Elderly Parent's Sleep: Understanding The Reasons And Solutions

As people age, their sleep patterns change. Older people tend to sleep more lightly and wake up multiple times at night. They compensate for this lost sleep by taking restorative naps during the day. While this is normal, excessive daytime sleepiness in the elderly can be indicative of underlying health issues.

Some common causes of excessive daytime sleepiness in the elderly include boredom and lack of engagement, polypharmacy, depression, low energy, dementia, sleep disorders, nutrient deficiencies, and chronic diseases.

If you are concerned about your elderly parent sleeping all day, it is important to consult a doctor to determine the underlying cause and recommend appropriate solutions.

Depression and anxiety

Depression is a serious mood disorder that can affect the way a person feels, acts, and thinks. It is a common problem among older adults, but it is not a normal part of aging. If you suspect that your elderly parent may be suffering from depression, it is important to seek help from a qualified doctor.

Untreated depression can be a cause of daytime sleepiness in the elderly. Depression is often underdiagnosed in older individuals, so it is important to have your parent assessed by a doctor if you notice any signs or symptoms.

Some common symptoms of depression include:

• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, guilt, worthlessness, or helplessness
• Irritability, restlessness, or having trouble sitting still
• Loss of interest in once pleasurable activities, including sex
• Decreased energy or fatigue
• Moving or talking more slowly
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, waking up too early in the morning, or oversleeping
• Eating more or less than usual, usually with unplanned weight gain or loss
• Thoughts of death or suicide, or suicide attempts

If your elderly parent is experiencing several of these symptoms for more than two weeks, it is important to talk to a doctor.

Anxiety disorders are also common in older adults and can contribute to sleep problems. Anxiety is associated with a greater likelihood of poor sleep efficiency, increased sleep onset latency, poor quality of sleep, and daytime sleepiness. If your parent is suffering from an anxiety disorder, they may benefit from interventions such as breathing exercises or problem-solving techniques to reduce worries and rumination at bedtime.

Additionally, social isolation and loneliness are risk factors for both depression and anxiety. Encouraging your parent to stay socially connected and participate in activities they enjoy can help improve their mental health and sleep quality.

If your elderly parent is experiencing depression or anxiety, treatment options such as counselling, medication, or other forms of therapy can help improve their symptoms and sleep patterns. It is important to work with a doctor to find the most effective treatment plan for your parent's individual needs.

Dementia

People with dementia often experience changes in their sleep patterns, spending a lot of their time sleeping during the day and night. This can be distressing for family and friends, who may worry that something is wrong.

Additionally, people with dementia may experience a depletion of melatonin, a hormone that regulates sleep/wake cycles. They may also have low sleep pressure, meaning they do not feel tired at bedtime due to long periods of low activity or boredom during the day.

Other factors that can contribute to excessive daytime sleeping in people with dementia include:

• Coexisting conditions, such as depression, which is common in those with vascular brain conditions.
• Side effects of medication, including antidepressants, antipsychotics, antihistamines, and sleeping pills.
• Sleep disorders unrelated to dementia, such as sleep apnoea, where breathing occasionally stops during sleep.
• Changes in their internal 'biological clock', which judges what time it is, causing them to feel sleepy at the wrong time of day.
• Damage to other parts of the brain that control whether or not a person stays awake.

If your elderly parent is sleeping all day, it is important to determine the underlying cause. Consulting a doctor can help rule out any infections, conditions, or medications that could be affecting their sleep.

• Maintaining a regular sleep schedule and bedtime routine that involves quiet, soothing activities.
• Limiting naps during the day or keeping them under 30 minutes.
• Engaging in physical exercise early in the day, which can lead to better sleep at night and reduce napping.
• Scheduling social activities, as people with dementia who participated in one to two hours of social activity per day showed improved nighttime sleep.
• Increasing light exposure during the day, as light is a key regulator of the circadian rhythm.
• Avoiding stimulants such as caffeine, alcohol, and nicotine.
• Treating any pain, sleep disorders, or depression that may be contributing to sleep disturbances.
• Creating a calming bedroom environment with a comfortable temperature, minimal noise, and low lighting.

