Current Neurology and Neuroscience Reports

, Volume 12, Issue 2, pp 193–204 | Cite as

The Management of Sleep and Circadian Disturbance in Patients with Dementia

  • Qiuping Pearl Zhou
  • Lorena Jung
  • Kathy C. Richards
Sleep (M Thorpy and M Billiard, Section Editors)

Abstract

Sleep and circadian disturbances are common among patients with dementia. Symptomatic manifestations vary according to dementia subtype, with one commonly shared pattern—the irregular sleep-wake rhythm (ISWR), a circadian disorder characterized by an absence of the sleep-wake cycle’s circadian synchronization. Hypothesized mechanisms of circadian rhythm disturbance include suprachiasmatic nucleus (SCN) circadian pacemaker damage, pineal gland and melatonin secretion alterations, and reduced zeitbeigers and decreased input to the SCN. Management options include prescribed sleep/wake scheduling, light therapy, melatonin, physical and social activity, and mixed modality. The mixed-modality approach is the most effective method in treating ISWR. Pharmacologic interventions are controversial, with no evidence supporting their effectiveness while associated with multiple side effects. They should be used with caution and only be considered as short-term therapy. All treatment strategies should be individualized to achieve the best outcomes.

Keywords

Sleep disturbance Circadian rhythm disturbance Irregular sleep-wake rhythm (ISWR) Dementia Alzheimer’s disease Sleep management Light therapy Melatonin therapy Nonpharmacologic interventions Pharmacologic interventions Mixed modality 

References

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

  1. 1.
    Rose KM, Lorenz R. Sleep disturbances in dementia. J Gerontol Nurs. 2010;36(5):9–14.PubMedCrossRefGoogle Scholar
  2. 2.
    Foley DJ, Monjan AA, Brown SL, et al. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep. 1995;18(6):425–32.PubMedGoogle Scholar
  3. 3.
    Goel N, Rao H, Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2009;29(4):320–39.PubMedCrossRefGoogle Scholar
  4. 4.
    Moe V, Larsen P. Symposium: cognitive processes and sleep disturbances: Sleep/wake patterns in Alzheimer’s disease: relationships with cognition and function. J Sleep Res. 1995;4(1):15–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Gaugler JE, Kane RL, Kane RA, Clay T, Newcomer R. Caregiving and institutionalization of cognitively impaired older people: utilizing dynamic predictors of change. Gerontologist. 2003;43(2):219–29.PubMedCrossRefGoogle Scholar
  6. 6.
    Hebert R, Dubois MF, Wolfson C, Chambers L, Cohen C. Factors associated with long-term institutionalization of older people with dementia: data from the Canadian Study of Health and Aging. J Gerontol A Biol Sci Med Sci. 2001;56(11):M693–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Rozzini L, Cornali C, Chilovi BV, et al. Predictors of institutionalization in demented patients discharged from a rehabilitation unit. J Am Med Dir Assoc. 2006;7(6):345–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Vitiello MV, Borson S. Sleep disturbances in patients with Alzheimer’s disease: epidemiology, pathophysiology and treatment. CNS Drugs. 2001;15(10):777–96.PubMedCrossRefGoogle Scholar
  9. 9.
    Reid, Kathryn J, Zee, Phyllis C. Circadian Disorders of the Sleep-Wake Cycle. In: Principles and Practice of Sleep Medicine. 5th ed. Elsevier Saunders: 470-482.Google Scholar
  10. 10.
    Wu Y-H, Swaab DF. Disturbance and strategies for reactivation of the circadian rhythm system in aging and Alzheimer’s disease. Sleep Med. 2007;8(6):623–36.PubMedCrossRefGoogle Scholar
  11. 11.
    McCurry SM, Ancoli-Israel S. Sleep dysfunction in Alzheimer’s disease and other dementias. Curr Treat Options Neurol. 2003;5(3):261–72.PubMedCrossRefGoogle Scholar
  12. 12.
