Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T04:10:03.009Z Has data issue: false hasContentIssue false

Chapter 19 - Sleep Disorders

from Section III - Care of the Elderly by Organ System

Published online by Cambridge University Press:  30 June 2022

By
Joseph M. Dzierzewski ,
Juan Carlos Rodríguez  and
Cathy Alessi
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

Sleep disorders are very prevalent in late life, though they are often unrecognized, underdiagnosed, and poorly treated. Epidemiological evidence suggests that over 50% of elderly people suffer from one of several different sleep disorders, with the most common sleep disorders being insomnia and sleep apnea. Both insomnia and sleep apnea carry many serious negative physical, mental, and social consequences. Epidemiology, diagnosis, and treatment management for both insomnia and sleep apnea in older adults are reviewed. Diagnosis of insomnia in older adults is based on self-report, while sleep apnea diagnosis requires a sleep study. Treatment of insomnia in late life is guided by behavioral and cognitive principles, with the gold-standard treatment approach being cognitive-behavioral therapy or CBT. Positive airway pressure (PAP) therapy is the recommended treatment approach for sleep apnea. Contextual factors that complicate the diagnosis and management of insomnia and sleep apnea in late life are reviewed with the aim of providing practical information for the medical professional working with older patients.

Keywords

insomniasleep apneaolder adultselderlydiagnosistreatment
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 235 - 244
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Foley, DJ, Monjan, AA, Brown, SL, et al. Sleep complaints among elderly persons: An epidemiological study of 3 communities. Sleep. 1995; 18:425–432.CrossRefGoogle Scholar
Mellinger, GD, Balter, MB, Uhlenhuth, EH. Insomnia and its treatment: Prevalence and correlates. Arch Gen Psychiatry. 1985; 42:225–232.CrossRefGoogle ScholarPubMed
Morgan, K. Sleep and aging. In: Lichstein, K, Morin, C, eds. Treatment of Late Life Insomnia. Thousand Oaks, CA: Sage Publications, 2000, pp. 3–36.CrossRefGoogle Scholar
Floyd, JA, Medler, SM, Ager, JW, et al. Age-related changes in initiation and maintenance of sleep: A meta-analysis. Res Nurs Health. 2000; 23:106–117.Google Scholar
Diagnostic Classification Steering Committee TMJC. International Classification of Sleep Disorders, 3rd edition. Rochester, NY: American Academy of Sleep Medicine, 2014.Google Scholar
Ford, DE, Kamerow, DB. Epidemiological study of the sleep disturbances and psychiatric disorders. JAMA. 1989; 262:1479–1484.Google Scholar
Vitiello, MV, Moe, KE, Prinz, PN. Sleep complaints cosegregate with illness in older adults: Clinical research informed by and informing epidemiological studies of sleep. J Psychosom Res. 2002; 53:555–559.CrossRefGoogle ScholarPubMed
Bloom, HG, Ahmed, I, Alessi, CA, et al. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc. 2009; 57:761–789.Google Scholar
Rodriguez, JC, Dzierzewski, JM, Alessi, CA. Sleep problems in the elderly. Med Clin North Am. 2015; 99:431–439.Google Scholar
Roth, T. Insomnia: Definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007; 3:S7–S10.CrossRefGoogle ScholarPubMed
Dzierzewski, JM, O’Brien, E, Kay, DB, et al. Tackling sleeplessness: Psychological treatment options for insomnia in older adults. Nat Sci Sleep. 2010; 2:47–61.Google ScholarPubMed
Spielman, AJ, Caruso, LS, Glovinsky, PB. A behavioral perspective on insomnia treatment. Psychiat Clinics of N Amer. 1987; 10:541–553.Google Scholar
