Sleep in the Geriatric Patient Population

ABSTRACT

Older patients often suffer from sleep disturbances caused by age-related physiological changes, polypharmacy, changes in circadian rhythm, retirement, and loss of spouse. Many seniors have readily diagnosed sleep disorders that can be treated to achieve improvement in daytime somnolence or cognitive impairments. After a discussion of normal age-related changes in sleep, specific sleep pathologies common in the elderly will be reviewed, including sleep apnea, restless legs syndrome, advanced sleep phase syndrome, and rapid eye movement sleep behavior disorder.

KEYWORDS

Sleep - aging - sleep apnea - periodic leg movements - restless legs syndrome - circadian rhythms

REFERENCES

• 1 Census USBot .Population Projects Program. Washington, DC; 2000 http://www.census.gov
• 2 Janssens J P, Pautex S, Hilleret H, Michel J P. Sleep disordered breathing in the elderly.  Aging (Milano). 2000;  12 417-429
• 3 Burger C. Sleep-disordered breathing and aging. In: Mahler D Pulmonary Disease in the Patient New York; Marcel Dekker, Inc 1993: 61-80
• 4 Avidan A Y. Sleep changes and disorders in the elderly patient.  Curr Neurol Neurosci Rep. 2002;  2 178-185
• 5 Dement W, Richardson G, Prinz P et al.. Changes of Sleep and Wakefulness with Age. 4th ed. New York; Van Nostrand Reinhold 1996
• 6 Moe K E, Vitiello M V, Larsen L H, Prinz P N. Symposium: cognitive processes and sleep disturbances. Sleep/wake patterns in Alzheimer's disease: relationships with cognition and function.  J Sleep Res. 1995;  4 15-20
• 7 Wauquier A, van Sweden B, Lagaay A M et al.. Ambulatory monitoring of sleep-wakefulness patterns in healthy elderly males and females (greater than 88 years): the “Senieur” protocol.  J Am Geriatr Soc. 1992;  40 109-114
• 8 Dement W C, Miles L E, Carskadon M. “White paper” on sleep and aging.  J Am Geriatr Soc. 1982;  30 25-50
• 9 Ancoli-Israel S. Sleep problems in older adults: putting myths to bed.  Geriatrics. 1997;  52 20-30
• 10 Rediehs M H, Reis J S, Creason N S. Sleep in old age: focus on gender differences.  Sleep. 1990;  13 410-424
• 11 Wooten V. Medical causes of insomnia. In: Kryger MH, Dement WC Principles and Practice of Sleep Medicine Philadelphia; WB Saunders Company 1994: 456-475
• 12 Johns M W. A new method for measuring daytime sleepiness: the Epworth sleepiness scale.  Sleep. 1991;  14 540-545
• 13 Shochat T, Pillar G. Sleep apnoea in the older adult: pathophysiology, epidemiology, consequences and management.  Drugs Aging. 2003;  20 551-560
• 14 Chan E D, Welsh C H. Geriatric respiratory medicine.  Chest. 1998;  114 1704-1733
• 15 Kronenberg R, Drage C W. Attenuation of the ventilatory and heart rate responses to hypoxia and hypercapnia with aging in normal man.  J Clin Invest. 1973;  52 1812-1819
• 16 Findley L J, Barth J T, Powers D C et al.. Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia.  Chest. 1986;  90 686-690
• 17 Greenberg D G, Watson R K, Deptula D. Neuropsychological dysfunction in sleep apnea.  Sleep. 1987;  10 254-262
• 18 Cohen-Zion M, Stepnowsky C, Marler D et al.. Changes in cognitive function associated with sleep disordered breathing in older people.  J Am Geriatr Soc. 2001;  49 1622-1627
• 19 Ancoli-Israel S, Klauber M R, Butters N et al.. Dementia in institutionalized elderly: relation to sleep apnea.  J Am Geriatr Soc. 1991;  39 258-263
