Current Treatment Options in Neurology

, Volume 3, Issue 1, pp 19–36 | Cite as

Sleep disorders in the elderly

  • Tamar Shochat
  • Jose Loredo
  • Sonia Ancoli-Israel

Opinion statement

Sleep disturbances in the elderly may not be a result of the aging process per se, but rather are likely caused by many factors that are amenable to treatment. These factors include medical and psychiatric problems, medications, and circadian rhythm changes, all of which can cause difficulties during sleep at night, and can lead to complaints of insomnia. Other factors that cause disturbances include a high prevalence of specific sleep disorders such as sleep disordered breathing (SDB), periodic limb movements during sleep (PLMS) and rapid eye movement (REM) sleep behavior disorder (RBD). Although these disorders are more prevalent in the older than younger population, they are not exclusive to this age group, and treatment options that are applicable to young adults are also applicable to older adults. On the other hand, dementia and Parkinson’s disease are two neurologic disorders that are almost exclusive to the elderly and most often involve sleep disturbances. Because there are many causes of sleep complaints, when considering treatment options one must identify the underlying problem. If caused by illness, effective treatment of a specific medical or psychiatric problem should help alleviate the sleep problem as well. Changes in the timing of drug administration may improve sleep. For the treatment of chronic insomnia, behavior techniques should always be used in combination with pharmacologic therapy, and sedative-hypnotic medications should be considered when appropriate. The treatment of choice for obstructive sleep apnea is continuous positive airway pressure (CPAP). For PLMS, dopaminergic agents are most effective. For RBD, clonazepam effectively controls the aversive sleep behaviors. Sleep disturbances secondary to dementia and Parkinson’s disease are usually problematic for the patient as well as the caregiver, whether in the home or in the nursing home. Proper management of these disturbances is beneficial in terms of delaying institutionalization and reducing nursing care costs, as well as improving the quality of life for both patient and caregiver.