Bastien, CH, Vallieres, A, Morin, CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001; 2:297–307.CrossRefGoogle ScholarPubMed
Buysse, DJ, Reynolds, CFI, Monk, TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2):193–213.Google Scholar
Morin, CM, Colecchi, C, Stone, J, et al. Behavioral and pharmacological therapies for late life insomnia: A randomized controlled trial. JAMA. 1999; 281:991–999.Google Scholar
Sivertsen, B, Omvik, S, Pallesen, S, et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults. JAMA. 2006; 295:2851–2858.Google Scholar
McCurry, SM, Logsdon, RG, Teri, L, et al. Evidence-based psychological treatments for insomnia in older adults. Psychol Aging. 2007; 22:18–27.Google Scholar
Morgenthaler, T, Kramer, M, Alessi, CA, et al. Practice parameters for the psychological and behavioral treatment of insomnia: An update. An American Academy of Sleep Medicine report. Sleep. 2006; 29:1415–1419.Google Scholar
Siebern, AT, Manber, R. New developments in cognitive behavioral therapy as the first-line treatment of insomnia. Psychol Res Behav Manag. 2011; 4:21–28.Google Scholar
Stewart, R, Besset, A, Bebbington, P, et al. Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16 to 74 years. Sleep. 2006; 29:1391–1397.CrossRefGoogle Scholar
Alessi, CA. Sleep problems. In: Durso, SC, Sullivan, GM, eds. Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine, 8th edition. 2013. New York: American Geriatrics Society, pp. 316–339.Google Scholar
Young, T, Peppard, PE, Gottlieb, DJ. Epidemiology of obstructive sleep apnea: A population health perspective. Am J Respir Crit Care Med. 2002; 165:1217–1239.CrossRefGoogle ScholarPubMed
George, CFP. Sleep apnea, alertness, and motor vehicle crashes. American Journal of Respiratory and Critical Care Medicine. 2007; 176(10):954–956.Google Scholar
Punjabi, NM, et al. Sleep-disordered breathing and mortality: A prospective cohort study. PLoS Medicine. 2009; 6(8):e1000132.Google Scholar
Kales, A, et al. Severe obstructive sleep apnea – I: onset, clinical course, and characteristics. Journal of Chronic Diseases. 1985; 38(5):419–425.Google Scholar
Cowan, DC, Allardice, G, MacFarlane, D, et al. Predicting sleep disordered breathing in outpatients with suspected OSA. BMJ Open. 2014; 4:E004519.CrossRefGoogle ScholarPubMed
Epstein, LJ, Kristo, D, Strollo, PJ Jr., et al. Clinical guidelines for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009; 15:263–276.Google Scholar
Qaseem, A, et al. Management of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2013; 159(7):471–483.Google Scholar
Strohl, KP, et al. An official American Thoracic Society Clinical Practice Guideline: Sleep apnea, sleepiness, and driving risk in noncommercial drivers. An update of a 1994 statement. American Journal of Respiratory and Critical Care Medicine. 2013; 187(11):1259–1266.Google Scholar
Campos-Rodriguez, F, Pena-Grinan, N, Reyes-Nunâez, N, et al. Mortality in obstructive sleep apnea-hypopnea patients treated with positive airway pressure. Chest. 2005; 128:624–633.Google Scholar
Giles, TL, Lasserson, TJ, Smith, BJ, et al. Continuous positive airway pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006; 25:CD001106.Google Scholar
Rosenthal, L, Gerhardstein, R, Lumley, A, Guido, P, Day, R, Syron, ML, Roth, T. CPAP therapy in patients with mild OSA: Implementation and treatment outcome. Sleep Medicine. 2000; 1(3):215–220.Google Scholar
Krahn, LE, Lin, SC, Wisbey, J, et al. Assessing sleep in psychiatric inpatients: Nurse and patient reports versus wrist actigraphy. Ann Clin Psychiatry. 1997; 9:203–210.Google Scholar
Venkateshiah, SB, Collop, NA. Sleep and sleep disorders in the hospital. Chest. 2012; 141:1337–1345.Google Scholar