    Gehrman PR, Martin JL, Shochat T, et al. Sleep-disordered breathing and agitation in institutionalized adults with Alzheimer disease. Am J Geriatr Psychiatry. 2003;11(4):426–33.PubMedGoogle Scholar
  13. 13.
    Song Y, Dowling GA, Wallhagen MI, Lee KA, Strawbridge WJ. Sleep in older adults with Alzheimer’s disease. J Neurosci Nurs. 2010;42(4):190–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Plassman BL, Langa KM, Fisher GG, et al. Prevalence of dementia in the United States: the aging, demographics, and memory study. Neuroepidemiology. 2007;29(1–2):125–32.PubMedCrossRefGoogle Scholar
  15. 15.
    Thies W, Bleiler L. 2011 Alzheimer’s disease facts and figures. Alzheimers Dement. 2011;7(2):208–44.PubMedCrossRefGoogle Scholar
  16. 16.
    • Petit D, Montplaisir J, Boeve BF. Alzheimer’s Disease and Other Dementias. In: Principles and Practice of Sleep Medicine. 5th ed. Elsevier Saunders; 2011:1038-1047. This chapter provides a comprehensive review of dementias and treatment strategies. Google Scholar
  17. 17.
    Moran M, Lynch CA, Walsh C, et al. Sleep disturbance in mild to moderate Alzheimer’s disease. Sleep Med. 2005;6(4):347–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Buysse DJ, Reynolds CF, Hoch CC, et al. Rapid eye movement sleep deprivation in elderly patients with concurrent symptoms of depression and dementia. J Neuropsychiatry Clin Neurosci. 1992;4(3):249–56.PubMedGoogle Scholar
  19. 19.
    Gagnon J-F, Petit D, Fantini ML, et al. REM sleep behavior disorder and REM sleep without atonia in probable Alzheimer disease. Sleep. 2006;29(10):1321–5.PubMedGoogle Scholar
  20. 20.
    Hoch CC, Reynolds CF, Houck PR. Sleep patterns in Alzheimer, depressed, and healthy elderly. West J Nurs Res. 1988;10(3):239–56.PubMedCrossRefGoogle Scholar
  21. 21.
    Lee JH, Bliwise DL, Ansari FP, et al. Daytime sleepiness and functional impairment in Alzheimer disease. Am J Geriatr Psychiatry. 2007;15(7):620–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Deschenes CL, McCurry SM. Current treatments for sleep disturbances in individuals with dementia. Curr Psychiatry Rep. 2009;11(1):20–6.PubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedCrossRefGoogle Scholar
  24. 24.
    Ferman TJ, Boeve BF, Smith GE, et al. Dementia with Lewy bodies may present as dementia and REM sleep behavior disorder without parkinsonism or hallucinations. J Int Neuropsychol Soc. 2002;8(7):907–14.PubMedCrossRefGoogle Scholar
  25. 25.
    Boeve BF, Silber MH, Ferman TJ. REM sleep behavior disorder in Parkinson’s disease and dementia with Lewy bodies. J Geriatr Psychiatry Neurol. 2004;17(3):146–57.PubMedCrossRefGoogle Scholar
  26. 26.
    Comella CL. Sleep disorders in Parkinson’s disease: an overview. Mov Disord. 2007;22 Suppl 17:S367–73.PubMedCrossRefGoogle Scholar
  27. 27.
    Gjerstad MD, Boeve B, Wentzel-Larsen T, Aarsland D, Larsen JP. Occurrence and clinical correlates of REM sleep behaviour disorder in patients with Parkinson’s disease over time. J Neurol Neurosurg Psychiatry. 2008;79(4):387–91.PubMedCrossRefGoogle Scholar
  28. 28.
    Ferman TJ, Boeve BF, Smith GE, et al. Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies. Neurology. 2011;77(9):875–82.PubMedCrossRefGoogle Scholar
  29. 29.
