Why Do Elderly People Sleep All The Time, Including During The Day?

Elderly adults daytime sleeping

You may have noticed yourself or an older relative sleeping a lot, and it’s normal to wonder ‘how much is too much sleep?’ Older people do tend to have different sleeping habits than younger people, so learning what is and is not normal in terms of daily sleep could help to identify any potential health issues. Here, we are exploring what counts as ‘normal’ sleep, what sleep changes are typical as we age, the most common causes of excessive daytime sleepiness, when this could be cause for concern, how to improve daytime alertness, and how home care could help.

At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For over 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about sleep in older adults, we can help.

At what age does our sleep start to change?

We all experience changes in our sleep patterns periodically due to things like illness, anxiety, having young children, jet lag, and other factors. Research has long shown that it is considered normal for older people to experience more of these changes, with sleep becoming lighter and more intermittent throughout the night from around middle-age. Fluctuations in melatonin production and circadian rhythms can affect sleep over time, and a 2019 study found that up to 75% of older people reported disturbed sleep.

While it’s relatively normal for older people to start experiencing lighter sleep, more frequent waking during the night, and feel more tired earlier in the evening, what is not considered typical with age is excessive sleep. Research shows older people need roughly the same amount of sleep as other adults, which is an average of around 7 to 9 hours a night – any more than this (such as 12+ hours of sleep a night/day) could be cause for concern. Also, symptoms like struggling to stay awake for meals, experiencing constant fatigue, or missing medications due to increased sleep could indicate there is an underlying issue.

Remember, poor sleep is not simply “part of ageing”, so take steps to get to the bottom of what could be causing this. Although some older people suffer from fatigue and take a short nap in the day, consistent daytime sleepiness and excessive sleep should be investigated. For older adults, getting adequate, quality sleep can help to manage chronic health conditions, support mental health, and improve quality of life, so it is important to address any sleep issues promptly.

You can read more in our guide to healthy sleep and insomnia in the elderly.

What commonly causes excessive sleep in older adults?

Some of the most common causes of excessive daytime sleep or tiredness include:

Medication Side Effects

Many older people live with multiple health conditions, and are therefore taking multiple medications to stay healthy.According to the Department of Health and Social Care’s National Overprescribing Review, 8.4 million patients in England regularly take five or more medicines — and for older adults managing multiple health conditions, certain combinations can negatively affect sleep.

Taking multiple medications at once could result in an older person sleeping for much longer each day than they typically would. These include medications like antidepressants, antibiotics, antihistamines, cancer treatments, antipsychotics, and certain painkillers, which can lead older adults to feel drowsy and sleep more.

Regular medication reviews with your GP can help to ensure the combination of medications you are taking remains safe, and gives them an opportunity to address excessive tiredness by potentially making changes to your dosage or medication schedule. For example, they may suggest taking sedative medications before bedtime and stimulating medications and diuretics during the day, to improve sleep cycles.

Underlying Health Conditions

Many older adults live with multiple health conditions that could be causing excessive tiredness, or they might be experiencing this symptom due to an undiagnosed condition. In either case, understanding what is causing tiredness is important so you can take steps to improve this where possible.

Some common health conditions that could be causing excessive sleepiness include:

Anaemia (low iron levels)
Thyroid imbalance, either overactive thyroid or underactive thyroid
Heart conditions, such as heart failure – a National Sleep Foundation survey of people over 65 found that those with more medical conditions, including cardiac and pulmonary diseases, reported significantly more sleep issues
Diabetes, which can cause persistent fatigue
Infections, which are known to cause fatigue
Chronic kidney or liver disease

A 2004 study found that having multiple chronic conditions, such as heart disease, arthritis, or lung diseases, were found to be linked to one or more sleep problems, including difficulty getting to sleep, or daytime sleepiness.

Poor Nighttime Sleep Quality

Poor sleep at night can lead to tiredness during the day, which is common in older people; as many as 16 million UK adults — around a third — report having insomnia, with two thirds of UK adults suffering from disrupted sleep Other health conditions can disrupt sleep, such as sleep apnoea (which disrupts regular breathing patterns while sleeping) and restless leg syndrome (which causes involuntary jerking movements in the legs during sleep). When nighttime sleep is affected, older people may feel more tired during the day and take naps.