Iranzo, A, Santamaria, J, Bereguer, J, et al. Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction. Neurology. 2002; 58:911–916.CrossRefGoogle ScholarPubMed
Kaw, R, et al. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. British Journal of Anaesthesia. 2012; aes308.Google Scholar
D’Apuzzo, MR, Browne, JA. Obstructive sleep apnea as a risk factor for postoperative complications after revision joint arthroplasty. The Journal of Arthroplasty. 2012; 27(8):95–98.Google Scholar
Koch, S, et al. Effectiveness of sleep management strategies for residents of aged care facilities: Findings of a systematic review. Journal of Clinical Nursing. 2006; 15(10):1267–1275.CrossRefGoogle ScholarPubMed
Ancoli-Israel, S, et al. Sleep apnea in female patients in a nursing home: Increased risk of mortality. CHEST Journal. 1989; 96(5):1054–1058.Google Scholar
Alessi, CA, Martin, JL, Webber, AP, et al. Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. J Am Geriatr Soc. 2005; 53:803–810.CrossRefGoogle ScholarPubMed
Koch, S, Haesler, E, Tiziani, A, et al. Effectiveness of sleep management strategies for residents of aged care facilities: Findings of a systematic review. J Clin Nurs. 2006; 15:1267–1275.CrossRefGoogle ScholarPubMed
Roth, HL. Dementia and sleep. Neurol Clin. 2012; 30:1213–1248.Google Scholar
McCleery, J, Cohen, DA, Sharpley, AL. Pharmacotherapies for sleep disturbances in Alzheimer’s disease. Cochrane Database Syst Rev. 2014; 3:CD009178.Google Scholar
Buysse, DJ. Sleep health: Can we define it? Does it matter? Sleep. 2014; 37(1):9–17.Google Scholar
Dzierzewski, JM, Dautovich, N, Ravyts, S. Sleep and cognition in the older adult. Sleep Medicine Clinics. 2018; 13(1):93–106. doi:10.1016/j.jsmc.2017.09.009.Google Scholar
Okun, ML, et al. Psychometric evaluation of the Insomnia Symptom Questionnaire: A self-report measure to identify chronic insomnia. J Clin Sleep Med.2009; 5(1):41–51.Google Scholar
Qaseem, A, et al. Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016; 165:125–133. doi: 10.7326/M15-2175.Google Scholar
Fung, CH, Martin, JL, Alessi, CA, Dzierzewski, JM, Cook, I, Moore, A, Grinberg, A, Zeidler, M, Kierlin, L. Hypnotic discontinuation using a blinded (masked) tapering approach: A case series. Frontiers in Psychiatry. 2019; 10:717. doi: 10.3389/fpsyt.2019.00717.CrossRefGoogle ScholarPubMed
Alessi, CA, Martin, JL, Fiorentino, L, et al. Cognitive behavioral therapy for insomnia in older veterans using nonclinician sleep coaches: A randomized controlled trial. Journal of the American Geriatrics Society. 2016; 64(9):1830–1838. doi: 10.1111/jgs.14304.Google Scholar
Wang, G, Goebel, JR, Li, C, Hallman, HG, Gilford, TM, Li, W. Therapeutic effects of CPAP on cognitive impairments associated with OSA. Journal of Neurology. 2019; 267(10):2823–2282. doi:10.1007/s00415-019-09381-2.Google Scholar
Withrow, K, Evans, S, Harwick, J, Kezirian, E, Strollo, P. Upper airway stimulation response in older adults with moderate to severe obstructive sleep apnea. Otolaryngol Head Neck Srg. 2019; 161(4):714–719. doi: 10.1177/0194599819848709.Google Scholar
DePietro, RH, Knutson, KL, Spampinato, L, et al. Association between inpatient sleep loss and hyperglycemia of hospitalization. Diabetes Care. 2017; 40(2):188–193. doi: 10.2337/dc16-1683.CrossRefGoogle ScholarPubMed
Hu, RF, Jiang, XY, Chen, J, Zeng, Z, Chen, XY, Li, Y, Huining, X, Evans, DJ, Wang, S. Non‐pharmacological interventions for sleep promotion in the intensive care unit. Cochrane Database of Systematic Reviews; 2015; 10. doi: 10.1002/14651858.CD008808.pub2.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×