Over the past several years, much research has focused on normal age-related changes in sleep as a function of aging. However, in addition to these common changes, aging is also associated with an increase in sleep complaints and chronic sleep disturbances, resulting in poorer daytime functioning and increases in health care usage. This chapter reviews sleep and sleep disorders in order adults, including information on presentation, etiology, pathophysiology, evaluation, and management of sleep-related issues.
Approximately 50% of community-dwelling elderly persons complain of some form of sleep difficulty. Subjective and objective reports show that when compared to their younger counterparts, older adults take longer to fall asleep, have lower sleep efficiency (defined as the amount of sleep given the amount of time in bed), have more nighttime awakenings, wake up earlier than they would like in the morning, and require more daytime naps (Table 55-1). Polysomnographic (PSG) sleep recordings have confirmed these findings, showing that despite older adults spending more time in bed, they have a harder time getting to sleep, get overall less sleep, and have more nighttime awakenings, resulting in reduced sleep efficiency. It is not surprising then that Multiple Sleep Latency Tests (MSLTs), objective measures assessing daytime sleepiness via PSG-recoded napping opportunities, indicate that older adults are significantly sleepier throughout the day than are younger adults.
Table 55-1 Sleep Complaints of Older Adults ||Download (.pdf)
Table 55-1 Sleep Complaints of Older Adults
Spend too much time in bed
Spend less time asleep
Increase in number of awakenings
Increase in time to fall asleep
Less satisfied with sleep
Significant increase in daytime sleepiness
Napping more often and longer
One central question raised by researchers in the field is whether these age-related changes represent a decrease in the need for sleep or a decrease in the ability to sleep. Although this question is still being debated and there is no clear consensus on whether there is a reduced need for sleep, there is clearly a reduced ability to sleep in this population. As discussed in this chapter, sleep difficulties in this population are associated with several factors, including specific sleep disorders, changes in the endogenous circadian clock, medical and psychiatric illness, and medication intake (Table 55-2). Recent developments in sleep research have identified several effective treatments for many of these sleep difficulties. Given the high prevalence of sleep complaints and sleep disorders in this population and the link between insufficient sleep and heightened levels of morbidity and mortality, there is a clear need for increased awareness, assessment, and treatment of these sleep disturbances.
Table 55-2 Factors Contributing to Sleep Disturbances in Older Adults ||Download (.pdf)
Table 55-2 Factors Contributing to Sleep Disturbances in Older Adults
Circadian rhythm changes
Primary sleep disturbances (e.g. SDB, PLMS)
Medical illness (e.g., hyperthyroidism, arthritis)
Psychiatric illness (e.g., depression, anxiety disorders)