Abstract
Sleep disorders are not a normal part of aging, although complaints of difficulty with sleep are not uncommon in late life. The cause of sleep disorders in the elderly is usually multifactorial and often associated with poor health. Aging is correlated with an increase in latency of sleep (the amount of time it takes to fall asleep) and decrease in slow-wave sleep (restorative sleep). Changes in sleep patterns affect men and women differently. The available data for the diagnosis and proper treatment of sleep disorders in older adults is hampered by a lack of controlled studies examining objective sleep measures in the elderly. This chapter summarizes information on epidemiology, sleep physiology, diagnosis, and treatment for sleep disorders in the elderly.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
AASM: The American Academy of Sleep Medicine - Association for Seep Clinicians and Researchers. http://www.aasmnet.org.
Ropper AH, Adams RD, Victor M, Samuels MA. Adams and Victor's principles of neurology. 9th ed. New York: McGraw-Hill Medical; 2009.
Fetveit A. Late-life insomnia: a review. Geriatr Gerontol Int. 2009;9(3):220–34.
Ancoli-Israel S. Sleep and its disorders in aging populations. Sleep Med. 2009;10(Suppl 1):S7–11.
Vitiello MV, Moe KE, Prinz PN. Sleep complaints cosegregate with illness in older adults: clinical research informed by and informing epidemiological studies of sleep. J Psychosom Res. 2002;53(1):555–9.
Foley D, Ancoli-Israel S, Britz P, Walsh J. Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res. 2004;56(5):497–502.
Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97–111.
Zdanys KF, Steffens DC. Sleep disturbances in the elderly. Psychiatr Clin North Am. 2015;38(4):723–41.
Reynolds CF, Kupfer DJ, Taska LS, Hoch CC, Sewitch DE, Spiker DG. Sleep of healthy seniors: a revisit. Sleep. 1985;8(1):20–9.
Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7(8):1311–22.
Moe KE, Prinz PN, Vitiello MV, Marks AL, Larsen LH. Healthy elderly women and men have different entrained circadian temperature rhythms. J Am Geriatr Soc. 1991;39(4):383–7.
Moe KE. Reproductive hormones, aging, and sleep. Semin Reprod Endocrinol. 1999;17(4):339–48.
Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007;3(5 Suppl):S7–10.
NIH State-of-the-Science Conference Statement on manifestations and management of chronic insomnia in adults. NIH Consens State Sci Statements. 2005;22(2):1-30.
Mellinger GD, Balter MB, Uhlenhuth EH. Insomnia and its treatment. Prevalence and correlates. Arch Gen Psychiatry. 1985;42(3):225–32.
Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002;162(8):893–900.
Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O. Sleep-disordered breathing in community-dwelling elderly. Sleep. 1991;14(6):486–95.
Ancoli-Israel S, Kripke DF. Prevalent sleep problems in the aged. Biofeedback Self Regul. 1991;16(4):349–59.
Woodward M. Insomnia in the elderly. Aust Fam Physician. 1999;28(7):653–8.
Rajput V, Bromley SM. Chronic insomnia: a practical review. Am Fam Physician. 1999;60(5):1431–8. discussion 1441-1432
Woodward M. Hypnosedatives in the elderly. CNS Drugs. 1999;11(4):263–79.
Vgontzas AN, Kales A. Sleep and its disorders. Annu Rev Med. 1999;50:387–400.
Ohayon MM. Nocturnal awakenings and comorbid disorders in the American general population. J Psychiatr Res. 2008;43(1):48–54.
Rahman SA, Flynn-Evans EE, Aeschbach D, Brainard GC, Czeisler CA, Lockley SW. Diurnal spectral sensitivity of the acute alerting effects of light. Sleep. 2014;37(2):271–81.
Hattar S, Liao HW, Takao M, Berson DM, Yau KW. Melanopsin-containing retinal ganglion cells: architecture, projections, and intrinsic photosensitivity. Science. 2002;295(5557):1065–70.
Hubbard J, Ruppert E, Gropp CM, Bourgin P. Non-circadian direct effects of light on sleep and alertness: lessons from transgenic mouse models. Sleep Med Rev. 2013;17(6):445–52.
Patterson TL, Jeste DV. The potential impact of the baby-boom generation on substance abuse among elderly persons. Psychiatr Serv. 1999;50(9):1184–8.
Neubauer DN. Sleep problems in the elderly. Am Fam Physician. 1999;59(9):2551–8, 2559-2560
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.
Ohayon MM, Roth T. Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. J Psychosom Res. 2002;53(1):547–54.
Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28(4):499–521.
