Skip to main content
SpringerLink
Log in

Patterns of Sleep Disorders and Sedative Hypnotic Use in Seniors

  • Review Article
  • Epidemiology
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Summary

Adequate sleep is required for good physical and psychological health. Sleep disturbance is common and its prevalence increases with advancing age. Physiologically, sleep in elderly adults differs from that in younger adults, both in terms of quantity and quality. Sleep disturbance in old age may be associated with many physical and psychological conditions, and less commonly can occur as a primary disturbance. It must be distinguished from the understandable but unrealistic expectations of many elderly people that they will sleep for as long and as soundly as when they were younger.

The evaluation of a patient with a sleep disorder requires full medical psychiatric and social histories, mental state and physical examinations and appropriate investigations. If present, an underlying condition should be treated. Management strategies for sleep disorders include attention to sleep hygiene, behavioural treatment and hypnotics. Ideally, a hypnotic should be prescribed for a limited period and then in the smallest effective dose.

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

  1. Williams RL, Karacan I, Hursch CJ. EEG of human sleep: clinical applications. New York: Wiley, 1974

    Google Scholar 

  2. Brezinova V. The number and duration of the episodes of the various EEG stages in young and older people. Electroencephalogr Clin Neurophysiol 1975; 39: 273–8

    Article  PubMed  CAS  Google Scholar 

  3. Morgan K. Why do old people complain of poor sleep? In: Hörne JA, editor. Current approaches in sleep disorders. Dorset: Dorset Press, 1989: 11–9

    Google Scholar 

  4. Zepelin H, McDonald CS, Zammit GK. Effects of age on auditory awakening thresholds. J Gerontol 1984; 39: 294–300

    PubMed  CAS  Google Scholar 

  5. Prinz PN. Sleep patterns in the healthy aged: relationship with intellectual function. J Gerontol 1977; 32: 179–86

    Google Scholar 

  6. Oswald I. Assessment of insomnia. BMJ 1981; 283: 120–45

    Article  Google Scholar 

  7. Adams K, Tomeny M, Oswald I. Physiological and psychological differences between good and poor sleepers. J Psychiatr Res 1986; 20: 301–16

    Article  Google Scholar 

  8. Morgan K, Dallosso H, Ebrehim S. Characteristics of subjective insomnia in the elderly living at home. Age Ageing 1988; 17: 1–8

    Article  PubMed  CAS  Google Scholar 

  9. Oswald I. Disorders of sleep. In: Handbook of psychiatry 2. Mental disorders and somatic illness. Cambridge: Cambridge University Press, 1983: 75–9

    Google Scholar 

  10. Kripke DF, Ancoli-Israel S, Mason S. Sleep-related mortality and morbidity in the aged. In: Chase MH, Weitzman ED, editors. Sleep disorders: basic and clinical research. New York: Spectrum, 1983: 415–44

    Google Scholar 

  11. Rosen J, Reynolds CF, Yeager AL. Sleep disturbances in survivors of the Nazi Holocaust. Am J Psychiatry 1991; 148: 419–20

    Google Scholar 

  12. Kripke DF, Simons RN, Garfinkel L. Short and long sleep and sleeping pills: is increased mortality associated? Arch Gen Psychiatry 1979; 36: 103–16

    Article  PubMed  CAS  Google Scholar 

  13. Kripke DF, Garfinkel L. Excess nocturnal deaths related to sleeping pill and tranquillizer use. Lancet 1984; 1: 99

    Article  PubMed  CAS  Google Scholar 

  14. Livingston G, Blizard B, Mann A. Does sleep disturbance predict depression in elderly people? A study in inner London. Br J Gen Pract 1993; 43: 445–8

    PubMed  CAS  Google Scholar 

  15. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention. JAMA 1989; 262: 1479–84

    Article  PubMed  CAS  Google Scholar 

  16. Morgan K, Healey DW, Healey P. Factors influencing persistent subjective insomnia in old age: a follow-up study of good and poor sleepers aged 65–74. Age Ageing 1989; 18: 117–22

