Evie Summers
As people age, their sleep patterns change, and they may find themselves sleeping more than they used to. This can be due to a variety of factors, including health issues, medication side effects, mental health challenges, and changes in circadian rhythms. Daytime sleepiness in older adults can be a symptom of underlying health issues such as sleep apnea, cognitive impairment, or cardiovascular problems. It can also be caused by boredom and a lack of stimulating activities during the day. Additionally, older adults may experience insomnia or other sleep disturbances, impacting their overall sleep quality. Understanding the reasons behind excessive sleepiness in older individuals is essential for improving their sleep patterns and overall well-being.
| Characteristics | Values |
|---|---|
| Circadian rhythm disturbances | 20% of older people experience excessive daytime sleepiness |
| Sleep disorders | Sleep apnea, restless leg syndrome, narcolepsy |
| Medication side effects | Antidepressants, blood pressure drugs, atypical antipsychotics, diuretics, bronchodilators, corticosteroids, decongestants, β-blockers, cardiovascular, neurologic, psychiatric, and gastrointestinal medications |
| Health issues | Arthritis, chronic pain, diabetes, dementia, Alzheimer's, Parkinson's, insomnia |
| Lifestyle factors | Boredom, retirement, lack of activities, depression, loneliness, loss of loved ones |
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What You'll Learn
Depression and boredom
Boredom and exhaustion are common factors contributing to excessive daytime napping in older adults. Retirement, diseases, or social isolation can lead to a significant decrease in daily activities, causing boredom and a need for napping during the day. This boredom can be detrimental to an older adult's quality of life and lead to depressive symptoms.
Depression is a common cause of sleep problems in older adults, with approximately 5% of older adults experiencing depression. Depression can cause a loss of interest in activities, excessive fatigue, and changes in sleep patterns, such as insomnia or oversleeping. It is important to note that depression is not a normal part of aging and can be treated with medical attention, therapy, and support from loved ones.
Older adults may also experience changes in their circadian rhythms, making it more difficult to adjust to changes in their sleep schedules. Additionally, underlying medical and mental health conditions, as well as the side effects of medications, can contribute to excessive sleepiness.
To improve the sleep habits of older adults, it is recommended to establish a consistent sleep schedule, reduce distractions in the bedroom, and engage in daily activities to reduce boredom and improve overall well-being.
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Medication side effects
Sleep medicines are often used by older people to combat insomnia and other sleep issues. However, these medications can have side effects and may not be very effective, especially in the long term. Older people are advised to try non-drug treatments first, as there may be safer ways to improve sleep.
Sleeping pills are available over the counter (OTC) or by prescription. OTC sleep aids often contain antihistamines, which treat allergies but can also cause drowsiness. Other OTC options include natural supplements like melatonin and valerian root, which is an herb that supposedly aids relaxation and sleep. However, these natural remedies can also have side effects. For example, valerian root can cause dizziness, dry mouth, and mental dullness. Melatonin use has increased among US adults, with many taking more than the recommended amount. Melatonin is also available in a 2-mg prolonged-release formulation approved for insomnia in older adults in Europe. Ramelteon, another melatonin receptor agonist, is also approved for treating insomnia in older adults. Both melatonin and ramelteon have been found to improve total sleep time, sleep latency, and subjective sleep quality in older adults. Common side effects of these medications include somnolence, dizziness, fatigue, and headaches.
Prescription sleep medications such as zolpidem (Ambien) and eszopiclone (Lunesta) are also associated with adverse effects. These drugs can cause dizziness, confusion, and an increased risk of falls and fractures. They can also impair mental and physical function in older adults and may interact with other medications to suppress breathing and cause respiratory depression. Z-drugs, a class of prescription sleep medications, carry additional risks for older adults, especially those with kidney or liver dysfunction or a history of depression and suicidal thoughts. It is recommended that older adults avoid alcohol consumption while taking Z-drugs, as this can increase the risk of adverse effects.
Other prescription sleep medications, such as doxepin and amitriptyline, may cause headaches and somnolence, especially at higher doses. Antipsychotics, another class of medications sometimes used to treat insomnia, carry an increased risk of stroke and sudden cardiac death in older adults and should be avoided unless specifically indicated for conditions like psychosis.
Overall, while sleep medications can be helpful in the short term for issues like jet lag or anxiety, they should be used with caution, especially in older adults. Non-drug therapies like cognitive behavioral therapy (CBT) and lifestyle changes, including regular exercise and reducing caffeine intake, are often recommended as safer and more effective ways to improve sleep in this population.
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Sleep disorders
The development of insomnia in older adults can be attributed to a variety of factors, including depression, psychological distress, medical conditions, medications, and circadian rhythm disturbances. Certain medications, such as β-blockers, bronchodilators, corticosteroids, decongestants, and diuretics, can cause sleep disturbances. Additionally, polypharmacy is common among older adults, and the combined effects of multiple medications can impact sleep.
Chronic insomnia disorder, characterised by daytime dysfunction such as fatigue and daytime sleepiness, is another sleep disorder that can affect older adults. The prevalence of insomnia among older adults can vary depending on the criteria used for diagnosis, with rates reported as 15% and 4% according to different classification systems. Sleep-maintenance insomnia and early awakening are more common in older adults than sleep-onset insomnia, likely due to age-related changes in sleep architecture and circadian rhythm.
