Sleep Disorders in the Older Patient

Age-related cognitive decline and disruptions in circadian rhythms are growing problems as the average human life span increases. Multiple strains of the senescence-accelerated mouse (SAM) show reduced life span, and the SAMP8 strain in particular has been well documented to show cognitive deficits in behavior as well as a bimodal pattern of circadian locomotor activity. However, little is known about circadian regulation within the hippocampus of these strains of mice. Here we test the hypothesis that in this early senescence model, disruption of the molecular circadian clock in SAMP8 animals drives disrupted behavior and physiology. We found normal rhythms in PER2 protein expression in the SCN of SAMP8 animals at 4 months, despite the presence of disrupted wheel-running activity rhythms at this age. Interestingly, a significant rhythm in PER2 expression was not observed in the hippocampus of SAMP8 animals, despite a significant 24-h rhythm in SAMR1 controls. We also examined time-restricted feeding as a potential strategy to rescue disrupted hippocampal plasticity. Time-restricted feeding increased long-term potentiation at Schaffer collateral-CA1 synapses in SAMP8 mice (compared to SAMR1 controls). Overall, we confirm disrupted circadian locomotor rhythms in this early senescence model (as early as 4 months) and discovered that this disruption is not due to arrhythmic PER2 levels in the SCN; however, other extra-SCN circadian oscillators (i.e., hippocampus) are likely impaired with accelerated aging.

Insomnia and short self-reported sleep duration are associated with suicidality, adjusting for concurrent depression. Yet, it is unknown whether they correlate with attempters' suicidal intent and the lethality of suicidal acts. This cross-sectional study in hospitalized suicide attempters aimed to investigate whether temporally proximal self-reported sleep disturbance predicts suicidal intent or exerts mediatory effects.

Attempters were retrospectively assessed for insomnia severity (Athens Insomnia Scale [AIS]) and average night sleep duration (ANSD) for 2 weeks preceding attempt. The effects of insomnia or ANSD on suicidal intent (Beck's Suicide Intent Scale [BSIS]) were explored in multiple regressions. Mediatory effects were investigated in structural equation models (SEMs).

A total of 127 adults (59.8% females) were interviewed within two weeks post–suicide attempt. Major psychiatric diagnoses included affective, psychotic, and alcohol-related disorders. Of the participants, 38.6% had current major depression (MDE). A total of 62.2% reported insomnia (AIS ≥ 6); 42.5% reported short ANSD (≤5 hours). BSIS was predicted by AIS (p = 0.034), short ANSD (p = 0.015), or insomnia with short ANSD (p = 0.006). In SEMs, indirect effects of current MDE, affective disorder, and alcohol-related disorder diagnoses on BSIS via AIS tested significant; both AIS and short ANSD partially mediated the effect of age on BSIS.

Insomnia, short ANSD, and, in particular, insomnia with short ANSD proximally predicted suicidal intent in recent attempters. The effects of current depression and affective and alcohol-related disorder diagnoses on suicidal intent were partially mediated by insomnia; both insomnia and short ANSD partially mediated the effect of age on suicidal intent. Therefore, management of sleep disturbance in at-risk subjects is important, as it may reduce unfavorable outcomes of suicidal acts.

L’avancée en âge s’accompagne de difficultés à initier et maintenir le sommeil nocturne. En conséquence, les seniors ont un moins bon sommeil et se plaignent plus souvent que les sujets plus jeunes. De nombreuses études ont montré que leur sommeil était fragmenté, avec peu de sommeil lent profond et d’ondes lentes. Les réveils matutinaux sont fréquents et accompagnés d’une incapacité à se rendormir. L’avancée en âge s’accompagne aussi d’une réduction conséquente de la dépense énergétique quotidienne liée à une réduction des activités physiques pratiquées et à une augmentation de la sédentarité. De nombreuses études ont montré que l’activité physique peut modifier positivement les paramètres du sommeil à travers deux mécanismes. Le premier est l’effet direct de l’activité physique sur l’horloge biologique interne. Il repose sur l’amélioration du contraste jour/nuit et donc de l’amplitude des rythmes par la pratique régulière d’activité physique. Le deuxième est l’effet direct de l’activité physique sur les paramètres homéostatiques de la régulation du sommeil. Ces deux mécanismes concourent au fait que la pratique régulière d’activité physique puisse maintenir un sommeil de qualité chez les seniors et qu’elle puisse être une alternative sanitaire et économique à la prescription de produits pharmacologiques.

Aging is accompanied by difficulties to initiate and maintain nocturnal sleep. As a consequence, the seniors have a poor sleep and complain more often than the younger subjects. Numerous studies show that their sleep is fragmented, with few slow wave sleep. Early awakenings are frequent and accompanied by incapacity to return back to sleep. Aging comes along with a consequent reduction of the daily energy expenditure related to a reduction of physical activities with an increase of the sedentary lifestyle. Numerous studies showed that physical activity can modify positively the sleep parameters through two mechanisms. The first one is the direct effect of physical activity upon the internal biological clock. It bases on the improvement of the day/night contrast by regular exercise and thus of the amplitude of the rhythms. The second is the direct effect of the physical activity on the homeostatic parameters of sleep regulation. These two mechanisms contribute to the fact that exercising regularly can maintain a quality of sleep in the elderly and that it can be a sanitary and economic alternative to the prescription of pharmacological compounds.

Aging is a multifactorial process that elicits changes in the duration and quality of sleep. Polysomnography is considered to be the standard examination for the analysis of sleep and consists of the simultaneous recording of selected physiological variables during sleep.

The objective of this study was to use polysomnography to compare sleep reported by senior citizens.

We selected 40 patients, both male and female, with ages ranging from 64 to 89 years from the Center for the Study of Aging at the Federal University of São Paulo. Patients answered questions about sleep on the Comprehensive Geriatric Assessment and underwent polysomnography.

The results were compared, and agreement between perceived sleep and polysomnography was found in several areas. There was an association between difficulty sleeping and sleep onset latency (p=0.015), waking up at night with sleep onset latency (p=0.005), total sleep time with daytime sleepiness (0.005) and snoring (0.027), sleep efficiency with sleepiness (0.004), snoring (0.033) and pause in breathing (p=0.024), awakenings with snoring (p=0.012) and sleep apnea with pauses in breathing (p=0.001).

These results suggest that the older adult population have a good perception of their sleep. The questionnaires aimed at this population should be used as an alternative to polysomnography.