Grandma's Sleep: Understanding Excessive Daytime Sleepiness In Elderly

Sleep patterns often change as people age. Older adults may experience changes in the quality and duration of their sleep due to factors such as alterations in their body's internal clock, hormone production, lifestyle changes, and health conditions. It is common for older adults to take naps during the day, which can be a normal compensatory mechanism for lost sleep at night. However, excessive daytime sleepiness in the elderly can also indicate underlying issues such as boredom, depression, medication side effects, or progression of conditions like dementia. Ensuring a healthy sleep routine, addressing health concerns, and promoting engagement in social, mental, and physical activities can help improve sleep patterns in older adults.

Boredom and lack of engagement

As people age, they may develop chronic health conditions and experience age-related changes that prevent them from doing the things they once enjoyed. This can be a serious blow to an elder's quality of life, leaving them with little to no schedule or things to look forward to. As a result, they may slide into the habit of napping throughout most of the day.

Elders may not be clinically depressed or even tired. Instead, their fatigue stems from boredom. They are no longer working, and they may struggle with reading or puzzles due to poor eyesight. Even watching TV can get old.

To help your grandma, you may need to find ways to stimulate her interest in life. This could mean some socialization through visitors, attending events at a senior centre, or even adult day care. Needing to adhere to a schedule, such as being ready for an adult day care bus, can be very helpful. After a few hours, your grandma may be much more inclined to be tired in the evening.

If adult day care isn't an option, consider hiring someone to come in during the day to provide companionship and plan some day trips. This will help your grandma maintain an interest in life.

Polypharmacy

The risks of polypharmacy are heightened for older adults, as they may process medications differently than younger individuals. For example, older adults may have different body compositions, and drug testing often does not include older adults, so the effects of medications on this population may not be fully understood.

To reduce the risks associated with polypharmacy, regular medication reviews with a doctor are recommended. This can help patients avoid unnecessary side effects and interactions, as well as identify medications that may no longer be needed. Additionally, working with a pharmacist can be beneficial, as they can help patients understand their medications, store and take them correctly, and identify potential drug interactions.

Deprescribing, or the reduction or discontinuation of medications, is also an important strategy to reduce the risks of polypharmacy. This involves working with a doctor to taper off or stop medications that are no longer beneficial or are causing harm. This process should be individualized and take into account the patient's health status, goals, and priorities.

In summary, polypharmacy is a serious concern for older adults, who are more likely to take multiple prescription medications and experience adverse effects. Regular medication reviews, working with a pharmacist, and deprescribing can help reduce the risks associated with polypharmacy and improve health outcomes for older adults.

Depression and low energy

Depression is not a normal part of aging, 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 fatigue is more than just tiredness. It is a physical sense of having no energy in your body. It can be relentless, and its symptoms vary, showing up as malaise, weakness, difficulty concentrating, lack of motivation, muscle aches, and whole-body exhaustion.

Depression is thought to affect neurotransmitters, the chemical messengers that facilitate communication between brain cells. In particular, depression impacts the neurotransmitters associated with the reward system and the system that regulates alertness. For example, having low levels of the neurotransmitter dopamine is linked not only to depression but also to disturbed sleep, low libido, brain fog, lack of motivation, and feelings of hopelessness.

Stress has a more profound impact on people with depression than those without the condition. Too much stress can cause your body to feel constantly drained of energy. As many as 75 percent of people with depression have trouble falling asleep or staying asleep.

• Exercise most days of the week: Regular exercise boosts your energy and helps you feel less exhausted over time. It can also help you fall asleep at night more easily.
• Stick to the same bedtime routine every night: Having a consistent sleep pattern helps maintain your body's circadian rhythm.
• Do your best to de-stress: Exercise, a nutritious diet, yoga, meditation, and leaning on loved ones for support can all help to reduce stress.
• Tell your doctor if you're struggling with fatigue: Your doctor can check if a medication or underlying health issue is causing your fatigue.

Dementia

In the later stages of dementia, a person might completely reverse their normal sleep pattern, staying up all night and sleeping during the day. This can be distressing for caregivers and loved ones, who may worry that something is wrong. However, it is important to know that this is a common feature of the disease and not necessarily a cause for alarm.

Some medications can also contribute to sleepiness in people with dementia, including antipsychotics, antidepressants, antihistamines, and sleeping pills. Additionally, sleeping disorders unrelated to dementia, such as sleep apnoea, can also lead to longer sleeping periods.

If the excessive sleeping has started suddenly or is accompanied by other concerning symptoms, it is important to consult a doctor to rule out any infections or conditions that could be affecting the person's sleep.

While it is generally not a reason for worry if the person doesn't appear uncomfortable or distressed, prolonged sleeping can lead to physical health problems, such as bedsores. In such cases, it is crucial to seek advice from a healthcare professional on how to best care for the person.

• Establish a healthy sleep routine.
• Limit daytime sleep to small naps to avoid confusing the body clock.
• Consult a doctor or pharmacist for a medication review, as some drugs can cause side effects, including drowsiness.
• Rule out infections or conditions that could affect sleep.

It is important to remember that each person with dementia is unique, and the impact on their sleep can vary. Some people with dementia may experience sleep problems such as disorientation, frequent waking, and difficulty distinguishing between night and day.

While the quality of sleep tends to deteriorate with age, even if a person with dementia sleeps more than average, it is unlikely to be all good quality sleep.

In summary, excessive daytime sleeping in the elderly can be a sign of dementia, especially in its later stages. It is important to consult a healthcare professional if there are concerns or sudden changes in sleep patterns, and to provide appropriate care to prevent physical complications. Supporting a person with dementia to establish a healthy sleep routine and limiting daytime naps can help improve their sleep quality and overall well-being.

Terminal illness

When a loved one is diagnosed with a terminal illness, it can feel like time has stopped. You may instinctively push the news away, or perhaps you cried, or swung into action. No matter what your initial reaction was, time and life go on, and you must now face the difficult reality of the situation.

It is important to talk about death and plan for end-of-life care. These conversations can be very difficult and painful, but there are ways to make them easier. It is normal to feel anticipatory grief when you know someone you care about is seriously ill. This means grappling with and grieving a loss before it completely unfolds. It is important to acknowledge and accept these feelings and seek support from others who have been through similar situations, support groups, or literature designed for caregivers.

As the end draws closer, you may need to make arrangements for end-of-life care and consider funeral plans. Legal and financial matters must also be addressed. An advance care directive can help ensure that a person's healthcare wishes and end-of-life concerns are known and respected. This includes a living will, which sets out medical wishes, and a health care power of attorney or health care proxy, which designates a person to act on the ill person's behalf.

Hospice care is a type of care that can provide comfort and support for those nearing the end of their life, typically when their life expectancy is six months or less. It can take place at home or in a healthcare facility and often involves a team of healthcare professionals, including doctors, nurses, aides, social workers, counsellors, and therapists. Hospice care aims to improve the patient's quality of life by providing pain relief, symptom management, and emotional support.

In the final stages of a terminal illness, the patient may experience a range of symptoms, including confusion, restlessness, agitation, constipation, diarrhea, nausea, vomiting, fatigue, and shortness of breath. It is important to communicate these symptoms to a healthcare provider to ensure they can be managed effectively.

Bereavement services are also available to support loved ones through the grieving process after the death of their family member.

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