Skip to main content

Advertisement

Log in

Sleep changes and disorders in the elderly patient

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Sleep disorders are very common among older patients. Our population as a whole is experiencing substantial growth in the geriatric population. Thus, it is all the more prudent that healthcare professionals become familiar with the major sleep disorders that affect the older patient, as well as the diagnosis and treatment of these disorders. This paper deals with the various sleep changes that take place in the course of the aging process and with the assessment of sleep disorders in the older patient. Special attention is paid to sleepdisordered breathing, periodic limb-movement disorder of sleep, insomnia, and circadian rhythm anthology, as well as parasomnias that are unique to the older patient. The final section of the paper deals with specific neurologic disorders and their impact on sleep patterns.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. McGheie A, Russel SM: The subjective assessment of normal sleep patterns. J Mental Sci 1962, 108:642–654.

    Google Scholar 

  2. Dement W, Richardson G, Prinz P, et al.: Changes of sleep and wakefulness with age. In Handbook of the Biology of Aging, edn 4. Edited by Finch C,Schnieder EL. New York: Van Nostrand Reinhold; 1996.

    Google Scholar 

  3. Prinz PN: Sleep patterns in the healthy aged: relationship with intellectual function. J Gerontol 1977, 32:179–185.

    Google Scholar 

  4. Wauquier A, Van Sweden B, Lagaay AM, Kemp B, Kamphuisen HA: Ambulatory monitoring of sleep-wakefulness patterns in healthy elderly males and females (>88 years): The "Senieur" protocol. J Am Geriatr Soc 1992, 40:109–114.

    PubMed  CAS  Google Scholar 

  5. Carskadon MA, Brown ED, Dement WC: Sleep fragmentation in the elderly: relationship to daytime sleep tendency. Neurobiol Aging 1982, 3:321–327.

    Article  PubMed  CAS  Google Scholar 

  6. Wooten V: Medical causes of insomnia. In Principles and Practice of Sleep Medicine. Edited by Kryger MH, Roth T, Dement WC. Philadelphia: WB Saunders; 1994:456–475.

    Google Scholar 

  7. Fairbanks DN, Fujita S, Ikematsu T, Simmons FB: Snoring and Obstructive Sleep Apnea. New York: Raven Press; 1987.

    Google Scholar 

  8. Ancoli-Israel S, Bliwise DL, Mant A: Sleep and breathing in the elderly. In Sleep and Breathing. Edited by Saunders NA,Sullivan CE. NewYork: Mercel Dekker; 1993:673–693.

    Google Scholar 

  9. Ancoli-Israel S, Jones DW, Hanger MA, et al.: Sleep in the nursing home. In Sleep and Respiration in Aging Adults. Edited byKuna ST,Suratt PM, Remmers JE. New York: Elsevier; 1991:77–84.

    Google Scholar 

  10. Ancoli-Israel S, Kripke DF, Klauber MR, et al.: Morbidity, mortality and sleep disordered breathing in community dwelling elderly. Sleep 1996, 19:277–282.

    PubMed  CAS  Google Scholar 

  11. Shepard JW: Cardiorespiratory changes in obstructive sleep apnea. In Principles and Practice of Sleep Medicine. Edited by Kryger MH, Roth T, Dement WC. Philadelphia: WB Saunders; 1989:537–551.

    Google Scholar 

  12. Bliwise DL, Feldman DE, Bliwise N, et al.: Risk factors for sleep disordered breathing in heterogeneous geriatric populations. J Am Geriatr Soc 1987, 35:132–141.

    PubMed  CAS  Google Scholar 

  13. Ancoli-Israel S, Kripke DF, Klauber MR, et al.: Sleep disordered breathing in community-dwelling elderly. Sleep 1991, 14:486–495.

    PubMed  CAS  Google Scholar 

  14. Bliwise DL: Review: sleep in normal aging and dementia. Sleep 1993, 16:40–81.

    PubMed  CAS  Google Scholar 

  15. Ancoli-Israel S, Coy TV: Are breathing disturbances in elderly equivalent to sleep apnea syndrome? Sleep 1994, 17:77–83.

    PubMed  CAS  Google Scholar 

  16. Derderian SS, Bridenbaugh RH, Rajagopal KR: Neuropsychologic symptoms in obstructive sleep apnea improve after treatment with nasal continuous positive airway pressure. Chest 1988, 94:1023–1027.

    PubMed  CAS  Google Scholar 

  17. Janssens JP, Pautex S, Hilleret H, Micel JP: Sleep disordered breathing in the elderly. Aging 2000, 12:417–429.

    PubMed  CAS  Google Scholar 

  18. Findley LJ, Presty SK, Barth J, Suratt PM: Impaired cognition and vigilance in elderly subjects with sleep apnea. In Sleep and Respiration in Aging Adults. Edited by Kuna ST,Suratt JE, Remmers JE. New York: Elsevier; 1991:259–265.

