Hypersomnia in old age: causes, symptoms and treatment

A very common problem in the elderly: they fall asleep easily.

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

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

The concept of hypersomnia

Hypersomnia is considered to be the presence of excessive sleepiness for at least one month. This sleepiness can be seen both in extended periods of sleep (as occurs in Kleine-Levin syndrome) and in the form of daytime sleepiness leading to functional limitation of the individual's activity in various domains.It is also common for people with hypersomnia to have lower intellectual performance and problems with concentration, memory and irritability.

This definition largely coincides with what occurs in elderly subjects, who frequently fall asleep during the daytime.. It could thus be said that many elderly people have hypersomnia in old age. However, it should be borne in mind that in most cases this fact can be explained by the change in sleep cycles that occur throughout life.

Sleep cycles

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

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

These cycles vary in quantity and quality throughout life.The total time dedicated to sleep as well as the number of hours per day in which each phase occurs. For example, babies dedicate a large part of the day to sleep, and in that time there is a high presence of hours dedicated to REM sleep.

Aging and sleep

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

It has been observed that in old age there is a marked tendency to sleep fragmentation, with multiple awakenings being common.There are usually multiple nocturnal awakenings. Likewise, slow-wave sleep, the sleep that is most restorative for the organism, is greatly reduced. The phase of sleep that occupies the most time is phase two, a light and not totally restorative sleep from which the subject can wake up easily.

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

In conclusion, lhe quantity and quality of sleep in the elderly is lower than it was at other stages of life.. As a result, during normative sleep periods, they do not get adequate rest, which leads to increased fatigue and daytime sleepiness. Thus, hypersomnia arises in old age as a normative process and without having to refer to the presence of other disorders.

Problems related to the onset of daytime sleepiness

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

1. Depression

For example, it is common for people with depression to suffer from either insomnia or hypersomnia.. It is common for people with depression to eventually manifest loss of positive reinforcement, anhedonia, disconnection from the environment, passivity and low energy and motivation. It is a condition that can occur at any age, but is especially common among the elderly population due to the high number of losses and declines associated with age.

The loss of physical and mental capacity, of roles (such as work), the emergence of dependence on help in some cases, the death of part of the social environment, or the increasing loneliness of the elderly are frequent reasons for those who reach old age to suffer from some type of depressive syndrome.

2. Consumption of medicines

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 that can cause increased sleepiness in old age. that can cause increased drowsiness.

3. Dementias

Patients with different types of dementia and neurodegenerative diseases also tend to have their sleep patterns altered, as for example in Alzheimer's disease.such as Alzheimer's disease.

4. Brain tumors or Cancer treatment

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

5. Anemia

Lack of essential nutrients can cause anemiaanemia, in which the body is limited by not having enough to function effectively. This can cause increased weakness and drowsiness 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, suppl.1. Pamplona.
• 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. Neurosci.; 5 (2). Mexico.