Other factors can impact sleep quality, such as regular bathroom visits throughout the night, or general anxiety that keeps you awake. Research into daytime sleepiness in older people has found that, often, older adults are unable to get adequate sleep at night, and some of their main complaints include having trouble falling asleep, having trouble staying asleep, and frequently waking during the night or very early in the morning. Women are also more likely to report insomnia than men.

Depression

Depression and insomnia are closely linked, and research shows that a depressed mood often predicts insomnia, while untreated insomnia can also result in depression, creating a vicious cycle. Depression is thought to be common as we age, affecting an estimated 22% of men and 28% of women aged 65 years and over in the UK. In those with depression, 75% have trouble falling asleep or staying asleep, leading to an increased need for sleep during the day. Depression is known to cause a lack of energy and motivation, and as a result, daytime sleepiness.

Dementia

Dementia negatively affects sleep, and in particular, it disrupts the person’s internal body clock so they are unable to tell whether they should be sleeping or awake during daylight hours. This can lead to trouble sleeping during the night, sundowning, or nighttime wandering, and as a result, feeling more tired during the day.

Increased sleep is a sign of the early stages of dementia, since common dementia conditions can cause damage to the brain in areas responsible for regulating sleep.

Chronic Pain

Conditions that cause chronic pain in older adults, such as arthritis, back pain or neuropathy, can disrupt sleep either due to pain in the specific area where the problem lies, or more general pain and discomfort that causes people to awaken in the night or struggle to get back to sleep when they do. In either case, this can lead to daytime sleepiness.

Chronic pain can be a major cause of excessive sleep, and up to half of older adults living with chronic pain are thought to experience sleep issues.

Dehydration/Malnutrition

Dehydration and malnutrition are common in older adults due to factors like health conditions, dental issues, and medications. Dehydration and malnutrition are often overlooked causes of excessive sleepiness in older adults, but a lack of essential nutrients and hydration means older people may lack the energy they need to continue with regular activities throughout the day, causing them to feel fatigued and seek naps or longer sleeps during daytime hours.

Lack of Daylight Exposure

Our circadian rhythms are partly determined by daylight exposure, which helps to regulate our body’s ability to tell when we should be sleeping and when we should be awake. Older people often experience changes in their circadian rhythms over time, which influences the timing of their sleep and causes many older adults to feel sleepy earlier in the evening.

For some people, this may develop into advanced sleep phase disorder (ASPD) which means they will typically feel the need to sleep between 6pm and 9pm, and may wake up very early as a result. If an older person chooses to fight their tiredness to align with the sleeping patterns of other people in their household, they may end up feeling tired during the day. Light therapy options can help, but mostly, older adults should respect their body’s natural sleepiness and opt for the bedtime that best suits their lifestyle.

Social isolation and loneliness can have an effect on our sleeping patterns, and can often lead to depression down the line, impacting sleep in a number of ways. If your older loved one appears to be sleeping excessively, getting them to do more during the day with friends and family could help by stimulating their brain, keeping them physically active, and easing any depression they are feeling. If you want to learn more, you may find our guide to signs of loneliness in the elderly helpful.

When should older people seek medical help for excessive sleep?

Oversleeping, which is defined as routinely sleeping for more than 9 hours, can cause further health problems due to a negative impact on the immune system, mental health, heart health, and more. Even without any future health implications, it could be a sign of a current underlying condition, so it is crucial to seek advice from a medical professional if you or a loved one is sleeping excessively at night or during the day.

Some red flags to watch out for include:

If sleepiness is interfering with daily life
If you are experiencing breathing pauses, gasping, or are snoring during sleep (this could be a sign of sleep apnoea)
If you are experiencing frequent confusion or disorientation upon waking
If you have recently had a fall, or have had a significant fall in the past
If you notice a sudden and drastic change in your sleep pattern
If you experience extreme fatigue during the day

Before speaking to your doctor, it can be helpful to keep a sleep diary for a week or so to note down when you go to bed, when you wake up, any naps you have, and how rested you feel each morning. You should also bring along a list of the medications you take (prescription, over-the-counter and supplements) so your GP can check what may be causing your sleepiness. They may ask questions about any recent changes in your life that could have contributed to sleep changes, so be prepared to discuss this.