    Google Scholar 

  19. Shepard JW: Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. Clin Chest Med 1992, 13:437–458.

    PubMed  Google Scholar 

  20. Grunstein RR, Sullivan CE: Continuous positive airway pressure for sleep breathing disorder. In Principles and Practice of Sleep Medicine. Edited byKryger MH, Roth T,Dement WC. Philadelphia: WB Saunders; 2000:894–912.

    Google Scholar 

  21. Kryger MH: Management of obstructive sleep apnea-hypopnea syndrome. In Principles and Practice of Sleep Medicine. Edited by Kryger MH, Roth T, Dement WC. Philadelphia: WB Saunders; 2000:940–954. This chapter provides a general review of the current management of obstructive sleep apnea. Special topics include management of sleep apnea in the critically ill patient.

    Google Scholar 

  22. Lowe AA: Dental appliances for the treatment of snoring and obstructive sleep apnea. In Principles and Practice of Sleep Medicine. Edited by Kryger MH, Roth T,Dement WC. Philadelphia: WB Saunders; 2000:929–939. This chapter describes the use of oral appliances for the treatment of sleep apnea and snoring. Protocols for use and contraindications are also included.

    Google Scholar 

  23. Coleman RM, Bliwise DL, Sajben N, et al.: Daytime sleepiness in patients with periodic movements in sleep. Sleep 1982, 5:S191-S202.

    PubMed  Google Scholar 

  24. Walters AS, Aldrich MS, Allen R, et al.: Toward a better definition of the restless legs syndrome. Mov Disord 1996, 10:634–642.

    Article  Google Scholar 

  25. 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.

    PubMed  CAS  Google Scholar 

  26. Ancoli-Israel S, Kripke DF, Klauber MR, et al.: Periodic limb movements in sleep in community-dwelling elderly. Sleep 1991, 14:496–500.

    PubMed  CAS  Google Scholar 

  27. Mitler MM, Browman CP, Menn SJ, Gujavarty K, Timms RM: Nocturnal myoclonus: treatment efficacy of clonazepam and temazepam. Sleep 1986, 9:385–392.

    PubMed  CAS  Google Scholar 

  28. Kaplan P, Allen RP, Buchholz DW, Walters JK: A double-blind, placebo-controlled study of the treatment of periodic limb movements in sleep using carbidopa/levidopa and propoxyphene. Sleep 1993, 16:717–723.

    PubMed  CAS  Google Scholar 

  29. Kavey N, Walters AS, Hening W, Gidro-Frank S: Opioid treatment of periodic movements in sleep in patients without restless legs. Neuropeptides 1988, 11:181–184.

    Article  PubMed  CAS  Google Scholar 

  30. Ford DE, Kamerow DB: Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 1989, 262:1479–1484.

    Article  PubMed  CAS  Google Scholar 

  31. Gillin JC, Byerley WF: The diagnosis and management of insomnia. N Engl J Med 1990, 322:239–248.

    Article  PubMed  CAS  Google Scholar 

  32. Reynolds CF: Sleep in affective disorders. In Principles and Practice of Sleep Medicine. Edited by Kryger MH, Roth T,Dement WC. Philadelphia: WB Saunders; 1989:413–415.

    Google Scholar 

  33. Benca RM, Obermeyer WH, Thisted RA, Gillin JC: Sleep and psychiatric disorders: a meta-analysis. Arch Gen Psychiatry 1992, 49:651–668.

    PubMed  CAS  Google Scholar 

  34. Dufour MC, Archer L, Gordis E: Alcohol and the elderly. Clin Geriatr Med 1992, 8:127–141.

    PubMed  CAS  Google Scholar 

  35. Espie CA: The Psychological Treatment of Insomnia. Chichester: John Wiley; 1991.

    Google Scholar 

  36. Hauri PJ, Esther MS: Insomnia. Mayo Clin Proc 1990, 65:869–882.

    PubMed  CAS  Google Scholar 

  37. 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 

  38. Espie CA, Brooks DN, Lindsay WR: An evaluation of tailored psychological treatment of insomnia. J Behav Ther Exp Psychiatry 1988,19:51–56.

    Article  PubMed  CAS  Google Scholar 

  39. Hauri PJ: Insomnia. Clin Chest Med 1998, 19:157–168.

    Article  PubMed  CAS  Google Scholar 

  40. Spielman AJ, Saskin P, Thorpy MJ: Treatment of chronic insomnia by restriction of time in bed. Sleep 1987, 10:45–56.

    PubMed  CAS  Google Scholar 

  41. Bootzin RR, Engle-Friedman M: Sleep disturbances. In Handbook of Clinical Gerontology. Edited by Edelstein BA,Carstensen LL. New York: Pergamon Press; 1997.