    Weisman D, McKeith I. Dementia with Lewy bodies. Semin Neurol. 2007;27(1):42–7.PubMedCrossRefGoogle Scholar
  30. 30.
    • Zoccolella S, Savarese M, Lamberti P, et al. Sleep disorders and the natural history of Parkinson’s disease: the contribution of epidemiological studies. Sleep Med Rev. 2011;15(1):41-50. This paper provides a thorough review of sleep disorders for PD patients. Google Scholar
  31. 31.
    American Sleep Disorders Association. International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual. Westchester, IL; 2001.Google Scholar
  32. 32.
    Pacchetti C, Manni R, Zangaglia R, et al. Relationship between hallucinations, delusions, and rapid eye movement sleep behavior disorder in Parkinson’s disease. Mov Disord. 2005;20(11):1439–48.PubMedCrossRefGoogle Scholar
  33. 33.
    Arnulf I, Bonnet AM, Damier P, et al. Hallucinations, REM sleep, and Parkinson’s disease: a medical hypothesis. Neurology. 2000;55(2):281–8.PubMedGoogle Scholar
  34. 34.
    Gjerstad MD, Wentzel-Larsen T, Aarsland D, Larsen JP. Insomnia in Parkinson’s disease: frequency and progression over time. J Neurol Neurosurg Psychiatry. 2007;78(5):476–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Dhawan V, Healy DG, Pal S, Chaudhuri KR. Sleep-related problems of Parkinson’s disease. Age Ageing. 2006;35(3):220–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Stevens S, Cormella CL, Stepanski EJ. Daytime sleepiness and alertness in patients with Parkinson disease. Sleep. 2004;27(5):967–72.PubMedGoogle Scholar
  37. 37.
    Poewe W, Högl B. Akathisia, restless legs and periodic limb movements in sleep in Parkinson’s disease. Neurology. 2004;63(8 Suppl 3):S12–6.PubMedGoogle Scholar
  38. 38.
    Harper DG, Stopa EG, McKee AC, et al. Differential circadian rhythm disturbances in men with Alzheimer disease and frontotemporal degeneration. Arch Gen Psychiatry. 2001;58(4):353–60.PubMedCrossRefGoogle Scholar
  39. 39.
    Anderson KN, Hatfield C, Kipps C, Hastings M, Hodges JR. Disrupted sleep and circadian patterns in frontotemporal dementia. Eur J Neurol. 2009;16(3):317–23.PubMedCrossRefGoogle Scholar
  40. 40.
    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.PubMedGoogle Scholar
  41. 41.
    • Mistlberger, R.E., Rusak, B. Circadian Rhythms in Mammals: Formal Properties and Environmental Influences. In: Principles and Practice of Sleep Medicine. 5th ed. Elsevier Saunders; 2011:363-389. This chapter provides a comprehensive review of the circadian rhythms in humans and associated factors. Google Scholar
  42. 42.
    Bonanni E, Maestri M, Tognoni G, et al. Daytime sleepiness in mild and moderate Alzheimer’s disease and its relationship with cognitive impairment. J Sleep Res. 2005;14(3):311–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Rabins PV, Mace NL, Lucas MJ. The impact of dementia on the family. JAMA: The Journal of the American Medical Association. 1982;248(3):333–5.CrossRefGoogle Scholar
  44. 44.
    Gallagher-Thompson D, Brooks 3rd JO, Bliwise D, Leader J, Yesavage JA. The relations among caregiver stress, “sundowning” symptoms, and cognitive decline in Alzheimer’s disease. J Am Geriatr Soc. 1992;40(8):807–10.PubMedGoogle Scholar
  45. 45.
