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  • Insomnia is a disorder involving difficulty falling asleep, difficulty staying asleep, and/or early morning awakening that is associated with daytime symptoms such as fatigue, irritability, or problems with concentration.

  • Sleep apnea is common among older adults and may present with symptoms such as snoring, choking, fatigue, insomnia, or other signs and symptoms.

  • Sleep disorders are common with certain neurologic disorders, such as dementia and Parkinson disease.

  • Depending on the particular sleep disorder, diagnoses are made based on clinical presentation and/or by testing in a sleep laboratory or by home-based sleep testing.


Sleep disturbance is common among older adults. The National Heart, Lung, and Blood Institute has highlighted the prevalence and associated deleterious health consequences of poor sleep with its statement of “one in three adults does not regularly get the recommended amount of uninterrupted sleep to protect their health.” Sleep difficulties and several primary sleep disorders increase in prevalence with age. However, in older adults, sleep disturbance often coexists with other conditions, which can exacerbate or lead to additional medical and psychosocial conditions and may impact treatment. For these reasons, sleep disturbance in older adults might often be best approached as a geriatric syndrome as the causes and contributing factors are generally multifactorial.

The prevalence of sleep difficulties varies based on how these problems are identified and defined, but studies suggest that >50% of community-dwelling older adults and >65% of long-term care facility residents experience sleeping difficulties. In addition, many community-dwelling older adults use nonprescription or prescribed sleeping medications.

Sleep architecture can be described based on findings of polysomnography, which involves multiple channels (eg, electroencephalogram, electrooculogram, electromyogram) of physiologic recording during sleep. Based on polysomnography, sleep can be categorized into two states: nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep is further divided into three stages, where N1 is the lightest sleep, N2 is where the majority of sleep time is spent, and N3 is deep sleep. N1 and N2 sleep increase with age, whereas N3 sleep decreases. Altered sleep patterns include decreased sleep efficiency (time asleep as a percentage of time in bed), decreased total sleep time, increased sleep latency (time to fall asleep), more arousals during the night, more daytime napping, and other changes.

Older adults may not report sleep complaints unless specifically asked. Presenting symptoms overlap significantly among common sleep disorders.


Clinical Findings

A. Symptoms & Signs

Occasional difficulty falling asleep or staying asleep is common. To diagnose insomnia, the International Classification of Sleep Disorders—3rd edition (ICSD 3) requires that the individual must have a sleep complaint (ie, difficulty initiating sleep, difficulty maintaining sleep, and/or waking up too early), the sleep complaint must occur despite adequate opportunity and circumstances for sleep, and ...

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