Skip to main content
SpringerLink
Log in

Management of Sleep Issues in Older Adults with Dementia

  • Chapter
  • First Online:
Dementia and Chronic Disease

  • 627 Accesses

Abstract

Commonly present in elderly patients with dementia are sleep disorders which require diagnosis and appropriate therapy. Obstructive sleep apnea has a higher prevalence in this patient population compared with cognitively non-impaired patients, and if diagnosed and treated, it may show improvement in daytime function and cognitive function. Insomnia is also common and may be caused by a number of medications that are frequently used by elderly patients. Treatment of insomnia may require cognitive behavioral therapy for insomnia (CBT-I), which has been associated with more lasting treatment response than pharmacologic therapy. Restless legs syndrome, rapid eye movement (REM) sleep behavior disorder, and circadian rhythm disorders may also complicate the care of the elderly patient with dementia. Appropriate diagnosis and treatment of sleep disorders in elderly patients with dementia will likely improve important patient outcomes such as cognitive function and daytime sleepiness.

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

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.

    CAS  PubMed  Google Scholar 

  2. Endeshaw Y. Clinical characteristics of obstructive sleep apnea in community-dwelling older adults. J Am Geriatr Soc. 2006;54(11):1740–4.

    PubMed  Google Scholar 

  3. Pan W, Kastin AJ. Can sleep apnea cause Alzheimer’s disease? Neurosci Biobehav Rev. 2014;47:656–69.

    PubMed  Google Scholar 

  4. 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.

    CAS  PubMed  Google Scholar 

  5. Guarnieri B, Sorbi S. Sleep and cognitive decline: a strong bidirectional relationship. It is time for specific recommendations on routine assessment and the management of sleep disorders in patients with mild cognitive impairment and dementia. Eur Neurol. 2015;74(1–2):43–8.

    PubMed  Google Scholar 

  6. Nikodemova M, Finn L, Mignot E, Salzieder N, Peppard PE. Association of sleep disordered breathing and cognitive deficit in APOE epsilon4 carriers. Sleep. 2013;36(6):873–80.

    PubMed  PubMed Central  Google Scholar 

  7. Aloia MS, Arnedt JT, Davis JD, Riggs RL, Byrd D. Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: a critical review. J Int Neuropsychol Soc. 2004;10(5):772–85.

    PubMed  Google Scholar 

  8. Sateia MJ. Neuropsychological impairment and quality of life in obstructive sleep apnea. Clin Chest Med. 2003;24(2):249–59.

    PubMed  Google Scholar 

  9. Wennberg AMV, Wu MN, Rosenberg PB, Spira AP. Sleep disturbance, cognitive decline, and dementia: a review. Semin Neurol. 2017;37(4):395–406.

    PubMed  PubMed Central  Google Scholar 

  10. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002;162(8):893–900.

    PubMed  Google Scholar 

  11. Roth HL. Dementia and sleep. Neurol Clin. 2012;30(4):1213–48.

    PubMed  Google Scholar 

  12. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485–91.

    CAS  PubMed  Google Scholar 

  13. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.

    CAS  PubMed  Google Scholar 

  14. Kryger MH, Roth T, Dement WC. Principles and practice of sleep medicine. 6th ed. St. Louis, Mo: Elsevier; 2017.

    Google Scholar 

  15. Mathieu A, Mazza S, Decary A, Massicotte-Marquez J, Petit D, Gosselin N, et al. Effects of obstructive sleep apnea on cognitive function: a comparison between younger and older OSAS patients. Sleep Med. 2008;9(2):112–20.

    CAS  PubMed  Google Scholar 

  16. Ancoli-Israel S, Palmer BW, Cooke JR, Corey-Bloom J, Fiorentino L, Natarajan L, et al. Cognitive effects of treating obstructive sleep apnea in Alzheimer’s disease: a randomized controlled study. J Am Geriatr Soc. 2008;56(11):2076–81.