• 20 Hoch C C, Reynolds III C F, Kupfer D J. Sleep disordered breathing in normal and pathological aging.  J Clin Psychiatry. 1986;  47 499-503
• 21 Erkinjuntti T, Partinen M, Sulkava R. Sleep apnea in multiinfarct dementia and Alzheimer's disease.  Sleep. 1987;  10 419-425
• 22 Bliwise D L, Yesavage J A, Tinklenberg J R, Dement W C. Sleep apnea in Alzheimer's disease.  Neurobiol Aging. 1989;  10 343-346
• 23 Scheltens P, Visscher F, Van Keimpema A, Lindeboom J, Taphoorn M, Wolters E. Sleep apnea syndrome presenting with cognitive impairment.  Neurology. 1991;  41 155-156
• 24 Kadotani H, Kadotani T, Young T et al.. Association between apolipoprotein E epsilon4 and sleep-disordered breathing in adults.  JAMA. 2001;  285 2888-2890
• 25 Resta O, Caratozzolo G, Pannacciulli N et al.. Gender, age and menopause effects on the prevalence and the characteristics of obstructive sleep apnea in obesity.  Eur J Clin Invest. 2003;  33 1084-1089
• 26 Antonijevic I A, Stalla G K, Steiger A. Modulation of the sleep electroencephalogram by estrogen replacement in postmenopausal women.  Am J Obstet Gynecol. 2000;  182 277-282
• 27 Keefe D L, Watson R, Naftolin F. Hormone replacement therapy may alleviate sleep apnea in menopausal women: a pilot study.  Menopause. 1999;  6 196-200
• 28 Popovic R M, White D P. Upper airway muscle activity in normal women: influence of hormonal status.  J Appl Physiol. 1998;  84 1055-1062
• 29 Carskadon M A, Bearpark H M, Sharkey K M et al.. Effects of menopause and nasal occlusion on breathing during sleep.  Am J Respir Crit Care Med. 1997;  155 205-210
• 30 Young T, Finn L, Austin D et al.. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study.  Am J Respir Crit Care Med. 2003;  167 1181-1185
• 31 Shahar E, Redline S, Young T et al.. Hormone replacement therapy and sleep-disordered breathing.  Am J Respir Crit Care Med. 2003;  167 1186-1192
• 32 Dancey D R, Hanly P J, Soong C et al.. Impact of menopause on the prevalence and severity of sleep apnea.  Chest. 2001;  120 151-155
• 33 Rubinstein I, Colapinto N, Rotstein L E et al.. Improvement in upper airway function after weight loss in patients with obstructive sleep apnea.  Am Rev Respir Dis. 1988;  138 1192-1195
• 34 Quinnell T G, Smith I E. Obstructive sleep apnoea in the elderly: recognition and management considerations.  Drugs Aging. 2004;  21 307-322
• 35 Pepin J L, Krieger J, Rodenstein D et al.. Effective compliance during the first 3 months of continuous positive airway pressure. A European prospective study of 121 patients.  Am J Respir Crit Care Med. 1999;  160 1124-1129
• 36 Kribbs N B, Pack A I, Kline L R et al.. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea.  Am Rev Respir Dis. 1993;  147 887-895
• 37 Russo-Magno P, O'Brien A, Panciera T et al.. Compliance with CPAP therapy in older men with obstructive sleep apnea.  J Am Geriatr Soc. 2001;  49 1205-1211
• 38 Aloia M S, Di Dio L, Ilniczky N et al.. Improving compliance with nasal CPAP and vigilance in older adults with OSAHS.  Sleep Breath. 2001;  5 13-21
• 39 Shochat T, Cohen-Zion M. Ancoli-Israel S. The effects of CPAP treatment on cognitive function in dementia: a pilot study.  , (abstract) Sleep. 2000;  23 A218
• 40 Bloch K E, Iseli A, Zhang J N et al.. A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment.  Am J Respir Crit Care Med. 2000;  162 246-251