    Article  PubMed  CAS  Google Scholar 

  17. Ancoli-Israel S, Parker L, Sinaee R. Sleep fragmentation in patients in a nursing home. J Gerontol 1989; 44; 18–21

    Google Scholar 

  18. Morgan K. Sedative-hypnotic drug use and aging. Arch Gerontol Geriatr 1983; 2: 181–99

    Article  PubMed  CAS  Google Scholar 

  19. Dawling S, Crome P. Clinical pharmacokinetic considerations in the elderly: an update. Clin Pharmacokinet 1989; 17(4): 236–63

    Article  PubMed  CAS  Google Scholar 

  20. Williamson J, Chopin JM. Adverse reactions to prescribed drugs in the elderly: a multicentre investigation. Age Ageing 1980; 9(2): 73–80

    Article  PubMed  CAS  Google Scholar 

  21. Lamy PP. Adverse drug effects. Clin Geriatr Med 1990; 6(2): 293–307

    PubMed  CAS  Google Scholar 

  22. Ray WA. Psychotropic drugs and injuries among the elderly: a review. J Clin Psychopharmacol 1992; 12(6): 386–96

    PubMed  CAS  Google Scholar 

  23. Weedle PB, Poston JW, Parish PA. Use of hypnotic medicines by elderly people in residential homes. J R Coll Gen Pract 1988; 38: 156–8

    PubMed  CAS  Google Scholar 

  24. Garrard J, Dunham T, Makris L, et al. Longitudinal study of psychotropic drug use by elderly nursing home residents. J Gerontol 1992; 47(6): 183–8

    Google Scholar 

  25. Morgan K, Gilleard CJ. Patterns of hypnotic prescribing and usage in residential homes for the elderly. Neuropharmacology 1980; 20: 1355–6

    Google Scholar 

  26. Hamilton M, Shapiro CM. Frequency of symptoms in melancholia (depressive illness). Br J Psychiatry 1989; 154: 201–6

    Article  PubMed  CAS  Google Scholar 

  27. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington: American Psychiatric Association, 1987

    Google Scholar 

  28. Kupfer DJ. Foster FG. EEG sleep and depression. In: Williams RL, Karacan I, Frazier SH, editors. Sleep disorders, diagnosis and treatment. New York: Wiley, 1978: 163–204

    Google Scholar 

  29. Berrios GE. Management of sleep disorders. In: Berrios GE, Dowson JH, editors. Treatment and management in adult psychiatry. London: Bailliere Tindall, 1983: 460–75

    Google Scholar 

  30. Ramsay R, Katona C. Therapeutic sleep deprivation for depression in the elderly. J Clin Exp Gerontol 1990; 12(3): 191–202

    Google Scholar 

  31. Shulman K. Conceptual problems in the assessment of depression in old age. Psychiatr J Univ Ottawa 1989; 14: 364–71

    CAS  Google Scholar 

  32. Pokorny AD. Sleep disturbances, alcohol and alcoholism: a review. In: Williams RL, Karacan I, editors. Sleep disorders. New York: Wiley Medical, 1978

    Google Scholar 

  33. Lishman WA. Toxic disorders. In: Organic disorders: the psychological consequences of cerebral disorder. London: Blackwell Scientific Publications, 2nd ed., 1987: 515

    Google Scholar 

  34. Iliffe S, Haines A, Booroff A, et al. Alcohol consumption by elderly people: a general practice survey. Age Aging 1991; 20: 120–3

    Article  CAS  Google Scholar 

  35. Saunders PA, Copeland JRM, Dewey ME. Alcohol use and abuse in the elderly: findings from the Liverpool longitudinal study of continuing health in the community. Int J Ger Psychiatry 1989; 4: 103–8

    Article  Google Scholar 

  36. Naik PC, Jones RG. Alcohol histories taken from elderly people on admission. BMJ 1994; 308: 248

    Article  PubMed  CAS  Google Scholar 

  37. Mclnnes, Powell J. Drug and alcohol referrals: are elderly substance diagnoses and referrals being missed? BMJ 1994; 308: 444–6

