Elderly Sleeping All Day: What Does It Mean?

As people age, their sleep patterns change. Older people tend to sleep more lightly than when they were younger, and often wake up during the night due to achy joints or the need to use the bathroom. Many compensate for this lost sleep by catching a nap during the day, which is normal. However, daytime sleepiness in the elderly becomes a problem when they spend most of their time dozing instead of engaging in life.

There are many reasons why an elderly person might sleep all day. Boredom and lack of engagement can be a factor, as can polypharmacy, which is a serious concern for older adults. Depression and low energy are also common causes, as are chronic pain, nutritional deficiencies, and medication side effects.

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 instances, excessive sleeping in individuals with one or more serious medical conditions can indicate that their health has deteriorated. However, this may not necessarily mean that death is near, but it is a reason to contact their doctor.

Boredom and lack of engagement

To address boredom and lack of engagement in older adults, it is important to find ways to stimulate their interest in life. This may involve providing opportunities for:

• Socialization through visitors, attending events at a senior center, or adult day care.
• Engaging in meaningful leisure activities that match their interests and abilities.
• Providing assistance with transportation to facilitate participation in activities outside the home.
• Encouraging participation in volunteer work or part-time employment, if possible.
• Offering a variety of engaging activities, such as games, crafts, or social gatherings.
• Promoting physical activity and exercise to improve overall health and well-being.
• Addressing any underlying health conditions or pain that may be contributing to boredom and fatigue.
• Encouraging family members and caregivers to spend time with the older adult and engage them in conversation, shared activities, or outings.

Polypharmacy

Older people may take multiple medications for coexisting chronic conditions, such as heart disease, high blood pressure, and diabetes. They may also be taking drugs that are no longer necessary, or additional medications to offset the side effects of other drugs, further increasing the risk of polypharmacy. Non-prescription drugs and herbal supplements can also interact with prescription medications and cause side effects.

Symptoms of polypharmacy include confusion, weakness, dizziness, and gastrointestinal problems. The risk of polypharmacy is higher for older adults, as they may process medications differently. Taking multiple prescription drugs can increase the risk of drug-drug interactions, drug-disease interactions, and oversedation, which can cause drowsiness and raise the risk of accidents.

To manage polypharmacy, older adults should have regular check-ups and medication reviews with a healthcare practitioner. This can help to identify medications that are no longer needed, minimise side effects, and reduce the risk of interactions. It is also important to involve a health advocate or caregiver, who can help keep track of any changes to the drug regimen.

To reduce the incidence of polypharmacy, medication regimes for elderly patients should be evaluated regularly. Where possible, a single drug should be prescribed instead of multiple drugs for a single condition, and medications should be started at a lower dosage. Drugs that are suspected of causing problems should be discontinued, and unnecessary drugs prescribed by different healthcare providers should be eliminated.

Depression and low energy

Depression is not a normal part of ageing, but it is estimated that major depressive disorder occurs in five percent of community-dwelling elders, while up to 16 percent of older adults have clinically relevant depressive symptoms.

Depression can cause fatigue, and fatigue can also be a symptom of grief and loss, which are common experiences for older people. Other emotional stresses, such as financial or personal problems, can also cause fatigue.

If an older person is experiencing depression, they may benefit from therapy or medication. Holistic approaches such as mindfulness practices, meditation, and yoga can also help. Regular exercise has been shown to have similar effects to talk therapy in reducing stress, anxiety, and depression.

It is important to note that fatigue can also be a symptom of other health issues, so it is recommended to talk to a doctor to determine the underlying cause.

Dementia

People with dementia tend to sleep more frequently during 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, sleeping more is a common feature of later-stage dementia as the disease progresses, the brain becomes more damaged, and the person gradually becomes weaker and frailer.

People with dementia may find simple tasks, like communicating or eating, exhausting, which can make them sleep more during the day as their symptoms become more severe. They may also experience time disorientation, where they're unable to distinguish between night and day, and sleep during the day as a result.

Other factors that can contribute to excessive sleepiness in people with dementia include medications, melatonin depletion, low sleep pressure, sundowning, and sleep disorders unrelated to dementia, such as sleep apnoea.