Milligan SA, Chesson AL. Restless legs syndrome in the older adult: diagnosis and management. Drugs Aging. 2002;19(10):741–51.
Pilowsky I, Crettenden I, Townley M. Sleep disturbance in pain clinic patients. Pain. 1985;23(1):27–33.
Wyse JM, Chen YI, Sahai AV. Celiac plexus neurolysis in the management of unresectable pancreatic cancer: when and how? World J Gastroenterol. 2014;20(9):2186–92.
Habermehl D, Brecht IC, Debus J, Combs SE. Palliative radiation therapy in patients with metastasized pancreatic cancer - description of a rare patient group. Eur J Med Res. 2014;19:24.
Cooke JR, Ancoli-Israel S. Normal and abnormal sleep in the elderly. Handb Clin Neurol. 2011;98:653–65.
Stepnowsky CJ, Ancoli-Israel S. Sleep and its disorders in seniors. Sleep Med Clin. 2008;3(2):281–93.
Postuma RB, Gagnon JF, Vendette M, Fantini ML, Massicotte-Marquez J, Montplaisir J. Quantifying the risk of neurodegenerative disease in idiopathic REM sleep behavior disorder. Neurology. 2009;72(15):1296–300.
Postuma RB, Gagnon JF, Montplaisir J. Rapid eye movement sleep behavior disorder as a biomarker for neurodegeneration: the past 10 years. Sleep Med. 2013;14(8):763–7.
Iranzo A, Molinuevo JL, SantamarÃa J, et al. Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol. 2006;5(7):572–7.
Drogos LL, Gill SJ, Tyndall AV, et al. Evidence of association between sleep quality and APOE ε4 in healthy older adults: a pilot study. Neurology. 2016;87(17):1836–42.
Gottlieb DJ, DeStefano AL, Foley DJ, et al. APOE epsilon4 is associated with obstructive sleep apnea/hypopnea: the Sleep Heart Health Study. Neurology. 2004;63(4):664–8.
Grace JB, Walker MP, McKeith IG. A comparison of sleep profiles in patients with dementia with lewy bodies and Alzheimer's disease. Int J Geriatr Psychiatry. 2000;15(11):1028–33.
Bliwise DL, Mercaldo ND, Avidan AY, Boeve BF, Greer SA, Kukull WA. Sleep disturbance in dementia with Lewy bodies and Alzheimer's disease: a multicenter analysis. Dement Geriatr Cogn Disord. 2011;31(3):239–46.
Weldemichael DA, Grossberg GT. Circadian rhythm disturbances in patients with Alzheimer's disease: a review. Int J Alzheimers Dis. 2010;2010.
Pollak CP, Perlick D. Sleep problems and institutionalization of the elderly. J Geriatr Psychiatry Neurol. 1991;4(4):204–10.
Gibson RH, Gander PH, Jones LM. Understanding the sleep problems of people with dementia and their family caregivers. Dementia. 2014;13(3):350–65.
Lim MM, Gerstner JR, Holtzman DM. The sleep-wake cycle and Alzheimer's disease: what do we know? Neurodegener Dis Manag. 2014;4(5):351–62.
McCurry SM, Logsdon RG, Teri L, et al. Characteristics of sleep disturbance in community-dwelling Alzheimer's disease patients. J Geriatr Psychiatry Neurol. 1999;12(2):53–9.
Bloom HG, Ahmed I, Alessi CA, et al. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc. 2009;57(5):761–89.
Dauvilliers Y. Insomnia in patients with neurodegenerative conditions. Sleep Med. 2007;8(Suppl 4):S27–34.
Deschenes CL, McCurry SM. Current treatments for sleep disturbances in individuals with dementia. Curr Psychiatry Rep. 2009;11(1):20–6.
Khachiyants N, Trinkle D, Son SJ, Kim KY. Sundown syndrome in persons with dementia: an update. Psychiatry Investig. 2011;8(4):275–87.
Bedrosian TA, Nelson RJ. Sundowning syndrome in aging and dementia: research in mouse models. Exp Neurol. 2013;243:67–73.
Schneider JA, Arvanitakis Z, Yu L, Boyle PA, Leurgans SE, Bennett DA. Cognitive impairment, decline and fluctuations in older community-dwelling subjects with Lewy bodies. Brain. 2012;135(Pt 10):3005–14.
Donaghy PC, McKeith IG. The clinical characteristics of dementia with Lewy bodies and a consideration of prodromal diagnosis. Alzheimers Res Ther. 2014;6(4):46.
Zupancic M, Mahajan A, Handa K. Dementia with lewy bodies: diagnosis and management for primary care providers. Prim Care Companion CNS Disord 2011;13(5).
