Daytime Slumber: Understanding Elderly Sleep Patterns And Concerns

As people age, their sleep patterns change. Older people tend to sleep more lightly and wake up multiple times during the night due to achy joints or the need to use the bathroom. This can result in daytime sleepiness, which is normal. However, it becomes a problem when an elderly person spends most of their day sleeping instead of engaging in daily activities.

There are several reasons why an elderly person may sleep all day. One common cause is depression, which is not a normal part of ageing and can be triggered by boredom, loneliness, or the loss of a sense of purpose. Other possible causes include medication side effects, chronic pain, vitamin deficiencies, and boredom. Additionally, people with dementia often experience excessive daytime sleepiness, especially in the later stages of the disease.

If you are concerned about an elderly person sleeping all day, it is important to consult a doctor to rule out any underlying health issues and ensure they are receiving proper care.

Depression

If an elderly person is experiencing depression, they may benefit from antidepressant medication. However, it is important to note that finding the correct medication may take time and trial and error, and sleepiness can be a common side effect of antidepressants.

It is recommended to seek help from a doctor if an elderly person is experiencing depression or other mental health issues.

Medication

The following types of medication can cause excessive sleepiness:

• Cardiovascular, neurologic, psychiatric, and gastrointestinal medications
• Sedating medications
• Stimulating medications
• Diuretics
• Beta-blockers
• Bronchodilators
• Corticosteroids
• Decongestants
• Antidepressants
• Antipsychotics
• Anticonvulsants
• Antihistamines
• Sleeping pills

When treating insomnia in the elderly, it is recommended that sedating medications are administered prior to bedtime, while stimulating medications and diuretics are taken during the day.

It is important to note that the use of multiple medications can lead to interactions that magnify side effects, and the effects of polypharmacy on sleep should not be overlooked. A medication review with a doctor or pharmacist is recommended to rule out any side effects.

Dementia

People with dementia tend to sleep more frequently throughout the day and night, and time spent sleeping typically increases as dementia progresses. This can be distressing for family and friends, who may worry that something is wrong. However, it is a common feature of later-stage dementia. As the disease progresses, the person with dementia may find simple tasks, such as communicating or eating, exhausting, leading to increased sleep during the day.

The quality of sleep for people with dementia is often poor. They tend to get less deep or 'slow-wave' sleep, which is important for keeping the brain healthy and refreshed. This can be influenced by their sleeping patterns before developing dementia, as some people naturally need more sleep than others.

There are several reasons why dementia affects sleep:

• Medications: Some medications for dementia or other conditions can cause drowsiness or insomnia. These include antidepressants, antipsychotics, and antihistamines.
• Fatigue: Dementia can be physically exhausting, and sleep is part of the body's healing process.
• Melatonin depletion: Dementia can cause the brain to produce less melatonin, a hormone that regulates sleep/wake cycles.
• Low sleep pressure: Those with dementia may experience long periods of low activity or boredom during the day, which can affect their ability to feel tired at night.
• Sundowning: This term describes the confusion and worsening of symptoms at night, which can disrupt sleep schedules.

Additionally, disordered sleep is a common side effect of dementia, as the condition can disrupt natural sleep patterns. Some people with dementia may also take sleep medications, which can further contribute to excessive sleepiness.

While excessive sleepiness in people with dementia is usually not a cause for medical intervention, caregivers should ensure they are checked on regularly to prevent secondary health conditions, such as bed sores, from developing. It is also recommended to consult a doctor to rule out any underlying health conditions or infections that may be causing sleepiness.

Tips for Supporting Sleep in People with Dementia

• Establish a daily routine: Keep the person engaged and active during the day to help them follow a nighttime sleep schedule.
• Avoid caffeine and heavy meals: Plan dinner several hours before bedtime, and reduce caffeine intake later in the day.
• Create a bedtime routine: Encourage a winding-down ritual, such as undressing and showering before bed.
• Avoid upsetting situations: Steer clear of distressing topics or disruptive television shows before bed.
• Keep a sleep diary: Track sleep patterns, including bedtime, wake-up time, and napping, to identify any trends or concerns.

Boredom

Elders may not be clinically depressed or even particularly tired. Instead, their fatigue stems from the fact that they are incredibly bored. With no schedule to keep and not much to occupy their time, they sleep the day away.

In addition, older people may struggle with reading or puzzles due to poor eyesight, and watching television can get old. They may also have retired, leading to a less structured sleep-wake schedule.

However, boredom is not the only cause of excessive daytime sleeping in the elderly. Other potential causes include depression, medication issues, dementia, and other health concerns.

Other Health Concerns

If an elderly person is sleeping all day, it could be a sign of an underlying health issue. It is important to consult a doctor to rule out any serious health problems. Here are some possible health concerns that could be causing excessive daytime sleepiness in elderly individuals:

• Chronic Pain and Medical Illnesses: Conditions such as osteoarthritis, chronic obstructive pulmonary disease, congestive heart failure, enlarged prostate, and cerebrovascular accidents can cause discomfort and disrupt sleep. These issues can lead to difficulty falling asleep, maintaining sleep, and frequent awakenings.
• Circadian Rhythm Disturbances: The body's internal clock, known as the circadian rhythm, can deteriorate with age. This can result in weaker and more disrupted sleep patterns. Elderly individuals may experience a phase advance in their sleep-wake cycle, feeling sleepy earlier in the evening and waking up earlier.
• Sleep-Disordered Breathing (SDB): SDB is an umbrella term for breathing disorders during sleep, ranging from snoring to obstructive apneas. It is characterised by complete cessations of respiration (apneas) and partial or reduced respiration (hypopneas). SDB can cause excessive daytime sleepiness, unintentional napping, and cognitive deficits.
• Periodic Limb Movement Disorder (PLMD)/Restless Legs Syndrome (RLS): PLMD is characterised by repetitive leg movements during sleep, while RLS is a condition where individuals experience an urge to move their legs while resting. Both conditions can disrupt sleep and cause daytime sleepiness.
• Rapid Eye Movement (REM) Sleep-Behavior Disorder (RBD): RBD is characterised by the absence of normal muscle atonia during REM sleep, leading to excessive motor activity while dreaming. Individuals may act out their dreams, sometimes violently, and recall vivid dreams upon waking.
• Dementia: Dementia can significantly disrupt sleep patterns, with patients experiencing excessive daytime sleepiness, nighttime wandering, confusion, and agitation. The severity of dementia often correlates with the severity of sleep disruption.
• Terminal Illness: In some cases, excessive sleeping may be a sign of advancing age or the progression of a terminal illness. However, it does not necessarily indicate that death is imminent.

Frequently asked questions