    Article  Google Scholar 

  38. Lader M, Lawson C. Sleep studies and rebound insomnia: methodological problems, laboratory findings, and clinical implications. Clin Neuropharmacol 1987; 10: 291–312

    Article  PubMed  CAS  Google Scholar 

  39. Tyrer P. ABC of Sleep Disorders: Withdrawal from hypnotic drugs. BMJ 1993; 306: 706–8

    Article  PubMed  CAS  Google Scholar 

  40. Sanford JRD. Tolerability of debility in elderly dependants by supporters at home: its significance for hospital practice. BMJ 1975; 3: 471–3

    Article  PubMed  CAS  Google Scholar 

  41. Prinz P, Vitaliano P, Vitiello M. Sleep, EEG and mental function changes in mild, moderate and severe senile dementia of the Alzheimer’s type. Neurobiol Aging 1982; 3: 361–70

    Article  PubMed  CAS  Google Scholar 

  42. Shiromani PJ, Gillin JC. Acetylcholine and the regulation of sleep: Basic mechanisms and clinical implications for affective illness and narcolepsy. Annu Rev Pharmacol Toxicol 1987; 27: 137–56

    Article  PubMed  CAS  Google Scholar 

  43. Reynolds CF, Kupfer DJ, Taska LS. EEG sleep in the healthy elderly, depressed, and demented subjects. Biol Psychiatry 1985; 20: 431–42

    Article  PubMed  Google Scholar 

  44. Greenblatt DJ, Diroll M, Abernathy DR, et al. Benzodiazepine kinetics: implications for therapeutics and pharmacogeriatrics. Drug Metab Rev 1983; 14: 251–92

    Article  PubMed  CAS  Google Scholar 

  45. Greenblatt DJ. Clinical pharmacokinetics of oxazepam and lorazepam. Clin Pharmacokinet 1981; 6: 88–105

    Article  Google Scholar 

  46. Lader M, Herrington R. Pharmacokinetics. In: Biological treatments in psychiatry. Oxford: Oxford University Press, 1990: 127

    Google Scholar 

  47. Heel RC, Brogden RN, Speight T. Temazepam: a review of its pharmacological properties and therapeutic efficacy as an hypnotic. Drugs 1981; 42: 374–85

    Google Scholar 

  48. Witts DJ, Bowhay AA, Garland M, et al. Studies of chlormethiazole in the elderly: pharmacokinetic effects. Age Ageing 1979; 8: 271–4

    Article  PubMed  CAS  Google Scholar 

  49. Anderson A. Zopiclone and nitrazepam. A multicentre placebocontrolled comparative study of efficacy and tolerance in insomniac patients in general practice. Sleep 1987; 10 Suppl. 1: 54–62

    PubMed  Google Scholar 

  50. Wadworth AN, McTavish D. Zopiclone. A review of its pharmacological properties and therapeutic efficacy as an hypnotic. Drugs Aging 1993; 3: 441–459

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, University College, London Medical School, Wolfson Building, Middlesex Hospital, London, England

    Eleanor Mullan &  Cornelius Katona

  2. Department of Psychiatry of the Elderly, Claybury Hospital, Woodford Bridge, Woodford Green, Essex, England

    Eleanor Mullan

  3. Department of Psychiatry of the Elderly, Princess Alexandra Hospital, Harlow, Essex, England

    Cornelius Katona

  4. Napsbury Hospital, London Colney, St Albans, Hertfordshire, England

    Michael Bellew

Authors
  1. Eleanor Mullan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cornelius Katona
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Bellew
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mullan, E., Katona, C. & Bellew, M. Patterns of Sleep Disorders and Sedative Hypnotic Use in Seniors. Drugs & Aging 5, 49–58 (1994). https://doi.org/10.2165/00002512-199405010-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199405010-00005

Keywords

Search

Navigation