Gooneratne NS, Vitiello MV. Sleep in older adults: normative changes, sleep disorders, and treatment options. Clin Geriatr Med. 2014;30(3):591–627.
Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review. Sleep. 2007;30(11):1484–501.
Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in prescription drug use among adults in the United States from 1999-2012. JAMA. 2015;314(17):1818–31.
Tannenbaum C. Inappropriate benzodiazepine use in elderly patients and its reduction. J Psychiatry Neurosci. 2015;40(3):E27–8.
Madhusoodanan S, Bogunovic OJ. Safety of benzodiazepines in the geriatric population. Expert Opin Drug Saf. 2004;3(5):485–93.
Mojtabai R, Olfson M. National trends in psychotropic medication polypharmacy in office-based psychiatry. Arch Gen Psychiatry. 2010;67(1):26–36.
Panel AGSBCUE. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.
Defrancesco M, Marksteiner J, Fleischhacker WW, Blasko I. Use of benzodiazepines in Alzheimer's disease: a systematic review of literature. Int J Neuropsychopharmacol. 2015;18(10):pyv055.
Bakken MS, Engeland A, Engesæter LB, Ranhoff AH, Hunskaar S, Ruths S. Risk of hip fracture among older people using anxiolytic and hypnotic drugs: a nationwide prospective cohort study. Eur J Clin Pharmacol. 2014;70(7):873–80.
de Jong MR, Van der Elst M, Hartholt KA. Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Ther Adv Drug Saf. 2013;4(4):147–54.
Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med. 2003;348(1):42–9.
Wagner J, Wagner ML. Non-benzodiazepines for the treatment of insomnia. Sleep Med Rev. 2000;4(6):551–81.
Doty RL, Treem J, Tourbier I, Mirza N. A double-blind study of the influences of eszopiclone on dysgeusia and taste function. Pharmacol Biochem Behav. 2009;94(2):312–8.
Brzezinski A, Vangel MG, Wurtman RJ, et al. Effects of exogenous melatonin on sleep: a meta-analysis. Sleep Med Rev. 2005;9(1):41–50.
Wurtman RJ, Zhdanova I. Improvement of sleep quality by melatonin. Lancet. 1995;346(8988):1491.
Serfaty M, Kennell-Webb S, Warner J, Blizard R, Raven P. Double blind randomised placebo controlled trial of low dose melatonin for sleep disorders in dementia. Int J Geriatr Psychiatry. 2002;17(12):1120–7.
Singer C, Tractenberg RE, Kaye J, et al. A multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer's disease. Sleep. 2003;26(7):893–901.
Roth T, Seiden D, Wang-Weigand S, Zhang J. A 2-night, 3-period, crossover study of ramelteon's efficacy and safety in older adults with chronic insomnia. Curr Med Res Opin. 2007;23(5):1005–14.
Roth T, Seiden D, Sainati S, Wang-Weigand S, Zhang J, Zee P. Effects of ramelteon on patient-reported sleep latency in older adults with chronic insomnia. Sleep Med. 2006;7(4):312–8.
Mini LJ, Wang-Weigand S, Zhang J. Self-reported efficacy and tolerability of ramelteon 8 mg in older adults experiencing severe sleep-onset difficulty. Am J Geriatr Pharmacother. 2007;5(3):177–84.
Johnson MW, Suess PE, Griffiths RR. Ramelteon: a novel hypnotic lacking abuse liability and sedative adverse effects. Arch Gen Psychiatry. 2006;63(10):1149–57.
Mendelson WB. A review of the evidence for the efficacy and safety of trazodone in insomnia. J Clin Psychiatry. 2005;66(4):469–76.
Bayer AJ, Pathy MS, Ankier SI. Pharmacokinetic and pharmacodynamic characteristics of trazodone in the elderly. Br J Clin Pharmacol. 1983;16(4):371–6.
Thase ME. Antidepressant treatment of the depressed patient with insomnia. J Clin Psychiatry. 1999;60(Suppl 17):28–31. discussion 46-28
Raskin DE. Trazodone and priapism. Am J Psychiatry. 1985;142(1):142–3.
Thase ME, Nierenberg AA, Keller MB, Panagides J, Group RPS. Efficacy of mirtazapine for prevention of depressive relapse: a placebo-controlled double-blind trial of recently remitted high-risk patients. J Clin Psychiatry. 2001;62(10):782–8.
de Boer T. The pharmacologic profile of mirtazapine. J Clin Psychiatry. 1996;57(Suppl 4):19–25.
Verhamme KM, Sturkenboom MC, Stricker BH, Bosch R. Drug-induced urinary retention: incidence, management and prevention. Drug Saf. 2008;31(5):373–88.
Laimer M, Kramer-Reinstadler K, Rauchenzauner M, et al. Effect of mirtazapine treatment on body composition and metabolism. J Clin Psychiatry. 2006;67(3):421–4.
Fava M. Weight gain and antidepressants. J Clin Psychiatry. 2000;61(Suppl 11):37–41.
Viramontes TS, Truong H, Linnebur SA. Antidepressant-induced hyponatremia in older adults. Consult Pharm. 2016;31(3):139–50.
Tripathi P, Tomar LR, Goyal P, Singh P. An unusual presentation of dose dependent SIADH secondary to mirtazapine therapy. Aust N Z J Psychiatry. 2015;49(11):1070–1.
Remick RA. Anticholinergic side effects of tricyclic antidepressants and their management. Prog Neuro-Psychopharmacol Biol Psychiatry. 1988;12(2-3):225–31.
Mandour RA. Antidepressants medications and the relative risk of suicide attempt. Toxicol Int. 2012;19(1):42–6.
Pearson NJ, Johnson LL, Nahin RL. Insomnia, trouble sleeping, and complementary and alternative medicine: analysis of the 2002 national health interview survey data. Arch Intern Med. 2006;166(16):1775–82.
Meolie AL, Rosen C, Kristo D, et al. Oral nonprescription treatment for insomnia: an evaluation of products with limited evidence. J Clin Sleep Med. 2005;1(2):173–87.
Tariq SH. Herbal therapies. Clin Geriatr Med. 2004;20(2):237–57.
Liu QQ, Zhang J, Guo RJ, et al. Efficacy and safety of the Chaihuguizhiganjiang-suanzaoren granule on primary insomnia: study protocol for a randomised controlled trial. BMJ Open. 2016;6(2):e008459.
Watson NF, Badr MS, Belenky G, et al. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. J Clin Sleep Med. 2015;11(8):931–52.
Stepanski EJ, Wyatt JK. Use of sleep hygiene in the treatment of insomnia. Sleep Med Rev. 2003;7(3):215–25.
Bootzin RR, Epstein D, Wood JM. Stimulus control instructions. In: Hauri P, editor. Case studies in insomnia. New York: Plenum Medical; 1991. p. 19–23.
Alberg AJ, Shopland DR, Cummings KM. The 2014 Surgeon General's report: commemorating the 50th Anniversary of the 1964 Report of the Advisory Committee to the US Surgeon General and updating the evidence on the health consequences of cigarette smoking. Am J Epidemiol. 2014;179(4):403–12.
Ogeil RP, Phillips JG. Commonly used stimulants: sleep problems, dependence and psychological distress. Drug Alcohol Depend. 2015;153:145–51.
Brower KJ, Hall JM. Effects of age and alcoholism on sleep: a controlled study. J Stud Alcohol. 2001;62(3):335–43.
Angarita GA, Emadi N, Hodges S, Morgan PT. Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review. Addict Sci Clin Pract. 2016;11(1):9.
Spielman AJ, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep. 1987;10(1):45–56.
Harsora P, Kessmann J. Nonpharmacologic management of chronic insomnia. Am Fam Physician. 2009;79(2):125–30.
Smith MT, Perlis ML. Who is a candidate for cognitive-behavioral therapy for insomnia? Health Psychol. 2006;25(1):15–9.
Edinger JD, Olsen MK, Stechuchak KM, et al. Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: a randomized clinical trial. Sleep. 2009;32(4):499–510.
Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. 2004;164(17):1888–96.
Smith MT, Huang MI, Manber R. Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clin Psychol Rev. 2005;25(5):559–92.
Perlis ML. Cognitive behavioral treatment of insomnia: a session-by-session guide. New York, NY: Springer; 2005.
Shub D, Darvishi R, Kunik ME. Non-pharmacologic treatment of insomnia in persons with dementia. Geriatrics. 2009;64(2):22–6.
JQ W, Appleman ER, Salazar RD, Ong JC. Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: a meta-analysis. JAMA Intern Med. 2015;175(9):1461–72.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Diaz, N.A. (2018). Sleep Disorders. In: Tampi, R., Tampi, D., Boyle, L. (eds) Psychiatric Disorders Late in Life. Springer, Cham. https://doi.org/10.1007/978-3-319-73078-3_18
Download citation
DOI: https://doi.org/10.1007/978-3-319-73078-3_18
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-73076-9
Online ISBN: 978-3-319-73078-3
eBook Packages: MedicineMedicine (R0)