Sleep Issues: Concerns for Your Aging Parent's Health

Sleep issues

Hello Dr.
Hong, I am inquiring on behalf of my mother, who is currently 58 years old and works a regular job from Monday to Friday.
I am quite worried that she is overexerting herself.
While she doesn't seem to have issues at work, during her off hours, she often appears to doze off easily.
Even when it's not yet bedtime, she frequently falls asleep on the couch while watching TV, reading magazines, or using her phone.
For instance, today after work, she attended an online class but was so tired that she couldn't concentrate and ended up dozing off while trying to take important notes with her phone, which is quite concerning.
She seems to be experiencing excessive daytime sleepiness, and although it's not yet bedtime, she doesn't go to sleep right away.
I wonder if this could be a form of "revenge bedtime procrastination." I feel that she lacks sufficient sleep and often remind her to go to bed earlier, but she feels that going to bed too early leads to waking up too early, which troubles her.
For example, if she goes to bed at 10 PM, she might wake up at 3 AM.
Sometimes she can fall back asleep, but other times it takes her longer to do so.
Although she is not yet in the elderly stage, it seems like she sometimes gets less than 6 hours of sleep, and I believe people her age should still aim for around 7 hours.
Is insufficient sleep a precursor to dementia? Additionally, is it concerning that she doesn't sleep through the night? She often wakes up in the middle of the night to use the bathroom or drink water.

She doesn't seem to think there is an issue with her sleep, but I am very worried.
Am I overthinking this? Does her situation indicate insomnia or some other sleep disorder? Would she need medication to help? I hope she can go to the hospital for an evaluation (would that be a sleep study?), but she seems reluctant, especially during the recent pandemic (she had previous lung issues but has since improved after a minor surgery and exercise).

Her sleeping posture seems off; she needs to prop herself up quite high to feel comfortable.
For a while, she snored very loudly, but it has improved somewhat.
However, she often breathes through her mouth while sleeping, which I find strange.
She frequently sleeps on the living room couch and sometimes needs the TV on to fall asleep.

I would like to ask for your advice and whether, based on my description, you can identify any specific issues or areas of concern.
What recommendations do you have for her daily life? How can I encourage her to pay more attention to her health? She is a mother who tends to push through her limits.
Thank you!

Niming, 50~59 year old female. Ask Date: 2021/08/09

Dr. Hong Yuanbin reply Internal Medicine

Based on your description, it seems that your mother may have sleep apnea, likely of mild to moderate severity.
It is recommended to wait until the pandemic situation stabilizes before scheduling a sleep study at a major hospital's sleep clinic to identify the underlying cause.
Unless she is experiencing significant insomnia, there is no need for sleeping pills at this time.
It would be best to wait for the results of the sleep study before considering any medication.
Thank you for your inquiry.

Reply Date: 2021/08/09

More Info

Understanding sleep issues, especially in aging parents, is crucial for their overall health and well-being. Your concerns about your mother's sleep patterns and daytime fatigue are valid and warrant attention.
From your description, it seems that your mother is experiencing several sleep-related issues. The fact that she easily dozes off during the day while engaged in activities like watching TV or using her phone suggests that she may not be getting sufficient restorative sleep at night. This could be due to a variety of factors, including lifestyle, stress, or underlying health conditions.

Firstly, it's important to recognize that adults generally require about 7 to 9 hours of sleep per night for optimal health. If your mother is consistently getting less than this, it could lead to cumulative sleep deprivation, which can affect her cognitive function, mood, and overall health. The fact that she wakes up multiple times during the night and struggles to return to sleep is also concerning. Frequent awakenings can disrupt the sleep cycle, preventing her from reaching the deeper stages of sleep that are essential for physical and mental recovery.

The symptoms you describe, such as excessive daytime sleepiness, difficulty concentrating, and the need to prop herself up to sleep comfortably, could indicate a condition known as sleep apnea. This is characterized by repeated interruptions in breathing during sleep, often leading to loud snoring and gasping for air. It can cause fragmented sleep and excessive daytime fatigue. Given that she has a history of lung issues, it would be wise to consider this possibility.
Additionally, the fact that she feels the need to drink water at night and frequently wakes up to use the bathroom could suggest nocturia, which can be caused by various factors, including fluid intake before bed, medications, or underlying health conditions such as diabetes or urinary tract issues.
Regarding your question about whether her sleep issues could be a precursor to dementia, while poor sleep is associated with cognitive decline, it is not a definitive indicator. However, chronic sleep deprivation can exacerbate cognitive issues and should be addressed.

To help your mother improve her sleep quality, consider the following recommendations:
1. Sleep Hygiene: Encourage her to establish a regular sleep schedule by going to bed and waking up at the same time every day. Create a calming bedtime routine to signal to her body that it's time to wind down.

2. Sleep Environment: Ensure her sleeping environment is conducive to rest. This includes a comfortable mattress and pillow, a dark and quiet room, and a cool temperature. If she prefers to sleep with the TV on, consider using a sleep timer to turn it off after she falls asleep.

3. Limit Stimulants: Advise her to avoid caffeine and nicotine in the hours leading up to bedtime, as these can interfere with her ability to fall asleep.

4. Physical Activity: Encourage her to engage in regular physical activity during the day, as this can help improve sleep quality. However, she should avoid vigorous exercise close to bedtime.

5. Consult a Healthcare Professional: Given her symptoms and your concerns, it may be beneficial for her to undergo a sleep study to evaluate for sleep disorders such as sleep apnea. If she is hesitant to visit a hospital, consider discussing telehealth options with her healthcare provider.

6. Address Underlying Health Issues: If she has existing health conditions, ensure they are well-managed, as these can significantly impact sleep quality.

7. Emotional Support: Since you mentioned that she tends to "push through" her fatigue, it might be helpful to have an open conversation about her health and the importance of self-care. Encourage her to express any stress or concerns she may have, as emotional well-being is closely linked to sleep quality.

In conclusion, your mother's sleep issues are concerning and should not be overlooked. By implementing these strategies and seeking professional guidance, you can help her achieve better sleep and improve her overall health. It’s essential to approach this topic with empathy and understanding, as changes in sleep patterns can be challenging to address, especially for those who may not recognize the severity of their situation.

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