    Ballard CG, Eastwood C, Gahir M, Wilcock G. A follow up study of depression in the carers of dementia sufferers. BMJ. 1996;312(7036):947–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Swaab DF, Grundke-Iqbal I, Iqbal K, et al. Tau and ubiquitin in the human hypothalamus in aging and Alzheimer’s disease. Brain Res. 1992;590(1–2):239–49.PubMedCrossRefGoogle Scholar
  47. 47.
    van de Nes JA, Kamphorst W, Ravid R, Swaab DF. Comparison of beta-protein/A4 deposits and Alz-50-stained cytoskeletal changes in the hypothalamus and adjoining areas of Alzheimer’s disease patients: amorphic plaques and cytoskeletal changes occur independently. Acta Neuropathol. 1998;96(2):129–38.PubMedCrossRefGoogle Scholar
  48. 48.
    Stopa EG, Volicer L, Kuo-Leblanc V, et al. Pathologic evaluation of the human suprachiasmatic nucleus in severe dementia. J Neuropathol Exp Neurol. 1999;58(1):29–39.PubMedCrossRefGoogle Scholar
  49. 49.
    Hofman MA, Swaab DF. Influence of aging on the seasonal rhythm of the vasopressin-expressing neurons in the human suprachiasmatic nucleus. Neurobiol Aging. 1995;16(6):965–71.PubMedCrossRefGoogle Scholar
  50. 50.
    Wu Y-H, Feenstra MGP, Zhou J-N, et al. Molecular changes underlying reduced pineal melatonin levels in Alzheimer disease: alterations in preclinical and clinical stages. J Clin Endocrinol Metab. 2003;88(12):5898–906.PubMedCrossRefGoogle Scholar
  51. 51.
    Swaab, D.F. Human Hypothalamus: Basic and Clinical Aspects, Part I. Elsevier; 2003.Google Scholar
  52. 52.
    Mishima K, Okawa M, Shimizu T, Hishikawa Y. Diminished melatonin secretion in the elderly caused by insufficient environmental illumination. J Clin Endocrinol Metab. 2001;86(1):129–34.PubMedCrossRefGoogle Scholar
  53. 53.
    Shochat T, Martin J, Marler M, Ancoli-Israel S. Illumination levels in nursing home patients: effects on sleep and activity rhythms. J Sleep Res. 2000;9(4):373–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Sperduto RD, Hiller R, Seigel D. Lens opacities and senile maculopathy. Arch Ophthalmol. 1981;99(6):1004–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Hirvelä H, Laatikainen L. Visual acuity in a population aged 70 years or older; prevalence and causes of visual impairment. Acta Ophthalmol Scand. 1995;73(2):99–104.PubMedCrossRefGoogle Scholar
  56. 56.
    Klaver CC, Ott A, Hofman A, et al. Is age-related maculopathy associated with Alzheimer’s Disease? The Rotterdam Study. Am J Epidemiol. 1999;150(9):963–8.PubMedGoogle Scholar
  57. 57.
    Hinton DR, Sadun AA, Blanks JC, Miller CA. Optic-nerve degeneration in Alzheimer’s disease. N Engl J Med. 1986;315(8):485–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Katz B, Rimmer S, Iragui V, Katzman R. Abnormal pattern electroretinogram in Alzheimer’s disease: evidence for retinal ganglion cell degeneration? Ann Neurol. 1989;26(2):221–5.PubMedCrossRefGoogle Scholar
  59. 59.
    Blanks JC, Schmidt SY, Torigoe Y, et al. Retinal pathology in Alzheimer’s disease. II. Regional neuron loss and glial changes in GCL. Neurobiol Aging. 1996;17(3):385–95.PubMedCrossRefGoogle Scholar
  60. 60.
    Bayer AU, Ferrari F, Erb C. High occurrence rate of glaucoma among patients with Alzheimer’s disease. Eur Neurol. 2002;47(3):165–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Barnes LL, Mendes de Leon CF, Wilson RS, Bienias JL, Evans DA. Social resources and cognitive decline in a population of older African Americans and whites. Neurology. 2004;63(12):2322–6.PubMedGoogle Scholar
  62. 62.
