Sleep Disorders in the Older Patient
Section snippets
Normal sleep changes associated with aging
Predictable age-related changes in sleep architecture consist of sleep fragmentation, reduced sleep efficiency, decreased quality of sleep, and a decrement in the amplitude of the low-frequency delta brainwave electrographic activity that comprises slow-wave sleep (SWS). Older people spend more time in the lighter stages of sleep, have a reduction in the amount of SWS, and experience increased fragmentations of the entire sleep cycle [1]. The latency to the first rapid eye movement (REM) period
Clinical sleep history in the older patient
The clinical assessment of aging patients who have sleep complaints involves a multidisciplinary approach. The history of present illness, past sleep history, and a detailed account of specific sleep complaints in the presence of the spouse often help to establish or guide the clinician toward the correct diagnosis. Inquiries regarding tobacco, alcohol, caffeine, and medications, including dosage and timing, are often useful in the assessment of underlying causes for insomnia or hypersomnolence.
Laboratory evaluation of sleep disorders in the older person
Objective assessment of sleep uses polysomnography (PSG), which is important in the assessment of sleep-disordered breathing, specific sleep stage abnormalities, nocturnal myoclonus, and unusual nocturnal behaviors. The MSLT provides objective assessment of excessive daytime somnolence. The use of videomanometry during the PSG may be useful when evaluating patients who have abnormal nocturnal spells, such as the REM sleep behavior disorder (RBD) and nocturnal seizures.
Case A
A 73-year-old woman presents to the sleep clinic complaining of difficulties initiating sleep over the past 5 years. She generally goes to bed at 10 pm and watches television in bed until about midnight. She describes difficulties with sleep initiation and feeling “worried” about not being able to fall asleep. She stays in bed and feels frustrated, becoming anxious as the hours pass, and finally falls asleep between 2 am and 3 am. She has difficulty awakening with her husband, who is typically
Summary
Sleep changes dramatically with old age. Subjective and objective measures demonstrate an increase in sleep and wake disturbances with advancing age. The older person has a more fragmented sleep, sleeps less deeply, and tends to experience early morning awakenings. When older patients have sleep disorders, they often present with excessive daytime sleepiness, insomnia, or abnormal motor activity. In making the appropriate diagnosis, the role of the provider is to review the patient's medical
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