Colin Snow
As people age, their sleep patterns change, and it is common for older adults to experience changes in the quality and duration of their sleep. Elderly people sleeping a lot could be indicative of underlying health issues. For instance, people with dementia, especially in the later stages, tend to sleep a lot during the day and night. Other reasons could be the side effects of medication, nutrient deficiencies, sleep apnea, depression, or obesity. It is important to consult a doctor to understand the underlying causes and address them.
| Characteristics | Values |
|---|---|
| Advanced stages of terminal illnesses | Sleeping much of the day |
| Depression | Loss of desire to engage in activities |
| Medication | Side effects such as drowsiness |
| Dementia | Sleeping all day and night |
| Lack of nutrients | Iron-deficiency anemia |
| Sleep apnea | Disrupted breathing during sleep |
| Obesity | Lack of movement |
| Difficulty concentrating | Accelerated brain aging |
| Aging | Decline in quality of nighttime sleep |
| Hormonal changes | Reduced melatonin production |
| Chronic health conditions | Heart disease, diabetes, arthritis |
| Lifestyle changes | Less exercise, boredom |
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What You'll Learn
Sleep and dementia
The reasons for these changes in sleep patterns are not fully understood, but it is believed that dementia affects the brain regions responsible for regulating sleep and wakefulness. The internal "biological clock" that governs our sleep-wake cycles may become disrupted, leading to sleep-wake reversals where individuals stay awake all night and sleep during the day.
Additionally, the quality of sleep tends to deteriorate with age. Older adults tend to experience a decline in slow-wave sleep, which is crucial for brain health and cognitive function. This can further contribute to the fatigue and exhaustion observed in individuals with dementia.
The type of dementia can also influence sleep patterns. For example, dementia caused by Lewy body disease, such as Parkinson's disease or dementia with Lewy bodies (DLB), is often associated with daytime sleepiness and restless nights. Individuals with these forms of dementia may experience confusion, nightmares, hallucinations, and rapid eye movement (REM) sleep behaviour disorder, where they act out their dreams, impacting their sleep quality and leaving them exhausted during the day.
Sleep disturbances in dementia can have significant implications for both the individuals and their caregivers. Poor sleep may exacerbate dementia symptoms, leading to increased confusion, coordination issues, and reduced energy levels during the day. Establishing a healthy sleep routine can be beneficial, promoting better rest and potentially improving quality of life.
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Medication side effects
Sleep difficulties become more common as people age, and approximately one in three people aged 65 and older take some type of sleep medicine. Sleeping pills are available over the counter (OTC) or by prescription. OTC sleep aids often contain an antihistamine, which treats allergies but can also cause drowsiness. Diphenhydramine, for example, is an antihistamine that blocks h1 receptors—histamine pathways in the brain that are crucial for promoting wakefulness. While diphenhydramine can be beneficial for those who use OTC sleeping pills to treat insomnia, it is generally recommended that older adults avoid using it except to manage allergic reactions. Evidence suggests that diphenhydramine may result in serious side effects in adults aged 65 and older, including decreased reaction times, dizziness, and anticholinergic effects. Anticholinergic effects mean that the medication acts on the signalling chemical called acetylcholine, which can have important consequences. The older you are, the greater the risk of adverse effects from diphenhydramine, and it generally should not be used as a sleep aid for those aged 65 and older. Growing evidence also suggests that the chronic use of these medications may be associated with the long-term development of dementia.
Prescription sleep medications work in different ways. Benzodiazepines, for instance, work by stimulating a chemical in the brain called GABA, which leads to sedation, muscle relaxation, and reduced anxiety. However, benzodiazepines can be addictive and lead to substance use disorder, so healthcare providers only prescribe them for short-term use. Z-drugs, such as zolpidem (Ambien) and eszopiclone (Lunesta), are non-benzodiazepines that were introduced in the 1990s and are approved by the Food and Drug Administration (FDA) for use as sleep aids. While these newer drugs have a "somewhat safer" profile than older drugs, they can still impair mental and physical function in older adults, leading to an increased risk of falls and confusion. When combined with other medications, especially painkillers or drugs for mood and anxiety, Z-drugs could also put patients at a higher risk of suppressing breathing and respiratory depression. Common side effects of Z-drugs include constipation, muscle weakness, and a "hangover effect" the day after taking the medication, with patients feeling drowsy, experiencing muddled thinking, and suffering from dizziness or balance problems. These daytime effects can negatively impact the ability to drive, work, go to school, and complete daily tasks.
In addition to the side effects mentioned above, sleeping pills can also cause parasomnia, a disruptive sleep disorder that can lead to dangerous behaviours while the patient is still mostly asleep. People who take Z-drugs may sleepwalk, eat, take medications, talk, or even drive without being fully awake. Most people do not remember doing these things after they wake up. Sedatives can also worsen snoring and sleep apnea, a potentially life-threatening condition. Finally, it is important to note that sleeping pills can lead to dependence and can make sleep problems worse over time if not used correctly.
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Depression
Sleep issues are common in older adults, with up to 40-50% of those over 60 reporting disturbed sleep. One of the causes of these sleep disturbances is depression, which can become more common with age. Older adults may experience feelings of loneliness, grief, or anxiety about the future, which can go undiagnosed and lead to fatigue. Depression can cause anyone, regardless of age, to lose the desire to engage in activities they once enjoyed. It is not a normal part of aging, and it can be treated with medical attention, therapy, and support from loved ones.