    Laurin D, Verreault R, Lindsay J, MacPherson K, Rockwood K. Physical activity and risk of cognitive impairment and dementia in elderly persons. Arch Neurol. 2001;58(3):498–504.PubMedCrossRefGoogle Scholar
  63. 63.
    Yesavage JA, Taylor JL, Kraemer H, et al. Sleep/wake cycle disturbance in Alzheimer’s disease: how much is due to an inherent trait? Int Psychogeriatr. 2002;14(1):73–81.PubMedCrossRefGoogle Scholar
  64. 64.
    Clayton JD, Kyriacou CP, Reppert SM. Keeping time with the human genome. Nature. 2001;409(6822):829–31.PubMedCrossRefGoogle Scholar
  65. 65.
    Morgenthaler T, Alessi C, Friedman L, et al. Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Sleep. 2007;30(4):519–29.PubMedGoogle Scholar
  66. 66.
    Bliwise DL, Hughes M, McMahon PM, Kutner N. Observed sleep/wakefulness and severity of dementia in an Alzheimer’s disease special care unit. J Gerontol A Biol Sci Med Sci. 1995;50(6):M303–6.PubMedCrossRefGoogle Scholar
  67. 67.
    McCurry SM, Vitiello MV, Gibbons LE, Logsdon RG, Teri L. Factors associated with caregiver reports of sleep disturbances in persons with dementia. Am J Geriatr Psychiatry. 2006;14(2):112–20.PubMedCrossRefGoogle Scholar
  68. 68.
    Hoch CC, Reynolds CF, Buysse DJ, et al. Protecting sleep quality in later life: a pilot study of bed restriction and sleep hygiene. J Gerontol B Psychol Sci Soc Sci. 2001;56(1):P52–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Alessi CA, Martin JL, Webber AP, et al. Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. J Am Geriatr Soc. 2005;53(5):803–10.PubMedCrossRefGoogle Scholar
  70. 70.
    Morgenthaler TI, Lee-Chiong T, Alessi C, et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep. 2007;30(11):1445–59.PubMedGoogle Scholar
  71. 71.
    McCurry SM, Gibbons LE, Logsdon RG, Vitiello MV, Teri L. Nighttime insomnia treatment and education for Alzheimer’s disease: a randomized, controlled trial. J Am Geriatr Soc. 2005;53(5):793–802.PubMedCrossRefGoogle Scholar
  72. 72.
    Harper DG, Volicer L, Stopa EG, et al. Disturbance of Endogenous Circadian Rhythm in Aging and Alzheimer Disease. American Journal of Geriatric Psych. 2005;13(5). Available at: http://journals.lww.com/ajgponline/Fulltext/2005/05000/Disturbance_of_Endogenous_Circadian_Rhythm_in.4.aspx.
  73. 73.
    Dunlap JC, Loros JL, DeCoursey PJ. Chronobiology: biological timekeeping. Sunderland: Sinauer; 2004.Google Scholar
  74. 74.
    Volicer L, Harper DG, Manning BC, Goldstein R, Satlin A. Sundowning and circadian rhythms in Alzheimer’s disease. Am J Psychiatry. 2001;158(5):704–11.PubMedCrossRefGoogle Scholar
  75. 75.
    •• McCurry SM, Pike KC, Vitiello MV, et al. Increasing walking and bright light exposure to improve sleep in community-dwelling persons with Alzheimer’s disease: results of a randomized, controlled trial. J Am Geriatr Soc. 2011;59(8):1393-1402. This study used a rigorous design to test the efficacy of walking, light exposure, and the combination of the two on sleep parameters. They found that all the interventions improved sleep in community-dwelling individuals with AD. Google Scholar
  76. 76.
