Napping in the morning? Aging may be affecting your circadian rhythm

Napping in the morning? Aging may be affecting your circadian rhythm

Your morning nap may be a sign that something is amiss with your health.

New research published in the Journal of the American Medical Association (JAMA) Network showed that frequent or excessive daytime napping in older adults can be warning signs of underlying health issues, including chronic conditions, sleep disorders and changes in circadian rhythms.

The study showed these factors contributed to an increased risk of mortality, and are also an opportunity to track napping patterns to identify health conditions early and prevent further decline.

Researchers reviewed data collected from napping patterns of 1,338 participants over 19 years and found that each additional hour of daytime napping, especially in the morning, was associated with an approximately 13 percent higher mortality risk. Each extra nap had roughly a 7 percent mortality rate and morning naps had a 30 percent increase in mortality rate.

Circadian Rhythm and Medications

"One of the key takeaways from this study is that aging affects the body's circadian rhythm, which regulates the sleep-wake cycle," said Jorge Alfonso, MD, an internal medicine physician based in South Yarmouth. "As a result, older adults tend to fall asleep and wake up earlier, which can contribute to a degree of sleep deprivation and increase the need for naps."

The National Institute on Aging reports that inadequate sleep is associated with a range of health concerns, including high blood pressure, heart disease, diabetes, cognitive impairment, emotional distress, strained relationships and an elevated risk of falls.

In addition to circadian rhythm changes, there are other reasons that could be interrupting your sleep.

Finding the Causes

The cause and effect of sleep disturbances and napping can be complicated.

Among the causes, according to Dr. Alfonso, are:

• Pain: Older adults tend to have a lot of pain in various areas of their body, including their back, hips and knees. Determining the cause of the pain can be helpful in controlling or alleviating it.
• Snoring: Snoring out loud can disrupt your sleep and cause you to wake multiple times during the night. It can also be a symptom of a potentially serious condition called sleep apnea.
• Nocturia: Women and men can be awakened three to five times a night to urinate, especially men who may have an enlarged prostate.
• Medications: Side effects can cause lethargy and fatigue. Beta blockers, and anticoagulants can cause fatigue even in the morning. Other medications include Gabapentin, Lyrica, and Cymbalta. Selective Serotonin Reuptake Inhibitors (SSRIs) for anxiety and depression such as Lexapro, Paxil, Zoloft can cause lethargy 24/7 resulting in the need for naps. Some medications that are used to treat chronic diseases have similar side effects.

"I care for many patients with multiple chronic conditions who take several medications, and many of these drugs can cause drowsiness within an hour of being taken," said Dr. Alfonso. "For example, a patient recovering from a stroke may be prescribed Gabapentin, while also taking an antidepressant to help manage anxiety or depression. These medications are often necessary, but their sedating effects can increase daytime sleepiness and napping. This can create a vicious cycle. As primary care physicians, we must be especially mindful of the medications we prescribe to older adults and carefully balance their benefits with potential side effects."

Understanding Your Sleep Patterns

"We need to find out why you are not sleeping," Dr. Alfonso said.

For that, a trip to your primary care provider may be in order. One of the first steps you can take, he said, is to answer the following questions that can help your provider determine some possible causes:

• Are you waking more times at night than usual?
• Are you noticing pain in your back, legs, hips or elsewhere?
• Do you snore loudly?
• Do you wake frequently for trips to the bathroom?
• Have you started any new medications?
• Do you have any changes in your living situation? Have you moved recently?
• Are you grieving changes in your life? Loss of a loved one or close friend?
• How has your napping pattern changed? Are they longer or more frequent? What time of the day do you usually nap and has that changed?