Many seniors compensate for this lost sleep by catching a restorative nap during the day. This is normal.

However, daytime sleepiness in the elderly becomes problematic when a person spends most of their time dozing instead of engaging in life. If this is the case, it's important to discover the underlying reason for their excessive napping. In some cases, you may need a doctor's help to narrow down the cause and recommend solutions.

- 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. When options for outings, activities, and entertainment are limited, it can deal a serious blow to an elder's quality of life. They may not be clinically depressed or even all that tired. Instead, their fatigue stems from the fact that they are incredibly bored.

- Polypharmacy: The average senior takes between four and five separate medications. All medications have side effects, so taking multiple drugs can produce interactions that magnify these effects. Older individuals metabolize medications differently than their younger counterparts, meaning they are even more susceptible to adverse effects like drowsiness and dizziness.

- Depression and low energy: Some elders become sad and lose interest in life, but depression is not a normal part of aging. Sleep issues and fatigue may indicate changes in a loved one's mental health.

- Dementia: Seniors with Alzheimer's disease or other forms of dementia often experience a wide array of sleep problems, especially in the later stages of the disease. As the brain changes, issues arise with circadian rhythms and temporal awareness, making it difficult for dementia patients to sleep through the night and keep a normal schedule.

- Terminal illness: In some instances, excessive sleeping in individuals with one or more serious medical conditions can indicate that their health has taken a turn. This may not necessarily mean that death is near, but it is a reason to contact their doctor.

Depression and low energy

• Circadian rhythm disturbances: The body's internal clock, which regulates sleep-wake cycles, can deteriorate with age, leading to disrupted sleep patterns.
• Medical conditions: Conditions like depression, anxiety, heart disease, diabetes, and arthritis can interfere with sleep.
• Medications: Many medications can cause sleep disturbances, and older adults often take multiple medications, increasing the risk of side effects.
• Lifestyle changes: Retirement, loss of independence, and social isolation can contribute to stress and anxiety, affecting sleep.
• Sleep disorders: Conditions like insomnia, sleep apnea, and restless legs syndrome can disrupt sleep and cause daytime sleepiness.
• Nutritional deficiencies: Low levels of nutrients like iron can lead to fatigue and weakness.
• Infections: Illnesses like the flu or pneumonia can make older adults tired as their body fights off the infection.

It is important to address excessive sleepiness in older adults as it can lead to cognitive decline, depression, and other health issues. Treatment options may include behavioural changes, such as improving sleep hygiene and developing healthy habits, or pharmacological interventions for underlying conditions.

Medication issues

• Antidepressants
• Antihistamines
• Sleep aids
• Anti-nausea medications
• Opioids
• Muscle relaxants
• Alpha and beta blockers

Additionally, the interactions of multiple medications may cause unanticipated effects on sleep.

Dementia

While it is not uncommon for older adults to experience changes in their sleep patterns, excessive sleepiness during the day could be a sign of an underlying health issue, such as dementia.

People with dementia, especially those in the later stages, often spend a lot of time sleeping, both during the day and at night. This can be distressing for family and friends, who may worry that something is wrong. However, sleeping more is a common feature of later-stage dementia as the disease progresses and the brain deteriorates. As a result, people with dementia may find even simple tasks like communicating or eating exhausting, leading to increased sleep during the day.

Causes of Excessive Sleep in Dementia

The type of dementia a person has can also cause them to sleep more during the day and restlessly at night. For example, people with dementia caused by Lewy body disease or Parkinson's disease often experience daytime sleepiness and disturbed nights. In addition, certain medications can contribute to sleepiness, including antipsychotics, antidepressants, antihistamines, and sleeping pills.

Treatment and Support

If a person with dementia is sleeping a lot, it is recommended to speak to a doctor to rule out any infections or conditions that could be affecting their sleep. A medication review may also be necessary, as medication can cause a range of side effects.