    Sloane PD, Williams CS, Mitchell CM, et al. High-intensity environmental light in dementia: effect on sleep and activity. J Am Geriatr Soc. 2007;55(10):1524–33.PubMedCrossRefGoogle Scholar
  77. 77.
    der Lek RF Riemersma-van, Swaab DF, Twisk J, et al. Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: a randomized controlled trial. JAMA. 2008;299(22):2642–55.CrossRefGoogle Scholar
  78. 78.
    Lewy AJ, Emens J, Jackman A, Yuhas K. Circadian uses of melatonin in humans. Chronobiol Int. 2006;23(1–2):403–12.PubMedCrossRefGoogle Scholar
  79. 79.
    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.PubMedCrossRefGoogle Scholar
  80. 80.
    •• Gehrman PR, Connor DJ, Martin JL, et al. Melatonin fails to improve sleep or agitation in double-blind randomized placebo-controlled trial of institutionalized patients with Alzheimer disease. Am J Geriatr Psychiatry. 2009;17(2):166-169. This study used a rigorous design and found that melatonin alone did not improve sleep. Google Scholar
  81. 81.
    Dowling GA, Burr RL, Van Someren EJW, et al. Melatonin and bright-light treatment for rest-activity disruption in institutionalized patients with Alzheimer’s disease. J Am Geriatr Soc. 2008;56(2):239–46.PubMedCrossRefGoogle Scholar
  82. 82.
    Gooneratne NS, Gehrman P, Gurubhagavatula I, et al. Effectiveness of ramelteon for insomnia symptoms in older adults with obstructive sleep apnea: a randomized placebo-controlled pilot study. J Clin Sleep Med. 2010;6(6):572–80.PubMedGoogle Scholar
  83. 83.
    Simpson D, Curran MP. Ramelteon: a review of its use in insomnia. Drugs. 2008;68(13):1901–19.PubMedCrossRefGoogle Scholar
  84. 84.
    Naylor E, Penev PD, Orbeta L, et al. Daily social and physical activity increases slow-wave sleep and daytime neuropsychological performance in the elderly. Sleep. 2000;23(1):87–95.PubMedGoogle Scholar
  85. 85.
    Benloucif S, Orbeta L, Ortiz R, et al. Morning or evening activity improves neuropsychological performance and subjective sleep quality in older adults. Sleep. 2004;27(8):1542–51.PubMedGoogle Scholar
  86. 86.
    Richards KC, Beck C, O’Sullivan PS, Shue VM. Effect of individualized social activity on sleep in nursing home residents with dementia. J Am Geriatr Soc. 2005;53(9):1510–7.PubMedCrossRefGoogle Scholar
  87. 87.
    •• Richards KC, Lambert C, Beck CK, et al. Strength training, walking, and social activity improve sleep in nursing home and assisted living residents: randomized controlled trial. J Am Geriatr Soc. 2011;59(2):214-223. This study used rigorous design to compare the effects of physical activity, social activity, and the combination of the two activities in treating sleep disorders. They found that the combined modality improved sleep, whereas physical activity or social activity alone did not show effect. Google Scholar
  88. 88.
    Simpson K, Richards K, Enderlin C, O’Sullivan P, Koehn M. Medications and sleep in nursing home residents with dementia. J Am Psychiatr Nurses Assoc. 2006;12(5):279–85.CrossRefGoogle Scholar
  89. 89.
    Bain KT. Management of chronic insomnia in elderly persons. Am J Geriatr Pharmacother. 2006;4(2):168–92.PubMedCrossRefGoogle Scholar
  90. 90.
    • Beland S-G, Preville M, Dubois M-F, et al. Benzodiazepine use and quality of sleep in the community-dwelling elderly population. Aging Ment Health. 2010;14(7):843-850. This paper reported that benzodiazepines are the most prescribed drugs to treat sleep complaints, but the effectiveness of the drugs on sleep quality is not well documented. Google Scholar
  91. 91.
    • Henry G, Williamson D, Tampi RR. Efficacy and tolerability of antidepressants in the treatment of behavioral and psychological symptoms of dementia, a literature review of evidence. Am J Alzheimers Dis Other Demen. 2011;26(3):169-183. This paper provided a comprehensive review of the evidence regarding the use of antidepressants in the treatment of behavioral and psychological symptoms of dementia . The authors concluded that some antidepressants can be effective in the treatment of sleeping disorders and are generally well tolerated in elderly demented patients. Google Scholar
  92. 92.
    • Camargos EF, Pandolfi MB, Freitas MPD, et al. Trazodone for the treatment of sleep disorders in dementia: an open-label, observational and review study. Arq Neuropsiquiatr. 2011;69(1):44-49. This paper reported that trazodone was effective to treat sleep disorders in two thirds of patients with dementia, with minimal side effects. Google Scholar
  93. 93.
    Nishno, Seiji, Mignot, Emmanuel. Wake-promoting medications: basic mechanisms and pharmacology. In: Principles and Practice of Sleep Medicine. 5th ed. Elsevier Saunders.Google Scholar
  94. 94.
    Ancoli-Israel S, Kripke DF, Klauber MR, et al. Periodic limb movements in sleep in community-dwelling elderly. Sleep. 1991;14(6):496–500.PubMedGoogle Scholar
  95. 95.
    Phillips B, Young T, Finn L, et al. Epidemiology of restless legs symptoms in adults. Arch Intern Med. 2000;160(14):2137–41.PubMedCrossRefGoogle Scholar
  96. 96.
    Ancoli-Israel S, Kripke DF, Klauber MR, et al. Sleep-disordered breathing in community-dwelling elderly. Sleep. 1991;14(6):486–95.PubMedGoogle Scholar
  97. 97.
    Ancoli-Israel S, Klauber MR, Butters N, Parker L, Kripke DF. Dementia in institutionalized elderly: relation to sleep apnea. J Am Geriatr Soc. 1991;39(3):258–63.PubMedGoogle Scholar
  98. 98.
    Cohen-Zion M, Stepnowsky C, Marler, et al. Changes in cognitive function associated with sleep disordered breathing in older people. J Am Geriatr Soc. 2001;49(12):1622–7.PubMedCrossRefGoogle Scholar
  99. 99.
    Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136–43.PubMedCrossRefGoogle Scholar
  100. 100.
    Tarasiuk A, Greenberg-Dotan S, Simon-Tuval T, Oksenberg A, Reuveni H. The effect of obstructive sleep apnea on morbidity and health care utilization of middle-aged and older adults. J Am Geriatr Soc. 2008;56(2):247–54.PubMedCrossRefGoogle Scholar
  101. 101.
    Trotti LM. REM sleep behaviour disorder in older individuals: epidemiology, pathophysiology and management. Drugs Aging. 2010;27(6):457–70.PubMedCrossRefGoogle Scholar
  102. 102.
    •• Aurora RN, Zak RS, Maganti RK, et al. Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 2010;6(1):85-95. This paper presents the practice guidelines based on the latest evidence. Google Scholar
  103. 103.
    Martin JL, Marler MR, Harker JO, Josephson KR, Alessi CA. A multicomponent nonpharmacological intervention improves activity rhythms among nursing home residents with disrupted sleep/wake patterns. J Gerontol A Biol Sci Med Sci. 2007;62(1):67–72.PubMedCrossRefGoogle Scholar
  104. 104.
    Ouslander JG, Connell BR, Bliwise DL, et al. A nonpharmacological intervention to improve sleep in nursing home patients: results of a controlled clinical trial. J Am Geriatr Soc. 2006;54(1):38–47.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Qiuping Pearl Zhou
    • 1
  • Lorena Jung
    • 1
  • Kathy C. Richards
    • 1
  1. 1.School of Nursing, College of Health and Human ServicesGeorge Mason UniversityFairfaxUSA

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