How can older adults improve their daytime alertness?

If you have had your excessive sleep issues investigated by a medical professional and they have found no underlying issues, they may recommend ways to improve daytime alertness and nighttime sleep, to get you back into a better sleep cycle. Some tips for this may include:

Daily Routine Adjustments

Maintain a structured wake-up time to regulate the body’s internal clock and promote consistent energy levels. By waking at the same time each day you create a routine, which helps to maintain a consistent sleep schedule. Use alarms to ensure you wake at the right time, and to help your brain learn when you should be asleep or awake.
Get morning light exposure by spending at least 30 minutes outside, or sit close to a window where you can take in the daylight. Doing this immediately after waking can help to reset your circadian rhythms and boost your alertness.
Taking short, timed naps can help you feel refreshed and give you a boost of energy without interfering with your sleep during the night. Studies find that 20-60% of older adults take naps during the day, so if you enjoy these and feel you benefit from them, don’t limit yourself too much. Short naps are thought to be better; studies suggest that a nap of around 30 minutes is associated with better health, while longer naps of 90 minutes or more are associated with adverse cardiovascular outcomes and declining cognitive function.
Take stimulant foods, drinks or medications at appropriate times, such as in the morning, so they keep you awake in the daytime rather than disturbing your sleep at night. If you plan to change your medication schedule, always consult your GP first.

Environmental Changes

Optimise your bedroom for optimal sleep during the night to improve the amount of rest you get. By adjusting the temperature and keeping the lighting low using things like blackout curtains, you could improve your sleep quality. A cool, dark, quiet bedroom can promote a restful night’s sleep, so take some time to make these changes in order to improve your sleep and therefore improve your daytime wakefulness. You can learn more about ideal temperatures in our guide to recommended room temperatures for the elderly.
Plan gentle activities in your day to keep you energised and make you less likely to nap. Safe exercises like walking, stretching or yoga could help to increase circulation and alertness, and provide opportunities for social interactions and stimulation to fight the feeling of daytime drowsiness, leading to a better sleep at night.

How can professional care help?

If you or a loved one is sleeping excessively and you want to make changes to your routine in order to combat this, a few ways in which a professional home carer could help include:

Encouraging a consistent daily routine with stimulating daytime activities and a great wind-down routine before bed, to help regulate sleep cycles
Promoting exposure to daylight in the morning
Assisting with gentle, safe exercises and physical activities
Monitoring medications for side effects such as tiredness
Helping to create an optimal sleep environment which can facilitate better nighttime rest and therefore more daytime energy
Helping to limit excessive daytime naps to avoid oversleeping during the day
Helping older adults to keep a sleep pattern diary to share with their GP, if relevant
Ensuring proper hydration and nutrition to support energy levels throughout the day
Encouraging and facilitating regular GP check-ups to figure out the underlying cause of excessive sleeping

Sleep problems can create a domino effect and cause even more issues, especially for vulnerable older adults who may live with additional health issues. If you believe your loved one is sleeping excessively throughout the day and night, start by arranging a GP appointment to get to the bottom of what is causing this, and work with them to make necessary lifestyle changes or care routine changes to get them back to feeling like their best, most energetic self.

Our Care Professionals are the best of the best, and highly trained to deliver the services you need, whether that means regular visiting care, live-in care, or respite care. If you feel you or a loved one could benefit from support from a home care professional to help with excessive sleeping, reach out to your local Home Instead office to find out more.

Michelle Tennant, Clinical Governance Lead

I am a Registered Nurse of 20 years and have been in the care sector since I was 17 years old, I have had experience in every role that exists in a care company, including Registered Manager, care consultant, recruiter, scheduling, auditing, complaints, and networking! My role in the National office is Clinical Governance Lead, and most recently have been working with DHSC and Chief Nurse Deborah Sturdy to develop a clinical governance framework for the delegated healthcare activities in social care, I am continuing to take the lead on our Healthcare at Home service and drive this in the network. In addition to my nursing role, I’m 5 years into my PhD in Aging at Lancaster University, with a key focus on the retention of Care Professionals in the social care sector.