Gina Johnson
Sleep is a complex process that changes as we age. Older adults tend to go to bed and wake up earlier, and the amount of time spent in each type of sleep decreases. Seniors may doze off during the day due to poor sleep at night, which can be caused by various factors such as insomnia, sleep apnea, restless leg syndrome, and REM sleep behavior disorder. Additionally, older adults are more likely to take medications and have medical conditions that can disrupt their sleep. Daytime sleepiness in the elderly can also be a symptom of underlying health issues such as depression or terminal illnesses. It is important to consult a doctor to address sleep issues and improve sleep quality.
| Characteristics | Values |
|---|---|
| Daytime napping | Research estimates that about 25% of older adults take naps, compared to around 8% of younger adults |
| Circadian rhythm | The amplitude of the circadian rhythm may decrease with age, increasing the frequency of nighttime awakenings and the severity of daytime sleepiness |
| Sleep schedule changes | Older people may find it more difficult to adjust to sudden changes in their sleep schedules |
| Nighttime urination | Nocturia increases with age due to physical changes in the urinary system, affecting up to 80% of older adults |
| Insomnia | Difficulty falling or staying asleep is one of the most common sleep issues in older adults, affecting up to 50% of patients with habitual snoring |
| Depression | Depression can cause excessive fatigue and is not a normal part of aging |
| Medication | Prescription drugs and over-the-counter medications for various conditions can cause excessive sleepiness |
| Sleep apnea | Fragmented sleep due to sleep apnea can lead to headaches, daytime sleepiness, and cognitive difficulties |
| Restless Legs Syndrome (RLS) | RLS affects 9%-20% of older people, causing an urge to move the legs while resting or sleeping |
| Exercise | Older adults who exercise regularly report better quality sleep |
| Sleep duration | Older adults need about seven to nine hours of sleep, similar to younger adults |
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What You'll Learn
Sleep disorders: Insomnia, sleep apnea, RLS, PLMD, RBD
While daytime napping is more common among older adults, excessive sleepiness during the day could indicate an underlying problem. Seniors may doze off during the day to compensate for poor sleep at night, but this can negatively impact their quality of life.
Prescription drugs and over-the-counter medications for conditions like anxiety, depression, insomnia, chronic pain, and allergies can cause excessive sleepiness. Additionally, older people may develop chronic health conditions that affect their sleep.
Insomnia
Insomnia is a persistent difficulty in falling or staying asleep. It is one of the most common sleep issues in older adults and can be caused by various overlapping factors. Treatment can help improve insomnia.
Sleep apnea
Sleep apnea causes fragmented sleep and can affect oxygen levels, leading to headaches, daytime sleepiness, and difficulty thinking clearly. It is associated with periodic limb movement disorder (PLMD) and can be treated with Continuous Positive Airway Pressure (CPAP) therapy.
Restless Legs Syndrome (RLS)
RLS affects 9-20% of older people and causes an urge to move the legs while resting or sleeping. It is often associated with discomfort and is relieved by movement. RLS is characterised by voluntary leg movements, which is how it differs from PLMD.
Periodic Limb Movement Disorder (PLMD)
PLMD affects 4-11% of older people and involves involuntary movements in the lower limbs, most commonly the feet. It can also occur in the upper extremities. PLMD is diagnosed when there is no underlying cause for the movements, such as sleep apnea or RLS. There is no specific treatment for PLMD, but medications used for RLS may be effective.
REM Sleep Behavior Disorder (RBD)
RBD primarily affects older people. While most people don't move while dreaming, RBD can cause people to physically act out their dreams, sometimes violently.
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Medication: Prescription drugs, antipsychotics, polypharmacy
Older adults tend to take more medicines than any other age group because they may have several diseases or other health problems at the same time. Polypharmacy, or the use of multiple medications, can lead to adverse effects or life-threatening symptoms. It is associated with falls, fractures, kidney impairment, frailty, cognitive dysfunction, and hospitalization. The risk of adverse reactions and drug interactions increases with the number of medications taken.
Antipsychotic medications are one type of prescription drug that older adults may take. These drugs are often used to treat elderly patients with dementia and psychosis. While they can reduce the frequency and intensity of symptoms, they also carry serious health risks. The Food and Drug Administration (FDA) has issued a black box warning about the use of antipsychotics in older adults with dementia due to the potential for severe side effects.
Older adults with dementia may exhibit behavioural and psychological symptoms such as delusions, apathy, and agitation. To manage these symptoms, they are often prescribed psychotropic or opioid medications such as sedatives, tranquilizers, and hypnotics. However, combinations of three or more of these drugs can be dangerous and may increase the risk of falls, overdoses, and memory problems.
Sleeping pills are another type of prescription drug that can have side effects in older adults. These drugs can cause drowsiness, dizziness, balance problems, and constipation or diarrhea. They may also lead to central nervous system depression and, in some cases, seizures, coma, or cardiovascular problems. It is important for older adults to use these medications with caution and follow the advice of their doctor and pharmacist.
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Dementia: Sundowning, Lewy body disease, sleep patterns
There are many reasons why older people may sleep more during the day. It could be a result of age-related changes to their sleep patterns, such as insomnia, or it could be due to underlying health conditions. In some cases, daytime sleepiness in older adults can indicate depression or chronic health issues that prevent them from engaging in activities they once enjoyed.
Additionally, certain prescription drugs and over-the-counter medications for conditions like anxiety, depression, insomnia, and chronic pain can cause excessive sleepiness in older adults. It is important to discuss any concerns about medication side effects with a doctor.
Dementia: Sundowning
Sundowning is a phenomenon observed in people with dementia, where they exhibit behaviours that are difficult to understand in the late afternoon or early evening. During this time, they may become agitated, distressed, or experience hallucinations or delusions. Sundowning can occur at any stage of dementia but is more common in the middle and later stages. While the exact causes are unknown, it is believed that various factors, such as tiredness, hunger, pain, or other unmet physical needs, may contribute to this behaviour.
Lewy Body Disease and Sleep Patterns
Lewy body dementia (LBD) is a common form of dementia, comprising 15-20% of all dementia cases. It is characterised by sleep disturbances, including poor sleep quality, excessive daytime sleepiness, and rapid eye movement behaviour disorder (RBD). These disturbances are more common and severe in LBD compared to other types of dementia, affecting up to 90% of people with the condition.
In summary, while daytime sleepiness in older adults can have various causes, it is important to identify and address any underlying health issues or side effects of medications. Sundowning and Lewy body dementia are two specific conditions associated with dementia that can significantly impact sleep patterns and overall well-being.
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Circadian rhythm: Sleep-wake cycle, sleep deprivation, napping
Circadian rhythm refers to the 24-hour cycle that the body's internal clocks typically follow. This rhythm is governed by the central circadian clock, located in the brain, and other circadian clocks found in organs throughout the body. These clocks are influenced by environmental cues, such as light and darkness, which help determine when an individual feels awake or drowsy.
Age-related changes in the body's regulation of circadian rhythms can make it challenging for older adults to adjust to sudden alterations in their sleep schedules. For example, older adults may experience difficulties recovering from jet lag or adapting to daylight saving time. The rhythm and timing of body clocks tend to decline with age, as neurons that promote sleep are gradually lost. Certain conditions, such as Alzheimer's disease, can further accelerate this loss of neurons, making it harder for older individuals to stay asleep.
Sleep-wake cycle disorders can also contribute to sleep disturbances in older adults. Insomnia, affecting up to half of older adults, is characterised by difficulty falling or staying asleep, resulting in insufficient sleep quality or quantity. Other sleep disorders, such as narcolepsy, can cause extreme daytime sleepiness and muscle weakness.
Napping is a common practice among older adults, with research indicating that about 25% of them take naps, compared to only 8% of younger adults. While short daytime naps may offer some benefits, extended napping and late-day napping can disrupt nighttime sleep. Additionally, excessive daytime napping has been linked to an increased risk of developing Alzheimer's disease. A study by UC San Francisco and Harvard Medical School found that participants who napped more than an hour a day had a 40% higher risk of developing Alzheimer's disease compared to those who napped less.
To promote better sleep habits and improve sleep quality, older adults can implement various strategies. Maintaining a regular sleep schedule, reducing distractions in the bedroom, and avoiding substances that hinder sleep, such as alcohol, tobacco, and caffeine, can all contribute to improved sleep. Regular exercise, managing underlying health conditions, and consulting with healthcare professionals for appropriate treatments are also essential in optimising sleep for older adults.
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Health issues: Depression, pain, terminal illness, exercise
As people age, their sleep patterns change due to various factors, and this can result in excessive daytime sleeping. While daytime napping can be beneficial in some cases, it can also lead to nighttime sleep disruptions. Older adults may face challenges in getting sufficient and quality sleep due to various health issues, including depression, pain, terminal illnesses, and a lack of exercise.
Depression is a concern for older adults, with research indicating that up to 16% of older adults experience clinically relevant depressive symptoms. Sleep issues and fatigue are often red flags indicating changes in mental health. Additionally, older adults may experience chronic pain, arthritis, or other conditions that cause discomfort and interfere with sleep.
Terminal illnesses, such as dementia, can significantly impact sleep patterns. People with dementia may experience extreme fatigue and completely reverse their normal sleep patterns, staying up all night and sleeping during the day. The quality of their sleep may also deteriorate, resulting in restless nights and daytime sleepiness.
Polypharmacy, or the use of multiple medications, is another factor contributing to daytime sleepiness in older adults. Prescription drugs and over-the-counter medications for conditions like depression, pain, insomnia, and allergies can have side effects, including drowsiness and dizziness. Older individuals metabolize these medications differently, making them more susceptible to adverse effects.
Additionally, a lack of exercise and physical activity can contribute to sleep issues in older adults. Aging adults may have limited options for outings, activities, and entertainment, leading to a decline in their overall quality of life. This lack of stimulation and schedule can result in excessive napping during the day.
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Frequently asked questions
There are many reasons why older people may sleep more during the day. One reason could be that they are compensating for poor sleep at night. Older adults tend to experience a decrease in the quality and quantity of their sleep, with an increase in lighter sleep and a decrease in REM sleep. They are also more likely to have medical conditions and take medications that can affect sleep.
Older people are more likely to experience insomnia, sleep apnea, restless legs syndrome, and REM sleep behaviour disorder. They are also more susceptible to the side effects of medications for conditions like anxiety, depression, high blood pressure, chronic pain, and allergies, which can cause excessive sleepiness.
Older people can improve their sleep hygiene by exercising regularly, reducing distractions in the bedroom, avoiding substances that hinder sleep, and maintaining a regular sleep schedule.
If excessive daytime sleepiness is interfering with an older person's quality of life, they should consult a doctor to identify and address any underlying health issues or medication side effects that may be contributing to their sleepiness.
