The Sleepy Man Syndrome: Understanding Daytime Slumber

There are many reasons why a man may sleep all day. Firstly, men may not realise they need more sleep, and view sleepiness as a sign of productivity. Secondly, men may have a sleep disorder, such as sleep apnea, narcolepsy, or delayed sleep-wake phase disorder. Thirdly, men may have busy work and social schedules, or work conditions such as shift work, that disrupt their sleep. Additionally, men may have habits that cause poor sleep, such as consuming alcohol, nicotine, and caffeine, or keeping an irregular sleep schedule. Finally, men may be experiencing mental health issues, such as depression or anxiety, that impact their sleep.

Depression and Low Energy

Depression can cause low energy and fatigue, and vice versa. Men with depression may feel they have very low energy and may lose interest in areas of their life, such as work, family, or hobbies. Other symptoms include sadness and irritability, difficulty concentrating, difficulty performing daily tasks, and problems with sexual desire and performance.

Men are four times more likely to commit suicide than women, and this may be because they are less likely to seek help for depression. If you are struggling with feelings of depression, it's important to talk to someone—a loved one, doctor, or therapist.

There are many other causes of low energy in men, including:

• Poor diet or nutritional deficiencies
• Lack of exercise
• Sleep disorders, such as insomnia or sleep apnea
• Low testosterone
• Thyroid disorders
• Certain medications
• Chronic fatigue syndrome
• Alcohol and drug abuse
• Chronic illness, such as chronic infection or inflammation, inflammatory bowel disease, or Parkinson's disease

If you are experiencing low energy, it's important to talk to your doctor, who can help determine the cause and suggest treatments or lifestyle changes.

Medication Side Effects

Medications with sedative effects, such as those used to treat anxiety, insomnia, and chronic pain, can cause drowsiness and disorientation during the day. Antidepressants, antipsychotics, antihistamines, and pain medications are also known to cause sleepiness.

Additionally, older individuals metabolize medications differently, making them more susceptible to adverse effects like dizziness and drowsiness. It is important to discuss medication side effects with a doctor and review the timing and dosage of medications to reduce excessive daytime sleepiness.

Furthermore, the interaction between multiple medications (polypharmacy) can also lead to increased drowsiness and other adverse effects.

In some cases, medication withdrawal can also cause sleepiness. Therefore, it is essential not to make any changes to medication without consulting a doctor.

Dementia and Sundowning

Sundowning is a phenomenon observed in people with dementia, wherein they exhibit behavioural changes in the late afternoon or early evening, such as distress, agitation, hallucinations, and delusions. Sundowning can occur at any stage of dementia but is more common in the middle and later stages. It is important to note that sundowning is not necessarily linked to sunset or limited to the end of the day.

The exact causes of sundowning are not fully understood, but several factors may contribute to its occurrence:

• Tiredness, hunger, pain, or other unmet physical needs
• Lack of exposure to sunlight during the day
• Overstimulation during the day from a noisy or busy environment
• Disturbance to the body's internal clock due to brain damage
• Fluctuating hormone levels throughout the day
• Sensory impairments, such as hearing or sight loss
• Tiredness in caregivers, which can upset the person with dementia
• Mood disorders, such as anxiety or depression
• Reduced number of caregivers (in a care home setting)
• Side effects of prescribed medications
• Identify and address the person's basic needs, such as using the toilet, eating, or managing pain.
• Modify the environment by closing curtains or blinds at dusk and covering reflective surfaces or televisions to reduce shadows and reflections that could cause confusion.
• Distract the person by engaging in calming conversations about pleasant memories or enjoyable topics.
• Identify and address any unmet needs, as agitation may be a sign of an underlying issue.

Additionally, it is important to note that people with dementia, especially in the later stages, may experience changes in their sleep patterns, sleeping more during the day. This can be concerning for caregivers, friends, and family. However, it is essential to understand why this may be occurring and seek appropriate support and care.