• 41 Hoekema A, Stegenga B, De Bont L G. Efficacy and co-morbidity of oral appliances in the treatment of obstructive sleep apnea-hypopnea: a systematic review.  Crit Rev Oral Biol Med. 2004;  15 137-155
• 42 Lowe A. Oral appliance therapy for snoring and sleep apnea. In: Pack A, ed. Sleep Apnea: Pathogenesis, Diagnosis, and Treatment New York; Marcel Dekker, Inc. 2002
• 43 Lowe A A. Dental Appliances for the Treatment of Snoring and Obstructive Sleep Apnea. Philadelphia; WB Saunders 1994
• 44 Riley R W, Li K K. Surgical Therapy for Obstructive Sleep Apnea-Hypopnea Syndrome. Philadelphia; WB Saunders 2000
• 45 Powell N B, Riley R W, Robinson A. Surgical management of obstructive sleep apnea syndrome.  Clin Chest Med. 1998;  19 77-86
• 46 Li H Y, Li K K, Chen N H et al.. Modified uvulopalatopharyngoplasty: the extended uvulopalatal flap.  Am J Otolaryngol. 2003;  24 311-316
• 47 Li K K. Surgical management of obstructive sleep apnea.  Clin Chest Med. 2003;  24 365-370
• 48 Riley R, Li K, Guilleminault C. Surgical Therapy for Obstructive Sleep Apnea-Hypopnea Syndrome. 3rd ed Philadelphia; WB Saunders Company 2000
• 49 Coleman R M. Periodic Movements in Sleep (Nocturnal Myoclonus) and Restless Legs Syndrome. Menlo Park, CA; Addison-Wesley Publishing Co 1982
• 50 Lesage S, Hening W A. The restless legs syndrome and periodic limb movement disorder: a review of management.  Semin Neurol. 2004;  24 249-259
• 51 Walter A S. Toward a better definition of the restless legs syndrome.  Mov Disord. 1995;  10 634-642
• 52 Bixler E O, 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
• 53 Coleman R M, Bliwise D L, Sajben N et al.. Daytime sleepiness in patients with periodic movements in sleep.  Sleep. 1982;  5 S191-S202
• 54 Ancoli-Israel S, Kripke D F, Klauber M R et al.. Periodic limb movements in sleep in community-dwelling elderly.  Sleep. 1991;  14 496-500
• 55 Phillips B, Ancoli-Israel S. Sleep disorders in the elderly.  Sleep Med. 2001;  2 99-114
• 56 Mitler M M, Browman C P, Menn S J et al.. Nocturnal myoclonus: treatment efficacy of clonazepam and temazepam.  Sleep. 1986;  9 385-392
• 57 Kaplan P, Allen R P, Buchholz D W et al.. A double-blind, placebo-controlled study of the treatment of periodic limb movements in sleep using carbidopa/levodopa and propoxyphene.  Sleep. 1993;  16 717-723
• 58 Kavey N, Walters A S, Hening W et al.. Opioid treatment of periodic movements in sleep in patients without restless legs.  Neuropeptides. 1988;  11 181-184
• 59 Klink M E, Quan S F, Kaltenborn W T et al.. Risk factors associated with complaints of insomnia in a general adult population. Influence of previous complaints of insomnia.  Arch Intern Med. 1992;  152 1634-1637
• 60 Miles L, Dement W C. Sleep & aging.  Sleep. 1980;  3 1-220
• 61 Foley D J, Monjan A A, Brown S L et al.. Sleep complaints among elderly persons: an epidemiologic study of three communities.  Sleep. 1995;  18 425-432
• 62 Brassington G S, King A C, Bliwise D L. Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64-99 years.  J Am Geriatr Soc. 2000;  48 1234-1240
• 63 Avidan A Y, James M L, Kristina M A, Wright G, Chervin R D. Insomnia and hypnotic use as predictors of falls and hip fractures in older nursing home residents.  Sleep. 2004;  27 A122
• 64 Gillin J C, Byerley W F. The diagnosis and management of insomnia.  N Engl J Med. 1990;  322 239-248
• 65 Edinger J D, Hoelscher T J, Webb M D et al.. Polysomnographic assessment of DIMS: empirical evaluation of its diagnostic value.  Sleep. 1989;  12 315-322
