Hypersomnia in old age: causes, symptoms and treatment
It is not strange that many elderly people mention that they spend much of the day sleeping. It is a very frequent reality in this population group, and it is a phenomenon that does not have to be linked to any pathology but to normative variations of sleep rhythms as the years go by.
In this article we collect and briefly explain the phenomenon of hypersomnia in old age .
The concept of hypersomnia
The excessive presence of drowsiness for at least a month is considered hypersomnia. This drowsiness can be seen both in extended periods of sleep (as in the Kleine-Levin syndrome) and in the form of daytime sleep that cause a functional limitation of the individual in its activity in various areas. It is also common for people with hypersomnia to have lower intellectual performance and problems of concentration, memory and irritability.
This definition largely coincides with what happens in elderly subjects, who fall asleep frequently during the day . It could be said, therefore, that many elderly people present hypersomnia in their old age. However, we must bear in mind that in most cases this fact has its explanation in the change in sleep cycles that occur throughout life.
The sleep cycles
Falling asleep is not like turning off a switch . The step from sleep to wakefulness does not happen in a sudden way in which suddenly our brain activity changes to repair and process information. In fact, as many readers already know, there are a total of five phases through which we spend continuously throughout the entire sleep period, repeating cyclically a pattern that lasts about 110 minutes.
Four of these phases correspond to slow or non-REM sleep, being the first two phases in which we fall asleep and disconnect from the environment and the two seconds (which often come together in a single phase called the Delta phase) the slow and restful sleep . The last phase corresponds to the paradoxical dream or REM phase, in which the information obtained during the watch is processed and phenomena such as dreams occur.
These cycles vary in quantity and quality throughout life , both in total time dedicated to sleep and in the number of daily hours in which each phase occurs. For example, babies spend a large part of the day sleeping, and at that time the high presence of hours devoted to REM sleep stands out.
Aging and sleep
As we grow, sleep patterns change. While REM sleep remains more or less constant (with slight decreases) from the age of twenty, the rest of the phases of sleep vary throughout life.
It has been observed that when reaching old age there is a marked tendency to fragment sleep , being usual that there are multiple nocturnal awakenings. Also, slow wave sleep is greatly reduced, the sleep that is most restorative for the organism. The phase of sleep that occupies most time is that of phase two, a light sleep and not totally restorative from which the subject can wake up easily.
Over time the circadian rhythms are shortened naturally, causing the subject to wake up every time before (although they also tend to go to bed soon).
In conclusion, l The amount and quality of sleep of the elderly is lower than that they had in other stages of life . This is why, during the normative periods of sleep, they do not finish rest properly, which causes them to increase their fatigue and daytime sleepiness. In this way, hypersomnia arises in old age as a normative process and without having to refer the presence of other alterations.
Problems linked to the appearance of daytime sleep
Increased fatigue and the presence of a slight increase in daytime sleep may be part of normative aging . But it can also be indicative of the existence of a physical or mental disorder, which is necessary to take into account the existence or otherwise of other symptoms beyond sleepiness.
For example, it is common for people with depression to suffer from either insomnia or hypersomnia . And it is common for people with depression to manifest in the long run the loss of positive reinforcement, anhedonia, disconnection from the environment, passivity and low level of energy and motivation. It is a condition that can be had at any age, but it is especially frequent among the elderly population due to the high number of losses and decreases of age.
The loss of physical and mental capacity, roles (such as work), the emergence of dependence on aid in some cases, the death of part of the social environment, or the increasing loneliness that older people show are reasons frequent that those who reach old age suffer from some type of depressive syndrome.
2. Consumption of medications
It is common that with age it is frequent 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 which can cause an increase in drowsiness.
Patients with different types of dementia and neurodegenerative diseases also tend to see their sleep patterns altered , as for example in Alzheimer's disease.
4. Brain tumors or cancer treatment
Another cause that can cause an increase in fatigue and hypersomnia in old age is the suffering of some type of tumor that affects or compresses the brain areas linked to sleep management. Likewise, the cancer treatment itself through chemotherapy can cause daytime hypersomnia .
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 an increase in the weakness and drowsiness of the elderly, causing hypersomnia.
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- 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. Rev. Mex. Neuroci .; 5 (2). Mexico.