Research has found that depression and sleep are interrelated. Depression may cause a person to sleep longer, and sleeping longer can, in turn, increase a person's depressed state. Older individuals with depression have been found to experience greater sleep disturbances. Older women with insomnia, in particular, seem to be more susceptible to depression. While studies in younger adults have suggested that treating insomnia may improve depression, similar studies have not been conducted in older adults.
It is important to be vigilant about any changes in an elderly person's health and activity patterns, as they can indicate underlying health issues. If an older adult is sleeping all day, it is crucial to ensure they are still maintaining personal hygiene, staying hydrated, taking their medications, and receiving proper nutrition. Additionally, they should not remain in the same position for too long to avoid bed sores and other health complications.
To address excessive daytime sleepiness in older adults, it is recommended to follow a regular sleep schedule. This involves going to bed and waking up at the same times every day, even on weekends or when travelling. Avoiding naps in the afternoon or evening is also advised, as they may affect an older adult's ability to fall asleep at night.
If you are concerned about an elderly loved one's sleeping habits, it is important to consult a doctor to identify any underlying health problems and determine the best course of action.
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Poor sleep at night
Medical Conditions and Medication Side Effects
The presence of underlying medical conditions can significantly impact sleep quality. Conditions such as heart and lung issues, including heart failure and chronic obstructive pulmonary disease, and cardiovascular disease, can affect breathing and disrupt sleep. Additionally, urinary problems, such as an enlarged prostate or overactive bladder, can cause frequent urination at night, disturbing sleep.
Medications taken to manage various health conditions can also contribute to poor sleep. Certain medications may have side effects that interfere with sleep, including drowsiness or insomnia. Caffeine, alcohol, and smoking can further exacerbate sleep problems. Caffeine intake, especially in the afternoon, can delay sleep by affecting the body's circadian rhythm. Alcohol consumption can increase the risk of sleep apnea and prevent deeper sleep stages, leading to more arousals during the night.
Sleep Disorders and Sleep-Wake Cycle Disturbances
Sleep disorders, such as insomnia, are common in older adults and can lead to difficulty falling asleep and maintaining restful sleep. Sleep apnea, characterised by brief interruptions in breathing during sleep, affects a significant proportion of individuals over 65. Other sleep disorders like restless leg syndrome can also disrupt sleep.
Disturbances in the sleep-wake cycle can result in a "night owl" pattern, with delayed bedtimes and continued sleep into the afternoon. This disruption can be influenced by lifestyle factors, work requirements, or changes in daily routines, making it challenging for the body to regulate sleepiness and wakefulness appropriately.
Pain and Discomfort
Chronic pain and discomfort from conditions like arthritis can make it challenging for elderly individuals to fall asleep and maintain restful sleep. Poor sleep can also be a symptom of fibromyalgia, a condition that may be more prevalent in older adults. Addressing pain management strategies can help improve sleep quality.
Dementia and Alzheimer's-Related Sleep Disturbances
Dementia, especially in its later stages, can cause significant sleep disturbances. Individuals with dementia may experience a reversal of their sleep patterns, staying up all night and sleeping during the day. The quality of their sleep deteriorates, and they may not obtain sufficient restorative sleep, impacting their overall health and well-being.
Alzheimer's disease, a form of dementia, can also cause daytime drowsiness and difficulty sleeping at night. Managing these sleep disturbances often requires a comprehensive approach that includes medication and non-pharmacological interventions.
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Ageing and health concerns
As people age, they may experience changes in the quality and duration of their sleep. This can be due to changes in the body's internal clock, which is located in the hypothalamus and regulates circadian rhythms. Older people may also produce less melatonin, a hormone that helps promote sleep. As a result, they may find it more difficult to adjust to changes in their sleep schedules, such as during daylight saving time or jet lag.
Additionally, older adults may develop chronic health conditions that interfere with their sleep. Conditions such as depression, anxiety, heart disease, diabetes, and arthritis can impact sleep quality. The use of multiple medications to manage these conditions can also lead to sleep disturbances, as older adults may be more susceptible to side effects like drowsiness.
Sleep disorders, such as sleep apnea and insomnia, become more prevalent with age. Sleep apnea can cause breathing disruptions during sleep, resulting in excessive daytime sleepiness even after a full night's rest. Insomnia can be treated with medications such as sedative-hypnotics, antihistamines, antidepressants, antipsychotics, and anticonvulsants.
Excessive daytime sleepiness in the elderly can be a cause for concern and may indicate underlying health issues. It is important to seek medical advice to identify and address any potential causes, such as nutrient deficiencies, obesity, or side effects of medications.
To improve sleep quality in older adults, it is recommended to maintain a regular sleep schedule, reduce distractions in the bedroom, avoid substances that interfere with sleep, and engage in physical exercise. Social engagement and participation in enjoyable activities can also help reduce boredom and depressive symptoms, contributing to better sleep.
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Frequently asked questions
Elderly people sleep a lot due to a variety of reasons, including:
- Depression
- Side effects of medication
- Lack of exercise
- Poor diet
- Medical treatments or surgical recovery
- Obesity
- Nutrient deficiencies
- Sleep apnea
- Dementia
To reduce daytime sleepiness, elderly people can:
- Exercise regularly
- Reduce distractions in the bedroom
- Avoid substances that discourage sleep
- Maintain a regular sleep schedule
- Avoid napping in the afternoon or evening
- Engage in daily activities and outings
- Broaden their social circle
Elderly people sleeping a lot should be a cause for concern when:
- They are sleeping all day
- They are experiencing health issues such as bed sores and dehydration
- They are exhibiting signs of depression
- They are struggling to perform simple daily tasks
- They are experiencing memory loss or cognitive impairment
