Skip to main content
SpringerLink
Log in

Current Concepts in the Diagnosis and Treatment of Sleep Disorders in the Elderly

  • Geriatric Disorders (W McDonald, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Sleep disorders are a pervasive problem throughout all patient populations but represent an especially important health problem for the elderly. Alterations in sleep architecture that occur as a part of normal aging will contribute to sleep problems as we grow older. Other contributing factors—including comorbid medical conditions, changes in lifestyle and schedule, altered circadian rhythm, among a host of others—can have detrimental effects on the health of the elderly. Coupled with a number of sleep disorders that either emerge or exacerbate with age, the effects of poor sleep often result in an overall worsening of quality of life. Treatment options can be unique in this population and often more difficult due to the effects of normal aging, as well as polypharmacy and possible medication interactions. The following article will focus on the common sleep disorders that can besiege this population, symptoms to aid in diagnosis, and specific treatment options to help improve quality of life in the elderly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Vitiello MV. Sleep in normal aging. Sleep Med Clin. 2006;1:171–6.

    Article  Google Scholar 

  2. Insufficient sleep is a public health epidemic (2014) Retrieved from http://www.cdc.gov/features/dssleep/. A review of the public health surveillance of quality, duration, behaviors, and disorders of sleep, and how their evolvement is further needed to monitor sleep disorders and their impact on public health.

  3. Cooke J, Ancoli-Israel S. Normal and abnormal sleep in the elderly. Handb Clin Neurol. 2011;98:653–65.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Edwards B, O’Driscoll D, Ali A, Jordan A, Trinder J, Malhotra A. Aging and sleep: physiology and pathophysiology. Semin Respir Crit Care Med. 2010;31(5):618–33.

    Article  PubMed Central  PubMed  Google Scholar 

  5. McCall W. Management of primary sleep disorders among elderly persons. Psychiatr Serv. 1995;46(1):49–55.

    Article  CAS  PubMed  Google Scholar 

  6. Diagnostic and statistical manual of mental disorders: DSM Library (2013) Retrieved from http://dsm.psychiatryonline.org/content.aspx?bookid=556§ionid=41101778

  7. Benca R, Ancoli-Israel S, Ancoli-Israel S, Moldofsky H. Special considerations in insomnia diagnosis and management: depressed, elderly, and chronic pain populations. J Clin Psychiatry. 2004;65(8):26–35.

    PubMed  Google Scholar 

  8. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guidelines for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):407–502.

    Google Scholar 

  9. Morin C, Benca R. Chronic insomnia. Lancet. 2012;379(9821):1129–41. A review of chronic insomnia and its effect on the population through prevalence studies, as well as, its effects on quality of life. Reviews clinical presentations, comorbidity, prognosis, diagnosis, and current treatments, focusing on CBT and pharmacotherapy.

    Article  PubMed  Google Scholar 

  10. Buysse D, Germain A, Moul D, Franzen P, Brar L, Fletcher M, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011;171(10):887–95.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Bloom H, Ahmed I, Alessi C, Ancoli-Israel S, Buysse D, Kryger M, et al. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc. 2009;57:761–89.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Malhotra A, White D. Obstructive sleep apnoea. Lancet. 2002;360:237–45.

    Article  PubMed  Google Scholar 

  13. Kim M, Lee J, Duffy J. Circadian rhythm sleep disorders. J Clin Outcomes Manag. 2013;20(11):513–28. A literature review with discussion of specific cases related to circadian rhythm sleep disorders, it presents the variant forms of the disorders, underlying causes, diagnostic approach, and current treatment modalities, including chronotherapy, phototherapy, and melatonin administration.

    PubMed Central  PubMed  Google Scholar 

  14. Wright K, Lowry C, & Lebourgeois M. Circadian and wakefulness-sleep modulation of cognition in humans. Front Mol Neurosci. 2012;5(50):1–12. A review article that that addresses the link between cognitive performance, learning, emotion, and safety in the context of an altered circadian rhythm. Provides detailed account of the pathophysiology of the circadian rhythm via brain arousal, and how circadian misalignment impairs cognition. Also provides descriptions of the variant types of circadian rhythm sleep-wake disorders.

  15. Zhou Q, Jung L, Richards K. The management of sleep and circadian disturbance in patients with dementia. Curr Neurol Neurosci Rep. 2012;12:193–204. A review of the circadian disturbance in dementia patients, with emphasis on irregular sleep-wake rhythm. Discusses different types of dementia and the physiology of the altered circadian rhythm and the pathophysiology of the rhythm disruption. Also discusses treatment options in this unique patient population.