Sleep disorders

There are several sleep disorders that are common in elderly people. These include:

• Sleep apnea, which is characterised by pauses in breathing or shallow breaths during sleep.
• Restless leg syndrome, which is characterised by an overwhelming urge to move the legs, usually due to uncomfortable sensations.
• REM sleep behaviour disorder, which involves acting out dreams, sometimes violently, during REM sleep.

Other factors that can cause sleep disorders in elderly people include:

• Depression and anxiety, which can manifest as extreme fatigue.
• Dementia, which can cause both excessive sleepiness and sleep deprivation.
• New medications, which can have fatigue as a side effect.
• Infections, which can cause fatigue and often go undiagnosed in older people.
• Nutrient deficiencies, which can result in feelings of sluggishness and weakness.
• Chronic diseases, which can cause fatigue as a symptom.

Medication

Prescription drugs and over-the-counter medications for various conditions can cause excessive sleepiness. These include treatments for anxiety, depression, high blood pressure, insomnia, chronic pain, Parkinson's disease, nausea, and allergies. Atypical (second-generation) antipsychotics, which are typically prescribed only when other options are ineffective, are known to be particularly hard on elderly patients, especially those with dementia. Antidepressants, while beneficial, often require trial and error to find the right one, and sleepiness can be a common side effect. Other common medications, such as blood pressure drugs, can also cause drowsiness.

If your elderly parent is sleeping too much during the day, it is important to consult their doctor to review their medications and determine if any adjustments can be made. This may involve reducing dosages, discontinuing certain medications, or altering the timing of doses to improve alertness during the day.

Additionally, some medications can contribute to sleep disturbances at night, leading to increased daytime sleepiness. These include antipsychotics, antidepressants, antihistamines, and sleeping pills. A healthy sleep routine and non-pharmaceutical methods, such as engaging in activities during the day and sticking to a set sleep schedule, are often recommended as the first line of treatment for improving sleep habits.

Medical treatments

If your elderly parent is sleeping all day, it is important to consult a doctor to determine the underlying causes and appropriate treatments. Here are some possible medical interventions to address excessive daytime sleepiness in older adults:

• Medication Review: Polypharmacy, or the use of multiple medications, is common among older adults and can lead to drug interactions and side effects that disrupt sleep. A doctor can review the medications, adjust dosages, change timing, or consider alternative treatments to reduce sleepiness.
• Depression Treatment: Depression is a common issue among older adults and can cause excessive fatigue. Medical attention, therapy, and social support can help address depression and improve sleep patterns.
• Sleep Hygiene: Encouraging good sleep hygiene practices can improve sleep quality. This includes maintaining a consistent sleep schedule, avoiding naps longer than 30 minutes, increasing exposure to daylight, and reducing caffeine, alcohol, and tobacco consumption.
• Exercise and Activity: Regular exercise and physical activity can help regulate sleep in older adults. Staying active and engaging in social interactions can reduce boredom and improve overall well-being.
• Cognitive Behavioral Therapy (CBT): CBT is a form of therapy that can help treat insomnia and improve sleep habits. It involves identifying and changing unhelpful thoughts and behaviours related to sleep.
• Bright Light Therapy: Exposure to bright light, especially in the late afternoon or early evening, can help strengthen sleep-wake cycles and improve sleep continuity, particularly in institutionalized elderly patients.
• Melatonin Therapy: Melatonin is a hormone that regulates sleep-wake cycles and is often prescribed to improve sleep efficiency. However, its long-term safety and optimal dosage are still being studied.
• Continuous Positive Airway Pressure (CPAP): CPAP is a treatment for sleep-disordered breathing, such as sleep apnea, which is common in older adults. It provides continuous positive airway pressure to keep the airway open during sleep, improving sleep quality and reducing sleep disruptions.
• Dopamine Agonists: These medications are used to treat Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD), which are common sleep disorders in older adults. They help reduce leg movements and associated sleep disturbances.
• Clonazepam: This long-acting benzodiazepine is the treatment of choice for Rapid Eye Movement (REM) Sleep Behavior Disorder, which is characterized by acting out dreams and violent movements during sleep.

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