It is not surprising that many older people mention that they spend much of the day sleeping. This is a very frequent reality in this group of population, and it is a phenomenon that does not have to be linked to any pathology but to normative variations of the rhythms of sleep as the years go by.

In this article we collect and briefly explain the phenomenon of hypersomnia in old age .

The concept of hypersomnia

Excessive sleepiness for at least one month is considered hypersomnia. This drowsiness can be seen both in extended periods of sleep (as occurs in Kleine-Levin syndrome) and in the form of daytime sleep that causes functional limitation of the individual in his activity in various areas.it is also common for people with hypersomnia to have reduced intellectual performance and problems with concentration, memory and irritability.

This definition coincides to a great extent with what happens in elderly subjects, who often fall asleep during the day . It could therefore be said that many elderly people suffer from hypersomnia in old age. However, it must be taken into account that in most cases this fact can be explained by the change in sleep cycles that occur throughout life.

Sleep cycles

Going to sleep is not like turning off a switch . The passage from sleep to wakefulness does not occur in a sudden way in which our brain activity suddenly changes to repair itself and process information. In fact, as many readers will know, there are a total of five phases that we go through continuously throughout the entire sleep period, repeating a pattern that lasts about 110 minutes in a cyclical manner.

Four of these phases correspond to slow or non-REM sleep, with the first two phases in which we fall asleep and disconnect from our surroundings and the second two (which often come together in a single phase called the Delta phase) being slow and restful sleep. The last phase corresponds to paradoxical sleep or REM phase, in which information obtained during wakefulness is processed and phenomena such as dreams occur.

These cycles vary in quantity and quality throughout life , both in total time spent sleeping and in the number of hours per day in which each phase occurs. For example, babies spend a large part of the day sleeping, and in this time the high presence of hours dedicated to REM sleep is noteworthy.

Aging and Sleep

As we grow, our sleep patterns change. While REM sleep remains more or less constant (with slight decreases) from the age of twenty, the other phases of sleep vary throughout life.

It has been observed that on reaching old age there is a marked tendency towards sleep fragmentation , with multiple night-time awakenings being common. Likewise, slow wave sleep, the sleep that is most repairing for the organism, is greatly reduced. The phase of sleep that occupies the most time is that of phase two, a light and not totally reparative sleep from which the subject can be easily awakened.

With the passage of time the circadian rhythms naturally shorten, causing the subject to wake up earlier and earlier (although they also tend to go to bed early).

In conclusion, l he quantity and quality of sleep of the elderly is less than that of other stages of life . That is why during the normative periods of sleep they do not finish their rest adequately, which causes them an increase in fatigue and daytime sleepiness. In this way, hypersomnia in old age emerges as a normative process and without having to refer to the presence of other alterations.

Problems associated with daytime sleepiness

Increased fatigue and the presence of a slight increase in daytime sleep may be part of a normative aging . But it may also be indicative of a physical or mental disorder, so it is necessary to take into account the existence or not of other symptoms beyond sleepiness.

1. Depression

For example, it is common for people with depression to suffer from either insomnia or hypersomnia . People with depression often show a loss of positive reinforcement, anhedonia, disconnection from their environment, passivity and a low level of energy and motivation. This is a condition that can occur at any age, but it is especially frequent among the elderly population due to the high number of losses and decreases typical of age.

The loss of physical and mental capacity, of roles (such as in the workplace), the emergence of dependence on aids in some cases, the death of part of the social environment, or the increasing loneliness that older people show, are frequent reasons for those who reach old age to suffer from some kind of depressive syndrome.

2. Medication consumption

With age, it is common to need different medications to treat different health problems. And this consumption is another of the main causes of hypersomnia in old age. Antihistamines, tranquilizers, analgesics, antiemetics and antidepressants are some of the drugs that can cause increased drowsiness.

3. Dementia

Patients with different types of dementia and neurodegenerative diseases also often see their sleep patterns altered , as for example in Alzheimer’s disease.

4. Brain Tumors or Cancer Treatment

Another cause that can lead to increased fatigue and hypersomnia in old age is the occurrence of some type of tumor that affects or compresses the brain areas linked to sleep management. Likewise, the very treatment of cancer through chemotherapy may cause daytime hypersomnia .

5. Anemia

The lack of essential nutrients can cause anemia , in which the body is limited by not having enough elements to function effectively. This can cause increased weakness and sleepiness in the elderly, leading to hypersomnia.

Bibliographic references:

  • Echávarri, C.; Erro, M.E. (2007). Sleep disorders in the elderly and dementia. Anales del Sistema Sanitario de Navarro, 30, supl.1.
  • Phillip, B. & Ancoli, S. (2000) Sleep disorders in the elderly. Sleep Med; 2: 99-114.
  • Reséndiz, M.; Valencia, M.; Santiago, M.V.; Castaño, V.A.; Montes, J.; Hernández, J. & García ,G. (2004). Excessive daytime sleepiness: causes and measurement. Neuroscience; 5 (2). Mexico.