• 66 Lichstein K L, Wilson N M, Noe S L, Aguillard R N, Bellur S N. Daytime sleepiness in insomnia: behavioral, biological and subjective indices.  Sleep. 1994;  17 693-702
• 67 Hauri P J, Wisbey J. Wrist actigraphy in insomnia.  Sleep. 1992;  15 293-301
• 68 Reynolds C FI. Sleep in Affective Disorders Philadelphia; Saunders Company 1989
• 69 Benca R M, Obermeyer W H, Thisted R A et al.. Sleep and psychiatric disorders: a meta- analysis.  Arch Gen Psychiatry. 1992;  49 651-668
• 70 Dufour M C, Archer L, Gordis E. Alcohol and the elderly.  Clin Geriatr Med. 1992;  8 127-141
• 71 Espie C A. The Psychological Treatment of Insomnia. Chichester, UK; John Wiley 1991
• 72 Hicks R, Dysken M W, Davis J M et al.. The pharmacokinetics of psychotropic medication in the elderly: a review.  J Clin Psychiatry. 1981;  42 374-385
• 73 Roth T, Roehrs T, Zorick F. Pharmacological Treatment of Sleep Disorders. New York; John Wiley & Sons 1988
• 74 Uchimura N, Hirano T, Mukai M et al.. Insomnia in the Aged New York; Plenum Press 1998
• 75 Monane M. Insomnia in the elderly.  J Clin Psychiatry. 1992;  53(suppl) 23-28
• 76 Avidan A Y. Insomnia in the geriatric patient.  Clin Cornerstone. 2003;  5 51-60
• 77 Gillin J C, Ancoli-Israel S. The Impact of Age on Sleep and Sleep Disorders Baltimore; Williams & Wilkins 1992
• 78 Bootzin R R. Behavioral Treatments for Insomnia New York; Academic Press, Inc 1978
• 79 Spielman A J, Saskin P, Thorpy M J. Treatment of chronic insomnia by restriction of time in bed.  Sleep. 1987;  10 45-56
• 80 Jacobs D, Ancoli-Israel S, Parker L et al.. Twenty-four-hour sleep-wake patterns in a nursing home population.  Psychol Aging. 1989;  4 352-356
• 81 Van Someren E J. Circadian and sleep disturbances in the elderly.  Exp Gerontol. 2000;  35 1229-1237
• 82 Czeisler C A, Kronauer R E, Allan J S et al.. Bright light induction of strong (type 0) resetting of the human circadian pacemaker.  Science. 1989;  244 1328-1332
• 83 Campbell S S, Terman M, Lewy A et al.. Light treatment for sleep disorders: Consensus report. V. Age-related disturbances.  J Biol Rhythms. 1995;  10 151-154
• 84 Campbell S S, Kripke D F, Gillin J C et al.. Exposure to light in healthy elderly subjects and Alzheimer's patients.  Physiol Behav. 1988;  42 141-144
• 85 Dawson D, Encel N. Melatonin and sleep in humans (Review).  J Pineal Res. 1993;  15 1-12
• 86 Reiter R J. The pineal gland and melatonin in relation to aging: a summary of the theories and of the data.  Exp Gerontol. 1995;  30 199-212
• 87 Haimov I, Lavie P, Laudon M et al.. Melatonin replacement therapy of elderly insomniacs.  Sleep. 1995;  18 598-603
• 88 Lewy A J, Sack R L. The role of melatonin and light in the human circadian system.  Prog Brain Res. 1996;  111 205-216
• 89 Lewy A J, Ahmed S, Sack R L. Phase shifting the human circadian clock using melatonin.  Behav Brain Res. 1996;  73 131-134
• 90 Chokroverty S. Sleep and degenerative neurologic disorders.  Neurol Clin. 1996;  14 807-826
• 91 Schenck C H, Bundlie S R, Patterson A L et al.. Rapid eye movement sleep behavior disorder: a treatable parasomnia affecting older adults.  JAMA. 1987;  257 1786-1789
• 92 Schenck C H, Mahowald M W. REM sleep parasomnias.  Neurol Clin. 1996;  14 697-720
• 93 Morrison A R. The pathophysiology of REM-sleep behavior disorder.  Sleep. 1998;  21 446-449
• 94 Parkes J D. The parasomnias.  Lancet. 1986;  2 1021-1025