Other sleep disorders that can affect older adults include sleep apnea, which disrupts sleep by causing intermittent pauses in breathing and preventing deep, restorative sleep. Additionally, older adults may experience hypersomnia disorders such as narcolepsy and idiopathic hypersomnia, although these are rarer in older subjects.
Treating the underlying medical conditions and comorbid diseases associated with insomnia is essential to improving sleep quality and overall health in older adults. Behavioural treatments, such as cognitive-behavioural therapy for insomnia (CBT-I), have been shown to be effective in treating insomnia in older adults.
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Circadian rhythm changes
The ageing process can also bring about other changes in sleep patterns and quality. Older adults may find it harder to fall asleep and stay asleep, experiencing more fragmented sleep and lighter sleep cycles. This can be due to various factors, such as achy joints, nocturia (the need to use the restroom frequently), or underlying health conditions.
Health issues such as arthritis, chronic pain, or neurological disorders can disrupt sleep and cause excessive daytime drowsiness. Additionally, older adults are more likely to experience multiple medical problems, and the medications used to treat these conditions can also impact sleep. Certain drugs, such as β-blockers, bronchodilators, and diuretics, are known to cause sleep disturbances.
The interplay between health conditions and medications can further complicate sleep patterns. Polypharmacy, or the use of multiple medications, is common among older adults, and the combination of drugs may have synergistic effects on sleep. Additionally, untreated or undiagnosed mental health issues, such as depression, can contribute to both insomnia and excessive daytime sleepiness.
It is important to note that age-related changes in circadian rhythms tend to stabilise after the age of 60, especially for older adults in good health. However, if newer changes in sleep habits are observed, it is crucial to seek medical advice to rule out any underlying medical conditions or other disruptions in social environment or lifestyle that may be contributing factors.
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Lack of exercise
Older adults may experience changes in their sleep patterns due to various factors, and one of these factors is a lack of exercise. Here are some ways in which a lack of exercise can contribute to sleep issues in older individuals:
Physical Fatigue and Sleep Quality
Regular physical activity can promote better sleep by inducing physical fatigue, which helps older adults fall asleep more easily and achieve deeper, more restorative sleep. When older people don't engage in enough exercise, they miss out on these benefits, potentially leading to difficulties in falling asleep and maintaining sleep throughout the night.
Health Conditions and Sleep
The absence of exercise can contribute to various health conditions that may disrupt sleep. For example, a lack of exercise can negatively impact muscle mass and function, insulin resistance, and hormonal changes, all of which can interfere with sleep quality. Additionally, conditions such as arthritis, osteoporosis, heart disease, and lung diseases are more prevalent in older adults who don't exercise regularly, further hindering their sleep.
Mental Health and Sleep
Mental health challenges, such as anxiety and depression, are often associated with sleep disturbances. Exercise is a powerful tool in reducing worry, anxiety, and depressive symptoms. Therefore, a lack of exercise can indirectly affect sleep quality by increasing the likelihood of mental health issues.
Boredom and Exhaustion
Retirement, diseases, or social isolation can lead to a significant decrease in daily activities for older adults, resulting in boredom and exhaustion. This lack of stimulation and structure to their days can contribute to excessive napping, disrupting their nighttime sleep patterns.
It's important to note that while exercise is crucial, older adults should be mindful of the timing of their workouts. It is recommended to exercise at regular times each day, avoiding strenuous activity within 3 hours of bedtime to prevent sleep disruption.
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Frequently asked questions
There are several reasons why older people may sleep more than younger people. Firstly, older people tend to experience lighter sleep, making it harder to fall and stay asleep. Secondly, age-related health issues, such as arthritis, dementia, or sleep apnea, can cause excessive fatigue and sleep disturbances. Thirdly, boredom and a lack of daily activities due to retirement or social isolation can lead to increased napping during the day. Additionally, mental health challenges, such as depression, are common in older adults and can cause excessive sleepiness. Finally, the side effects of medications for various health conditions can also contribute to increased sleepiness in older individuals.
Older adults often manage multiple health conditions with various medications, and some of these medications may have drowsiness as a side effect. According to a report, approximately 39% of individuals aged 65 and above take five or more medications. It is important to be aware of the potential side effects of medications and consult a doctor if sleepiness becomes a concern.
Insomnia, characterised by difficulty falling or staying asleep, is the most common sleep disturbance in older adults. Up to 40-50% of those over 60 experience insomnia, with women being more likely to report it than men. Insomnia in older adults is associated with overall poor health and mental well-being, and it can lead to the development or exacerbation of depression if left untreated.
Apart from sleep apnea, which is a common sleep disorder in older adults, other sleep disorders include Restless Leg Syndrome (RLS) and Narcolepsy. RLS causes an irresistible urge to move the legs at night, disrupting sleep. Narcolepsy is a chronic neurological disorder characterised by abnormal REM sleep, resulting in excessive daytime sleepiness and brief attacks of muscle weakness.
If an older adult is experiencing excessive daytime sleepiness, it is important to identify the underlying reasons. Maintaining a consistent sleep schedule, engaging in activities during the day, and seeking medical advice for any health or mental health concerns can help improve sleep patterns. Additionally, addressing any sleep disorders or medication side effects can also contribute to better sleep quality and overall health.