    Article  PubMed  Google Scholar 

  16. Schmidt C, Peigneux P, Cajochen C. Age-related changes in sleep and circadian rhythms: impact on cognitive performance and underlying neuroanatomical networks. Front Neurol. 2012;3:118.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Kondratova A, and Kondratov R. The circadian clock and pathology of the ageing brain. Nat Rev Neurosci. 2012;13(5):325–35.

  18. McNicholas W. Diagnosis of obstructive sleep apnea in adults. Proc Am Thorac Soc. 2008;5:154–60.

    Article  PubMed  Google Scholar 

  19. Bradley T, Floras J. Obstructive sleep apnoea and its cardiovascular consequences. Lancet. 2008;373:82–93.

    Article  PubMed  Google Scholar 

  20. Phillips B, Ancoli-Israel S. Sleep disorders in the elderly. Sleep Med. 2001;2:99–114.

    Article  PubMed  Google Scholar 

  21. Cooke J, Ayalon L, Palmer B, Loredo J, Corey-Bloom J, Natarajan L, et al. Sustained use of CPAP slows deterioration of cognition, sleep, and mood in patients with Alzheimer’s disease and obstructive sleep apnea: a preliminary study. J Clin Sleep Med. 2009;5(4):305–9.

    PubMed Central  PubMed  Google Scholar 

  22. Macey P, Woo M, Kumar R, Cross R, Harper R, Miles J. Relationship between obstructive sleep apnea severity and sleep, depression and anxiety symptoms in newly-diagnosed patients. PLoS ONE. 2010;5(4):E10211–1.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Feldman N (n.d.) Article—narcolepsy: diagnosis and treatment in the elderly « narcolepsy network. Retrieved October 19, 2014, from http://narcolepsynetwork.org/2010/06/article-narcolepsy-diagnosis-and-treatment-in-the-elderly/

  24. Jennum P, Riha R. Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing. Eur Respir J. 2009;33:907–14.

    Article  CAS  PubMed  Google Scholar 

  25. Weaver RN, Faan T, Collop N, & Eichler A (n.d.) Adherence with continuous positive airway pressure (CPAP). Retrieved from http://uptodate.com/contents/adherence-with-continuous-positive-airway-pressure-cpap

  26. Badr M (n.d.) Central sleep apnea: risk factors, clinical presentation, and diagnosis (R. Chervin & A. Eichler, Eds.). Retrieved from http://www.uptodate.com/contents/central-sleep-apnea-risk-factors-clinical-presentation-and-diagnosis

  27. Yumino D, Bradley T. Central sleep apnea and Cheyne-Stokes respiration. Proc Am Thorac Soc. 2008;5(2):226–36.

    Article  PubMed  Google Scholar 

  28. Muñoz R, Durán-Cantolla J, Martinez-Vila E, Gállego J, Rubio R, Aizpuru F, et al. Central sleep apnea is associated with increased risk of ischemic stroke in the elderly. Acta Neurol Scand. 2012;126:183–8.

    Article  PubMed  Google Scholar 

  29. Boeve B. REM sleep behavior disorder. Ann N Y Acad Sci. 2009;1184(2010):15–54.

    Google Scholar 

  30. Iranzo A, Santamaria J, Tolosa E. The clinical and pathophysiological relevance of REM sleep behavior disorder in neurodegenerative diseases. Sleep Med Rev. 2009;13:385–401.

    Article  PubMed  Google Scholar 

  31. Ju Y. Rapid eye movement sleep behavior disorder in adults younger than 50 years of age. Sleep Med. 2013;14:768–74.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Mccarter S, Boswell C, Louis E, Dueffert L, Slocumb N, Boeve B, et al. Treatment outcomes in REM sleep behavior disorder. Sleep Med. 2013;14:237–42. A study performed to gauge the best treatment to reduce injury frequency and characteristic motor activity during REM sleep, amongst known RBD patients at the Mayo Clinic. The treatments that were chosen were melatonin and clonazepam and both were effective in reducing injury and motor activity during REM sleep, although neither could eliminate injury potential altogether.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Postuma R, Gagnon J, Montplaisir J. REM sleep behavior disorder: from dreams to neurodegeneration. Neurobiol Dis. 2012;46:553–8. Review article that helps to further clarify the relationship between REM sleep behavior disorder and neurodegenerative disease. Provides explanation of the pathophysiology of REM sleep behavior disorder, interval time between RBD diagnosis and emergence of neurodegenerative disorders. Also discusses predictive symptoms of neurodegenerative development.