    PubMed  PubMed Central  Google Scholar 

  17. Aloia MS, Ilniczky N, Di Dio P, Perlis ML, Greenblatt DW, Giles DE. Neuropsychological changes and treatment compliance in older adults with sleep apnea. J Psychosom Res. 2003;54(1):71–6.

    PubMed  Google Scholar 

  18. Cooke JR, Ayalon L, Palmer BW, Loredo JS, 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  PubMed Central  Google Scholar 

  19. Troussiere AC, Charley CM, Salleron J, Richard F, Delbeuck X, Derambure P, et al. Treatment of sleep apnoea syndrome decreases cognitive decline in patients with Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2014;85(12):1405–8.

    PubMed  Google Scholar 

  20. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19–25.

    CAS  PubMed  Google Scholar 

  21. Nishihata Y, Takata Y, Usui Y, Kato K, Yamaguchi T, Shiina K, et al. Continuous positive airway pressure treatment improves cardiovascular outcomes in elderly patients with cardiovascular disease and obstructive sleep apnea. Heart Vessel. 2015;30(1):61–9.

    Google Scholar 

  22. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–41.

    CAS  PubMed  Google Scholar 

  23. Martinez-Garcia MA, Campos-Rodriguez F, Catalan-Serra P, Soler-Cataluna JJ, Almeida-Gonzalez C, De la Cruz MI, et al. Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous positive airway pressure treatment: a prospective observational study. Am J Respir Crit Care Med. 2012;186(9):909–16.

    PubMed  Google Scholar 

  24. Zimmerman ME, Arnedt JT, Stanchina M, Millman RP, Aloia MS. Normalization of memory performance and positive airway pressure adherence in memory-impaired patients with obstructive sleep apnea. Chest. 2006;130(6):1772–8.

    PubMed  Google Scholar 

  25. Pelletier-Fleury N, Rakotonanahary D, Fleury B. The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome. A Cox’s proportional hazard analysis. Sleep Med. 2001;2(3):225–32.

    CAS  PubMed  Google Scholar 

  26. Chai-Coetzer CL, Luo YM, Antic NA, Zhang XL, Chen BY, He QY, et al. Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study. Sleep. 2013;36(12):1929–37.

    PubMed  PubMed Central  Google Scholar 

  27. Chaput JP, Yau J, Rao DP, Morin CM. Prevalence of insomnia for Canadians aged 6 to 79. Health Rep. 2018;29(12):16–20.

    PubMed  Google Scholar 

  28. Zhang J, Lamers F, Hickie IB, He JP, Feig E, Merikangas KR. Differentiating nonrestorative sleep from nocturnal insomnia symptoms: demographic, clinical, inflammatory, and functional correlates. Sleep. 2013;36(5):671–9.

    PubMed  PubMed Central  Google Scholar 

  29. Guarnieri B, Adorni F, Musicco M, Appollonio I, Bonanni E, Caffarra P, et al. Prevalence of sleep disturbances in mild cognitive impairment and dementing disorders: a multicenter Italian clinical cross-sectional study on 431 patients. Dement Geriatr Cogn Disord. 2012;33(1):50–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Zhu K, van Hilten JJ, Marinus J. The course of insomnia in Parkinson’s disease. Parkinsonism Relat Disord. 2016;33:51–7.

    CAS  PubMed  Google Scholar 

  31. Hung CM, Li YC, Chen HJ, Lu K, Liang CL, Liliang PC, et al. Risk of dementia in patients with primary insomnia: a nationwide population-based case-control study. BMC Psychiatry. 2018;18(1):38.

    PubMed  PubMed Central  Google Scholar 

  32. Dam TT, Ewing S, Ancoli-Israel S, Ensrud K, Redline S, Stone K, et al. Association between sleep and physical function in older men: the osteoporotic fractures in men sleep study. J Am Geriatr Soc. 2008;56(9):1665–73.

    PubMed  PubMed Central  Google Scholar 

  33. st Stone KL, Ancoli-Israel S, Blackwell T, Ensrud KE, Cauley JA, Redline S, et al. Actigraphy-measured sleep characteristics and risk of falls in older women. Arch Intern Med. 2008;168(16):1768–75.

