Sleep Problems in the Elderly

Refreshing sleep requires both sufficient total sleep time as well as sleep that is in synchrony with the individual's circadian rhythm. Problems with sleep organization in elderly patients typically include difficulty falling asleep, less time spent in the deeper stages of sleep, early-morning awakening and less total sleep time. Poor sleep habits such as irregular sleep-wake times and daytime napping may contribute to insomnia. Caffeine, alcohol and some medications can also interfere with sleep. Primary sleep disorders are more common in the elderly than in younger persons. Restless legs syndrome and periodic limb movement disorder can disrupt sleep and may respond to low doses of antiparkinsonian agents as well as other drugs. Sleep apnea can lead to excessive daytime sleepiness. Evaluation of sleep problems in the elderly includes careful screening for poor sleep habits and other factors that may be contributing to the sleep problem. Formal sleep studies may be needed when a primary sleep disorder is suspected or marked daytime dysfunction is noted. Therapy with a benzodiazepine receptor agonist may be indicated after careful evaluation.

Complaints of sleep difficulty are common among the elderly. In a National Institute on Aging study of over 9,000 persons aged 65 years and older, over one half of the men and women reported at least one chronic sleep complaint.1 Typical symptoms of sleep problems in the elderly include difficulty falling asleep and maintaining sleep, early-morning awakening and excessive daytime sleepiness.
A variety of processes may interfere with sleep and wakefulness in the elderly.2,3 Among them are acute and chronic medical illnesses, medication effects, psychiatric disorders, primary sleep disorders, social changes, poor sleep habits and circadian rhythm shifts. Sleep-wake problems may be compounded further by inappropriate treatment initiated by the patient, family members, physicians or other care providers.

The consequences of chronic sleep problems can be considerable. Loss of sleep or chronic use of sedating medications may lead to falls and accidents.4,5 Sleep-disordered breathing may have serious cardiovascular, pulmonary and central nervous system effects. Evidence supports a strong association between sleep apnea and hypertension.6-8 In persons with dementia, severe sleep disruption often leads to nursing home placement. For all of these reasons, sleep problems in elderly patients should be properly evaluated and treated.