While sleeping more during the day is not usually a cause for concern, if a person is lying down and asleep for most of the time, they will need to be looked after to prevent the development of physical health problems. This care is typically provided by a health or social care professional in a care home or hospice.

Sleep and Brain Changes in Dementia

Sleep in Institutionalized Elderly with Dementia

Institutionalized elderly with dementia experience extremely fragmented sleep due to various environmental factors, including noise and light exposure. Studies have found that nursing home patients are exposed to less than 10 minutes of bright light per day, and those with more light exposure have fewer sleep disruptions.

Strategies for Improving Sleep

• Limit naps to 1 hour in the early afternoon
• Keep the environment dark at night and bright during the day
• Keep the environment quiet at night
• Maintain a regular sleep schedule
• Avoid napping in the afternoon or evening
• Minimize TV, computer, cellphone, and tablet use in the bedroom

Other possible health concerns

If your elderly loved one is sleeping all day, it is important to be vigilant about any changes in their health and activity patterns as they can be a symptom of oncoming health issues. The advanced stages of some terminal illnesses, for example, can come with loved ones sleeping much of the day. Excessive sleepiness during the day does not always mean death is close, however. But if your loved one is sleeping a lot more than they should be, contact the doctor and find out what is going on.

Seniors with Alzheimer’s disease or other forms of dementia often experience a wide array of sleep problems, especially in the later stages of the disease. As the brain changes, issues arise with circadian rhythms and temporal awareness, making it difficult for dementia patients to sleep through the night and keep a normal schedule. In some cases, sleeping during the day is the only way that patients can make up for the sleep they lose at night.

The quality of a person's sleep gradually deteriorates as they get older. They tend to get less deep or ‘slow-wave’ sleep, which helps to keep the brain healthy and refreshed. Even though a person with dementia may end up sleeping more than a typical person of their age – even as much as 14–15 hours a day – it is unlikely to all be good quality sleep.

People with dementia caused by Lewy body disease, such as Parkinson’s disease or dementia with Lewy bodies, are often sleepy by day but have very restless and disturbed nights. They can suffer from confusion, nightmares and hallucinations. Insomnia, sleep apnoea (breathing difficulties) and restless legs are common symptoms.

A person affected with these types of dementia may often unknowingly ‘act’ out their dreams by shouting and moving around in bed. They can even cause injury to themselves and/or their sleeping partner. This is called rapid eye movement (REM) sleep behaviour disorder or RBD, and tends to happen from the earliest stages of the disease onwards.

This can be exhausting and often leaves the person feeling like they haven’t slept at all, so they are very tired and sleepy during the day. It can be hard to stay awake during the day after a poor night’s sleep but, if possible, it’s best to try to limit sleep during the day to small bursts or ‘catnaps’. Otherwise, the person’s body clock can become very confused, and this makes sleeping well during the night even harder.

Boredom and lack of engagement

Boredom and a lack of engagement can be a significant issue for older adults, and it can lead to various physical and mental health issues. For example, older adults may experience a loss of community and a lack of social opportunities, leading to feelings of loneliness and isolation. This, in turn, can result in a decreased desire to engage in social activities and a reliance on solitary activities such as watching television or listening to the radio.

Additionally, boredom and lack of engagement in older adults can be related to mental health issues such as depression and anxiety. Strong emotions, such as grief, anxiety about the future, or feelings of loneliness, can manifest as physical symptoms like sudden extreme fatigue. Older adults may also experience changes in their sleep patterns, such as difficulty falling asleep or maintaining sleep, which can further contribute to feelings of tiredness and exhaustion.

To prevent excessive sleepiness and improve overall well-being, it is essential for older adults to maintain a healthy sleep schedule, avoid napping late in the day, minimise screen time before bed, and engage in regular physical activity. Socialising with friends and family, volunteering, and participating in enjoyable activities can also help reduce boredom and increase engagement in older adults.

Frequently asked questions