Obstructive Sleep Apnea Sleep Apnea Continuous Positive Airway Pressure Sleep Disorder Main Drug Interaction 
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  1. 1.
    Foley DJ, Monjan AA, Brown SL, et al.: Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 1995, 18:425–432.PubMedGoogle Scholar
  2. 2.
    Wooten V: Medical causes of insomnia. In Principles and Practice of Sleep Medicine. Edited by Kryger MH, Roth T, Dement WC Philadelphia: WB Saunders Company; 1994:456–475.Google Scholar
  3. 3.
    Blazer D, Burchett B, Service C, George LK: The association of age and depression among the elderly: an epidemiologic exploration. J Gerontol B Psychol Sci Soc Sci 1991, 46:M210-M215.Google Scholar
  4. 4.
    Ancoli-Israel S: Sleep problems in older adults: putting myths to bed. Geriatrics 1997, 52:20–30. A concise, well written review of sleep disorders in the elderly.PubMedGoogle Scholar
  5. 5.
    Young T, Palta M, Dempsey J, et al.: The occurrence of sleep disordered breathing among middle-aged adults. N Engl J Med 1993, 328:1230–1235.PubMedCrossRefGoogle Scholar
  6. 6.
    Ancoli-Israel S, Kripke DF, Klauber MR, et al.: Sleep disordered breathing in community-dwelling elderly. Sleep 1991, 14:486–495.PubMedGoogle Scholar
  7. 7.
    Lavie P, Ben-Yosef R, Rubin AE: Prevalence of sleep apnea syndrome among patients with essential hypertension. Am Heart J 1984, 108:373.PubMedCrossRefGoogle Scholar
  8. 8.
    Wittels EH: Obesity and hormonal factors in sleep and sleep apnea. Med Clin North Am 1985, 69:1265–1280.PubMedGoogle Scholar
  9. 9.
    Guilleminault C: Natural history, cardiac impact and long term follow-up of sleep apnea syndrome. In Sleep/Wake Disorders: Natural History, Epidemiology, and Long-term Evolution. Edited by Guilleminault C, Lugaresi E. New York: Raven Press; 1983:107–124.Google Scholar
  10. 10.
    Lavie P, Herer P, Peled R, et al.: Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep 1995, 18:149–157.PubMedGoogle Scholar
  11. 11.
    Ancoli-Israel S, Kripke DF, Klauber MR, et al.: Morbidity, mortality and sleep disordered breathing in community dwelling elderly. Sleep 1996, 19:277–282.PubMedGoogle Scholar
  12. 12.
    Ancoli-Israel S, Kripke DF, Klauber MR, et al.: Periodic limb movements in sleep in community-dwelling elderly. Sleep 1991, 14:496–500.PubMedGoogle Scholar
  13. 13.
    Bixler EO, Kales A, Vela-Bueno A, et al.: Nocturnal myoclonus and nocturnal myoclonic activity in a normal population. Res Commun Chem Pathol Pharmacol 1982, 36:129–140.PubMedGoogle Scholar
  14. 14.
    Mahowald MW, Schenck CH: REM sleep behavior disorder. In Principles and Practice of Sleep Medicine. Edited by Kryger MH, Roth T, Dement WC. Philadelphia: WB Saunders Company; 1994:574–588.Google Scholar
  15. 15.
    Schenck CH, Mahowald MW: Polysomnographic, neurologic, psychiatric, and clinical outcome report on 70 consecutive cases with the REM sleep behavior disorder (RBD): sustained clonazepam efficacy in 89.5% of 57 treated patients. Cleve Clin J Med 1990, 57:S10-S24.Google Scholar
  16. 16.
    Factor SA, McAlarney T, Sanchez-Ramos JR, Weiner WJ: Sleep disorders and sleep effect in Parkinson’s disease. Move Disord 1990, 5:280–285.CrossRefGoogle Scholar
  17. 17.
    Kales A, Ansel RD, Markham CH, et al.: Sleep in patients with Parkinson’s disease and normal subjects prior to and following levodopa administration. Clin Pharm.Ther 1971, 12:397–406.Google Scholar
  18. 18.
    Jellinger K: Pathology of parkinsonism. In Recent Developments in Parkinson’s Disease. Edited by Fahn S, Marsden CD, Jenner P, Teychenne P. New York: Raven Press; 1986, 33–66.Google Scholar
  19. 19.
    Zweig RM, Jankel WR, Hedreen JC, et al.: The pedunculopontine nucleus in Parkinson’s disease. Ann Neurol 1989, 26:41–46.PubMedCrossRefGoogle Scholar
  20. 20.
    Aldrich MS: Parkinsonism. In Principles and Practice of Sleep Medicine. Kryger MH, Roth T, Dement WC. Philadelphia: WB Saunders; 1994:783–789.Google Scholar
  21. 21.
    Apps MCP, Sheaff PC, Ingram DA, et al.: Respiration and sleep in Parkinson’s disease. J Neurol Neurosurg.Psychiat 1985, 48:1240–1245.PubMedCrossRefGoogle Scholar
  22. 22.
    Hoch CC, Reynolds CF: Cognitive function and sleep disordered breathing in dementia: the Pittsburgh experience. In Sleep and Respiration in Aging Adults. Edited by Kuna ST, Suratt PM, Remmers JE. New York: Elsevier; 1991:245–250.Google Scholar
  23. 23.
    Martin J, Stepnowsky C, Ancoli-Israel S: Sleep apnea in the elderly. In Breathing Disorders During Sleep. McNicholas WT, Phillipson EA. Philadelphia: WB Saunders; 1999.Google Scholar
  24. 24.
    Ancoli-Israel S, Klauber MR, Butters N, et al.: Dementia in institutionalized elderly: relation to sleep apnea. J Am Geriatr Soc 1991, 39:258–263.PubMedGoogle Scholar
  25. 25.
    Erkinjuntti T, Partinen M, Sulkava R, et al.: Sleep apnea in multiinfarct dementia and Alzheimer’s disease. Sleep 1987, 10:419–425.PubMedGoogle Scholar
  26. 26.
    Hauri P, Linde S: No More Sleepless Nights. New York: Wiley; 1990:1–262.Google Scholar
  27. 27.
    Bootzin RR, Nicassio PM: Behavioral treatments for insomnia. In Progress in Behavior Modification, vol 6. Edited by Hersen M, Eisler RM, Miller PM. New York: Academic Press; 1978:1–45.Google Scholar
  28. 28.
    Glovinsky PB, Spielman AJ: Sleep restriction therapy. In Case Studies in Insomnia. Edited by Hauri, PJ. New York: Plenum; 1991:49–63.Google Scholar