While excessive sleepiness in people with dementia is usually not a cause for concern, caregivers should ensure that the person is comfortable and prevent secondary health conditions like bed sores from developing. In some cases, excessive sleepiness may be due to an underlying health condition or a negative response to medication, so it's important to consult a doctor if there are any concerns.

To help manage a loved one's sleep patterns, caregivers can create a daily routine, avoid caffeinated drinks and heavy meals close to bedtime, establish a bedtime routine, and avoid upsetting situations before bed. It can also be helpful to keep a sleep diary to track sleep patterns and consult a doctor if excessive sleepiness persists.

Terminal illness

Sleep problems are very common in people living with a terminal illness, though not everyone is affected. Sleep is a complex function and is essential for our well-being. The pattern of when we sleep and when we wake is part of the body's overall circadian (daily) rhythm, which also controls other essential functions such as temperature and hormone levels.

Common sleep problems in terminal illness

• Insomnia – difficulty getting to sleep or staying asleep, or not feeling rested after sleep. This can lead to feeling tired during the day and unable to function as normal.
• Disorders of the sleep-wake cycle – this can happen when someone’s sleep at night is disrupted, perhaps due to a noisy environment, distressing symptoms or worries. Disrupted sleep at night can then lead to increased tiredness during the day, which in turn contributes to a cycle of disturbed sleep.
• Excessive daytime sleepiness – when people have difficulty staying awake during the day and may fall asleep or become drowsy. This is different from the tiredness and fatigue common in terminally ill patients.

Causes of sleep problems

There are many reasons why someone with a terminal illness may experience sleep problems, and there is often more than one contributing factor. Common causes include:

• Restless legs syndrome – a common nervous system condition that causes an overwhelming urge to move the legs and is associated with many illnesses including anaemia and chronic kidney disease.
• Bladder or bowel symptoms – having to get up to go to the toilet or being incontinent.
• Anxiety, worries, spiritual concerns and distress – this can cause difficulty sleeping at night and tiredness during the day.
• Reduced activity during the day – this can then contribute to a disrupted sleep-wake cycle.
• Medications – steroids, antidepressants, and other drugs can disrupt sleep.
• Respiratory problems – for example, breathlessness, cough or obstructive sleep apnoea.
• Stimulants – caffeine, nicotine or alcohol can all disrupt sleep.
• Withdrawal from medicines or substances – such as nicotine or alcohol.
• Other symptoms – sweating, itchiness, etc.
• Environmental conditions – noise and light levels, and visitors staying late.

How to help someone with a terminal illness sleep better

There are practical things that can be done to support someone with a terminal illness to get good quality sleep:

• Encourage the person to go to bed and get up at the same times each day.
• If possible, avoid napping during the day.
• If appropriate, encourage physical activity during the day.
• Check that the patient is comfortable and that pain and other symptoms are being managed.
• Speak to their doctor or nurse if you’re concerned about any symptoms.
• If they are living at home, ask for a referral to a district nurse for a review of their mattress.
• If the patient is spending large amounts of time in bed and finds it hard to change position, regular repositioning by care staff can help keep them comfortable and able to rest and sleep.
• Help the patient to feel relaxed before going to bed – listening to music, deep breathing, having a bath, etc.
• Encourage them to avoid caffeine, nicotine or alcohol before bed.
• Ask visitors not to stay too late.
• Set up their sleeping environment to be quiet, calm and at a comfortable temperature.
• Use earplugs and eye masks if noise and light levels are disruptive.
• Encourage them to avoid electronic devices such as tablets and smartphones before bed.
• If someone cannot sleep because of worries and concerns, suggest they keep a pen and paper beside their bed to write things down and deal with them in the morning.
• Encourage the person to talk about any worries or fears that are keeping them awake – they might benefit from talking to a psychologist, counsellor, faith leader or spiritual advisor. Cognitive behavioural therapy (CBT) can also be effective.
• Wellbeing therapies such as aromatherapy, massage or hypnotherapy might also be helpful.
• If you think medication might be required to help manage sleep problems, speak to their doctor or nurse.

Frequently asked questions