    Article  PubMed  Google Scholar 

  34. Arnulf I. REM sleep behavior disorder: motor manifestations and pathophysiology. Mov Disord. 2012;27(6):677–89.

    Article  PubMed  Google Scholar 

  35. Montplaisir J, Gagnon J, Fantini M, Postuma R, Dauvilliers Y, Desautels A, et al. Polysomnographic diagnosis of idiopathic REM sleep behavior disorder. Mov Disord. 2010;25(13):2044–51.

    Article  PubMed  Google Scholar 

  36. Aurora R, Zak R, Maganti R, Auerback S, Casey K, Chowdhuri S, et al. Best practice guidelines for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 2010;6(1):85–95.

    PubMed Central  PubMed  Google Scholar 

  37. Chen P, Cheng S. Restless legs syndrome among the elderly. Int J Gerontol. 2009;3(4):197–203.

    Article  Google Scholar 

  38. Ekbom K, Ulfberg J. Restless legs syndrome. J Intern Med. 2009;266:419–31.

    Article  CAS  PubMed  Google Scholar 

  39. Yeh P, Walters A, Tsuang J. Restless legs syndrome: a comprehensive overview on its epidemiology, risk factors, and treatment. Sleep Breath. 2012;16:987–1007.

    Article  PubMed  Google Scholar 

  40. Deepa S. Restless legs syndrome. J Parkinsonism Restless Legs Syndr. 2012;2:49–57. Article that reviews the diagnostic criteria, clinical features, etiopathogenesis, and treatment options for restless legs syndrome. Focus on dopaminergic system and relationship with RLS, as well as, possible genetic link to disease. Treatment options, mainly dopamine agonists are also discussed.

    Google Scholar 

  41. Wang J, O’Reilly B, Venkataraman R, Mysliwiec V, Mysliwiec A. Efficacy of oral iron in patients with restless legs syndrome and a low-normal ferritin: a randomized, double-blind, placebo-controlled study. Sleep Med. 2009;10:973–5.

    Article  PubMed  Google Scholar 

  42. Mathew J. Clinical features, diagnosis and treatment of narcolepsy. Prog Neurol Psychiatry. 2008;12(9):10–5.

    Article  Google Scholar 

  43. Chakravorty S, Rye D. Narcolepsy in the older adult. Drugs Aging. 2003;20(5):361–76.

    Article  PubMed  Google Scholar 

  44. Ohayon M, Ferini-Strambi L, Plazzi G, Smirne S, Castronovo V. How age influences the expression of narcolepsy. J Psychosom Res. 2005;59:399–405.

    Article  PubMed  Google Scholar 

  45. Wolkove N, Elkholy O, Baltzan M, Palayew M. Sleep and aging: 1. Sleep disorders commonly found in older people. Can Med Assoc J. 2007;176(9):1299–304.

    Article  Google Scholar 

  46. Nevsimalova S, Buskova J, Kemlink D, Sonka K, Skibova J. Does age at the onset of narcolepsy influence the course and severity of the disease? Sleep Med. 2009;10:967–72.

    Article  PubMed  Google Scholar 

  47. Attarian H. Narcolepsy in the older adult. In: Goswami M, Pandi-Perumal SR, Thorpy MJ, editors. Narcolepsy: A Clinical Guide. New York: Springer; (2010). p. 69-76.

  48. Burgess C, Scammell T. Narcolepsy: neural mechanisms of sleepiness and cataplexy. J Neurosci. 2012;32(36):12305–11. An article that explains the neural components and mechanisms of the reduced sleep latency and loss of muscle tone that is so pervasive in narcolepsy. Pays special attention to the role of orexin in future research and studies of the disorder.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Kevin Gleason declares that he has no conflict of interest.

W. Vaughn McCall has received consultancy fees from Otsuka and Merck, grants from the NIMH and America Foundation for Suicide Prevention. Dr. McCall has also received royalties from Wolters Kluwer and payment for development of educational materials from Global Medical Education.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Health Behavior, Medical College of Georgia, 997 St. Sebastian Way, Augusta, GA, 30912, USA

    Kevin Gleason & W. Vaughn McCall

Authors
  1. Kevin Gleason
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Vaughn McCall
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Vaughn McCall.

Additional information

This article is part of the Topical Collection on Geriatric Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gleason, K., McCall, W.V. Current Concepts in the Diagnosis and Treatment of Sleep Disorders in the Elderly. Curr Psychiatry Rep 17, 45 (2015). https://doi.org/10.1007/s11920-015-0583-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-015-0583-z

Keywords

Search

Navigation