    Google Scholar 

  42. Hicks R, Dysken MW, Davis JM, et al.: The pharmacokinetics of psychotropic medication in the elderly: a review. J Clin Psychiatry 1981, 42:374–385.

    PubMed  CAS  Google Scholar 

  43. Roth T, Roehrs T, Zorick F: Pharmacological treatment of sleep disorders. In Sleep Disorders: Diagnosis and Treatment. Edited by Williams RL, Karacan I,Moore CA. New York: John Wiley & Sons; 1988:373–395.

    Google Scholar 

  44. Gillin JC, Ancoli-Israel S: The impact of age on sleep and sleep disorders. In Clinical Psychopharmacology. Edited by Salzman C. Baltimore: Williams & Wilkins; 1992:213–234.

    Google Scholar 

  45. Jacobs D, Ancoli-Israel S, Parker L, Kripke DF: Twenty-fourhour sleep-wake patterns in a nursing home population. Psychol Aging 1989, 4:352–356.

    Article  PubMed  CAS  Google Scholar 

  46. Czeisler CA, Kronauer RE, Allan JS, et al.: Bright light induction of strong (type 0) resetting of the human circadian pacemaker. Science 1989, 244:1328–1332.

    Article  PubMed  CAS  Google Scholar 

  47. Campbell SS, Terman M, Lewy A, et al.: Light treatment for sleep disorders: consensus report. V. Age-related disturbances. J Biol Rhythms 1995, 10:151–154.

    Article  PubMed  CAS  Google Scholar 

  48. Dawson D, Encel N: Melatonin and sleep in humans [review]. J Pineal Res 1993, 15:1–12.

    Article  PubMed  CAS  Google Scholar 

  49. Touitou Y: Human aging and melatonin. Clinical relevance. Exp Gernontol 2001, 36:108–1100. s article provides an outstanding review of melatonin, theoretical applications, and changes in human melatonin that take place with aging.

    Google Scholar 

  50. Reiter RJ: The pineal gland and melatonin in relation to aging: a summary of the theories and of the data. Exp Gerontol 1995, 30:199–212.

    Article  PubMed  CAS  Google Scholar 

  51. Haimov I, Lavie P, Laudon M, et al.: Melatonin replacement therapy of elderly insomniacs. Sleep 1995, 18:598–603.

    PubMed  CAS  Google Scholar 

  52. Lewy AJ, Sack RL: The role of melatonin and light in the human circadian system In Progress in Brain Research. Edited by Buija RM. New York: Elsevier; 1996:205–216.

    Google Scholar 

  53. Chokroverty S: Sleep and degenerative neurologic disorders. Neurol Clin 1996, 14:807–826.

    Article  PubMed  CAS  Google Scholar 

  54. Schenck CH, Bundlie SR, Patterson AL, Mahowald MD: Rapid eye movement sleep behavior disorder: a treatable parasomnia affecting older adults. JAMA 1987, 257:1786–1789.

    Article  PubMed  CAS  Google Scholar 

  55. Turner RS, Chervin RD, Frey KA, Minoshima S, Kuhl DE: Probable diffuse Lewy body disease presenting as REM sleep behavior disorder. Neurology 1997, 49:523–527.

    PubMed  CAS  Google Scholar 

  56. Boeve BF, Silber MH, Ferman TJ, et al.: REM sleep behavior disorder and degenerative dementia: an association likely reflecting Lewy body disease. Neurology 1998, 51:363–370.

    PubMed  CAS  Google Scholar 

  57. Tan A, Salgado M, Fahn S: Rapid eye movement sleep behavior disorder preceding Parkinson’s disease with therapeutic response to levodopa. Mov Disord 1996, 11:214–216.

    Article  PubMed  CAS  Google Scholar 

  58. Shimizu T, Inami Y, Sugita Y, et al.: REM sleep without muscle atonia (stage1-REM) and its relation to delirious behavior during sleep in patients with degenerative diseases involving the brain stem. Jpn J Psychiatry Neurol 1990, 44:681–692.

    PubMed  CAS  Google Scholar 

  59. Phillips B, Ancoli-Israel S: Sleep disorders in the elderly. Sleep Med 2000, 2:99–114. outstanding review of common sleep problems affecting older patients. The paper reviews the common sleep problems affecting older patients and provides clinical presentations and an updated synopsis of current treatment modalities.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Avidan, A.Y. Sleep changes and disorders in the elderly patient. Curr Neurol Neurosci Rep 2, 178–185 (2002). https://doi.org/10.1007/s11910-002-0028-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-002-0028-z

Keywords

Navigation