End-of-Life Care

Signs of Approaching Death

A person who is nearing the end of their life may experience a range of symptoms and behavioural changes. These can include:

• Increased sleep and drowsiness
• Loss of appetite and difficulty eating and drinking
• Social withdrawal and decreased interest in activities
• Confusion and hallucinations
• Physical changes such as changes in body temperature, heart rate, breathing, and bladder control

Caring for the Dying Person

When caring for someone at the end of their life, it is important to:

• Make them as comfortable as possible
• Encourage eating and drinking if possible, but do not force it
• Continue to communicate with the person, even if they do not respond
• Be mindful of cultural and religious beliefs and customs
• Provide emotional support to the person and their loved ones

Sleep Changes at the End of Life

People who are nearing the end of their life often experience changes in their sleep patterns, sleeping more during the day and becoming more drowsy. This is a natural part of the dying process, as the body slows down and prepares for death.

Practical Tips for Encouraging Sleep

While increased sleep is common at the end of life, there are some practical things that can be done to encourage good quality sleep:

• Maintain a consistent sleep and wake schedule
• Avoid napping during the day if possible
• Encourage physical activity during the day
• Ensure the person is comfortable and that any pain or symptoms are well-managed
• Create a quiet, calm, and comfortable sleeping environment
• Limit caffeine, nicotine, and alcohol consumption, especially before bed
• Encourage relaxation before bed through music, deep breathing, or a warm bath

Supporting Loved Ones

The end-of-life period can be an emotionally distressing time for loved ones. It is important to provide support and help them adjust to any changes in the dying person's sleep patterns:

• Explain any sleep changes to loved ones and help them find new times to spend with the person
• Encourage loved ones to continue communicating with the person, as they may still be able to hear what is said
• Remind loved ones not to say anything they wouldn't want the person to hear

Planning for End-of-Life Care

It is important to have end-of-life discussions and planning as early as possible. This can include:

• Discussing treatment choices and plans
• Knowing the person's wishes and having them written down
• Making decisions about life-sustaining treatments
• Considering the person's spiritual needs and providing appropriate care

Boredom and Lack of Engagement

Boredom and a lack of engagement can be a significant factor in excessive daytime sleepiness, especially in older adults. As people age, they may develop chronic health conditions and experience age-related changes that prevent them from doing the things they once enjoyed. Limited options for activities and entertainment can take a toll on an older adult's quality of life, leading to boredom and fatigue.

Older adults who are retired no longer have the structure and engagement that a job provides. They may also struggle with reading or puzzles, and watching TV can get old. As a result, they may slide into the habit of napping throughout the day. This is particularly common among those living with dementia, who often experience issues with their circadian rhythms and temporal awareness, making it difficult to maintain a normal sleep schedule.

In addition, polypharmacy, or the use of multiple medications, is a serious concern for older adults. A recent study found that 89% of Americans aged 65 and older take prescription medications, with more than half taking four or more prescriptions. As all medications have side effects, taking multiple drugs can lead to interactions that increase the likelihood of adverse effects such as drowsiness and dizziness.

Prescription drugs and over-the-counter medications for conditions like anxiety, depression, high blood pressure, insomnia, chronic pain, Parkinson's disease, nausea, and allergies can all cause excessive sleepiness. Atypical antipsychotics, often used in the treatment of dementia, are also known to cause drowsiness in elderly patients.

To combat boredom and lack of engagement in older adults, it is important to encourage participation in life and provide opportunities for social interaction, mental stimulation, and physical activity. In-home care and adult day care are two options that can help set and maintain daily routines, provide engaging activities and outings, and broaden an older adult's social circle.

It is also crucial to be vigilant about an older adult's medications and health. Communicating with their physician about any adverse effects and exploring alternative treatment options or dosage adjustments can help improve alertness during the day.

By addressing boredom and lack of engagement, as well as managing medications and health, caregivers can improve an older adult's quality of life, enhance their mood and energy levels, and promote better sleep habits.

Frequently asked questions