    PubMed  Google Scholar 

  34. Cricco M, Simonsick EM, Foley DJ. The impact of insomnia on cognitive functioning in older adults. J Am Geriatr Soc. 2001;49(9):1185–9.

    CAS  PubMed  Google Scholar 

  35. Meng L, Zheng Y, Hui R. The relationship of sleep duration and insomnia to risk of hypertension incidence: a meta-analysis of prospective cohort studies. Hypertens Res. 2013;36(11):985–95.

    PubMed  PubMed Central  Google Scholar 

  36. Osorio RS, Pirraglia E, Aguera-Ortiz LF, During EH, Sacks H, Ayappa I, et al. Greater risk of Alzheimer’s disease in older adults with insomnia. J Am Geriatr Soc. 2011;59(3):559–62.

    PubMed  PubMed Central  Google Scholar 

  37. Bubu OM, Brannick M, Mortimer J, Umasabor-Bubu O, Sebastiao YV, Wen Y, et al. Sleep, cognitive impairment, and Alzheimer’s disease: a systematic review and meta-analysis. Sleep. 2017;40(1).

    Google Scholar 

  38. Dew MA, Hoch CC, Buysse DJ, Monk TH, Begley AE, Houck PR, et al. Healthy older adults’ sleep predicts all-cause mortality at 4 to 19 years of follow-up. Psychosom Med. 2003;65(1):63–73.

    PubMed  Google Scholar 

  39. Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res. 2002;53(3):737–40.

    PubMed  Google Scholar 

  40. Lichstein KL, Riedel BW, Lester KW, Aguillard RN. Occult sleep apnea in a recruited sample of older adults with insomnia. J Consult Clin Psychol. 1999;67(3):405–10.

    CAS  PubMed  Google Scholar 

  41. Lavie P. Insomnia and sleep-disordered breathing. Sleep Med. 2007;8 Suppl 4:S21–5.

    PubMed  Google Scholar 

  42. Ooms S, Ju YE. Treatment of sleep disorders in dementia. Curr Treat Options Neurol. 2016;18(9):40.

    PubMed  PubMed Central  Google Scholar 

  43. de Pooter-Stijnman LMM, Vrijkotte S, Smalbrugge M. Effect of caffeine on sleep and behaviour in nursing home residents with dementia. Eur Geriatr Med. 2018;9(6):829–35.

    PubMed  PubMed Central  Google Scholar 

  44. Alessi CA, Martin JL, Webber AP, Cynthia Kim E, Harker JO, Josephson KR. 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.

    PubMed  Google Scholar 

  45. Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia:update of the recent evidence (1998–2004). Sleep. 2006;29(11):1398–414.

    PubMed  Google Scholar 

  46. National Institutes of H. National Institutes of Health State of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults, June 13–15, 2005. Sleep. 2005;28(9):1049–57.

    Google Scholar 

  47. Grippe TC, Goncalves BS, Louzada LL, Quintas JL, Naves JO, Camargos EF, et al. Circadian rhythm in Alzheimer disease after trazodone use. Chronobiol Int. 2015;32(9):1311–4.

    CAS  PubMed  Google Scholar 

  48. Romeo R, Knapp M, Hellier J, Dewey M, Ballard C, Baldwin R, et al. Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial. Br J Psychiatry. 2013;202:121–8.

    PubMed  Google Scholar 

  49. 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.

    PubMed  Google Scholar 

  50. Meguro K, Meguro M, Tanaka Y, Akanuma K, Yamaguchi K, Itoh M. Risperidone is effective for wandering and disturbed sleep/wake patterns in Alzheimer’s disease. J Geriatr Psychiatry Neurol. 2004;17(2):61–7.

    PubMed  Google Scholar 

  51. Knol W, van Marum RJ, Jansen PA, Souverein PC, Schobben AF, Egberts AC. Antipsychotic drug use and risk of pneumonia in elderly people. J Am Geriatr Soc. 2008;56(4):661–6.