  29. 29.
    Walsh JK, Pollack CP, Scharf MB, et al.: Lack of residual sedation following middle-of-the-night zaleplon administration in sleep maintenance insomnia. Clin Neuropharmacol 2000, 23:17–21.PubMedCrossRefGoogle Scholar
  30. 30.
    Schwitzer J, Neudorfer C, Blecha H, Fleischhacker WW: Mania as a side effect of phototherapy. Biol Psychiatry 1990, 28:532–534.PubMedCrossRefGoogle Scholar
  31. 31.
    Wetter DW, Young TB, Bidwell TR, et al.: Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med 1994, 154:2219–2224.PubMedCrossRefGoogle Scholar
  32. 32.
    Debacker WA, Verbraecken J, Willemen M, et al.: Central apnea index decreases after prolonged treatment with acetazolamide. Am J Respir Crit Care Med 1995, 151:87–91.PubMedGoogle Scholar
  33. 33.
    Donat SM, Levy DA: Bleomycin associated pulmonary toxicity: is perioperative oxygen restriction necessary? J Urol 1998, 160:1347–1352.PubMedCrossRefGoogle Scholar
  34. 34.
    Javaheri S, Ahmed M, Parker TJ, Brown CR: Effects of nasal O2 on sleep related disordered breathing in ambulatory patients with stable heart faliure. Sleep 1999, 22:1101–1106.PubMedGoogle Scholar
  35. 35.
    Powell NB, Guilleminault C, Riley RW: Surgical therapy for obstructive sleep apnea. In Principles and Practice of Sleep Medicine. Edited by Kryger MH, Roth T, Dement WC. Philadelphia: WB Saunders; 1994:706–721.Google Scholar
  36. 36.
    Sher AE, Schechtman KB, Piccirillo JF: The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996, 19:156–177. An overview of surgical procedures for the treatment of obstructive sleep apnea approved by the American Sleep Disorders Association. Includes a meta-analysis on studies using uvulopalatopharygoplasty.PubMedGoogle Scholar
  37. 37.
    Walker RP, Grigg-Damberger M, Gopalsami C: Uvulopalatopharyngoplasty versus laser-assisted uvolopalatoplasty for the treatment of obstructive sleep apnea. The Laryngoscope 1997, 107:76–82.PubMedCrossRefGoogle Scholar
  38. 38.
    Walker RP, Grigg-Damberger M, and Gopalsami C: Laser-assisted uvalopalatoplasty for the treatment of mild, moderate and severe obstructive sleep apnea. Laryngoscope 1999, 109:79–85.PubMedCrossRefGoogle Scholar
  39. 39.
    Utley DS, Shin EJ, Clerk AA, Terris DJ: A cost-effective and rational surgical approach to patients with snoring, upper airway resistance syndrome, or obstructive sleep apnea syndrome. Laryngoscope 1997, 107:726–734.PubMedCrossRefGoogle Scholar
  40. 40.
    Troell RJ, Riley RW, Powell NB, Li K: Surgical management of the hypopharyngeal airway in sleep disordered breathing. Otolaryngol Clin North Am 1998, 31:979–1012.PubMedCrossRefGoogle Scholar
  41. 41.
    Riley RW, Powell NB, Guilleminault C: Obstructive sleep apnea syndrome: A review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 1993, 108:117–125.PubMedGoogle Scholar
  42. 42.
    Li KK, Riley RW, Powell NB, et al.: Postoperative airway findings after maxillomandibular advancement for obstructive sleep apnea. Laryngoscope 2000, 110:325–327.PubMedCrossRefGoogle Scholar
  43. 43.
    Prinsell JR: Maxillomandibular advancement surgery in a site-specific treatment approach for obstructive sleep apnea in 50 consecutive patients. Chest 1999, 116:1519–1529.PubMedCrossRefGoogle Scholar
  44. 44.
    Balsiger BM, Murr MM, Poggio JL, Sarr MG: Surgery for weight control in patients with morbid obesity. Med Clin North Am 2000, 84:77–489.CrossRefGoogle Scholar
  45. 45.
    Schmidt-Nowara WW, Lowe A, Wiegand L, et al.: Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep 1995, 18:501–510.PubMedGoogle Scholar
  46. 46.
    Ivanhoe JR, Cibirka RM, Lefebvre CA, Parr GR: Dental considerations in upper airway sleep disorders: a review of the literature. J Prosthet Dent 1999, 82:685–698. Reviews anatomical and etiological factors in obstructive sleep apnea as well as medical and dental treatment options, with emphasis on the dental devices.PubMedCrossRefGoogle Scholar
  47. 47.
    Bamford CR: Carbamazepine in REM sleep behavior disorder. Sleep 1993, 16:33–34.PubMedGoogle Scholar
  48. 48.
    Schenck CH, Bundlie SR, Patterson AL, Mahowald MW: Rapid eye movement sleep bahavior disorder: a treatable parasomnia affecting older adults. JAMA 1987, 257:1786–1789.PubMedCrossRefGoogle Scholar
  49. 49.
    Lapierre O, Montplaisir J: Polysomnographic features of REM sleep behavior disorder: development of a scoring method. Neurology 1992, 42:1371–1374.PubMedGoogle Scholar
  50. 50.
    Sforza E, Krieger J, Petiau C: REM sleep behavior: clinical and physiopathological findings. Sleep Med Rev 1997, 1:57–69. An excellent review on the pathophysiology, diagnostic criteria, clinical presentation, and treatment of REM behavior disorder.PubMedCrossRefGoogle Scholar
  51. 51.
    Scharf B, Moskovitz C, Lupton MD, Klawans HL: Dream phenomena induced by chronic levodopa therapy. J Neural Transm 1978, 43:143–151.CrossRefGoogle Scholar
  52. 52.
    Ancoli-Israel S, Kripke DF: Now I lay me down to sleep: the problem of sleep fragmentation in elderly and demented residents of nursing homes. Bull Clin Neurosci 1989, 54:127–132.Google Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Tamar Shochat
  • Jose Loredo
  • Sonia Ancoli-Israel
    • 1
  1. 1.Department of Psychiatry 116AVeterans Affairs San Diego Healthcare SystemSan DiegoUSA

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