    PubMed  Google Scholar 

  52. Xu J, Wang LL, Dammer EB, Li CB, Xu G, Chen SD, et al. Melatonin for sleep disorders and cognition in dementia: a meta-analysis of randomized controlled trials. Am J Alzheimers Dis Other Dement. 2015;30(5):439–47.

    Google Scholar 

  53. By the American Geriatrics Society Beers Criteria Update Expert P. American Geriatrics Society 2019 Updated AGS Beers Criteria(R) for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674–94.

    Google Scholar 

  54. Boeve BF, Silber MH, Saper CB, Ferman TJ, Dickson DW, Parisi JE, et al. Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain. 2007;130(Pt 11):2770–88.

    CAS  PubMed  Google Scholar 

  55. 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Schenck CH, Bundlie SR, Mahowald MW. Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology. 1996;46(2):388–93.

    CAS  PubMed  Google Scholar 

  57. Boeve BF, Molano JR, Ferman TJ, Smith GE, Lin SC, Bieniek K, et al. Validation of the Mayo Sleep Questionnaire to screen for REM sleep behavior disorder in an aging and dementia cohort. Sleep Med. 2011;12(5):445–53.

    PubMed  PubMed Central  Google Scholar 

  58. Aurora RN, Zak RS, Maganti RK, Auerbach SH, Casey KR, Chowdhuri S, et al. Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 2010;6(1):85–95.

    PubMed  PubMed Central  Google Scholar 

  59. American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.

    Google Scholar 

  60. Beaulieu-Bonneau S, Hudon C. Sleep disturbances in older adults with mild cognitive impairment. Int Psychogeriatr. 2009;21(4):654–66.

    PubMed  Google Scholar 

  61. Trenkwalder C, Allen R, Hogl B, Paulus W, Winkelmann J. Restless legs syndrome associated with major diseases: a systematic review and new concept. Neurology. 2016;86(14):1336–43.

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Figorilli M, Puligheddu M, Ferri R. Restless legs syndrome/Willis-Ekbom disease and periodic limb movements in sleep in the elderly with and without dementia. Sleep Med Clin. 2015;10(3):331–42, xiv–xv.

    PubMed  Google Scholar 

  63. Kim SS, Oh KM, Richards K. Sleep disturbance, nocturnal agitation behaviors, and medical comorbidity in older adults with dementia: relationship to reported caregiver burden. Res Gerontol Nurs. 2014;7(5):206–14.

    PubMed  Google Scholar 

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

    CAS  PubMed  PubMed Central  Google Scholar 

  65. Stopa EG, Volicer L, Kuo-Leblanc V, Harper D, Lathi D, Tate B, et al. Pathologic evaluation of the human suprachiasmatic nucleus in severe dementia. J Neuropathol Exp Neurol. 1999;58(1):29–39.

    CAS  PubMed  Google Scholar 

  66. Kodama A, Kume Y, Tsugaruya M, Ishikawa T. Deriving the reference value from the circadian motor active patterns in the “non-dementia” population, compared to the “dementia” population: what is the amount of physical activity conducive to the good circadian rhythm. Chronobiol Int. 2016;33(8):1056–63.

    PubMed  Google Scholar 

  67. Kazui H, Adachi H, Kanemoto H, Yoshiyama K, Wada T, Tokumasu Nomura K, et al. Effects of donepezil on sleep disturbances in patients with dementia with Lewy bodies: an open-label study with actigraphy. Psychiatry Res. 2017;251:312–8.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Baylor College of Medicine, Houston, TX, USA

    Skantha K. Manjunath & Philip Alapat

Authors
  1. Skantha K. Manjunath
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philip Alapat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philip Alapat .

Editor information

Editors and Affiliations

  1. Department of Internal Medicine, Section of Geriatrics and Palliative Medicine Baylor College of Medicine, Houston, TX, USA

    Angela Georgia Catic

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Manjunath, S.K., Alapat, P. (2020). Management of Sleep Issues in Older Adults with Dementia. In: Catic, A.G. (eds) Dementia and Chronic Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-46398-4_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-46398-4_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-46397-7

  • Online ISBN: 978-3-030-46398-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation