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Sleep Problems in the Elderly – Epidemiology and Impact

Sleep complaints are common in older adults 70% experience ≥1 symptom of insomnia 1 Most common symptom is difficulty maintaining sleep 1 35 % of individuals aged ≥65 years report nightly awakenings 2 Insomnia has significant effects on daily lives of elderly

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Sleep Problems in the Elderly – Epidemiology and Impact

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  1. Sleep complaints are common in older adults • 70% experience ≥1 symptom of insomnia1 • Most common symptom is difficulty maintaining sleep1 • 35% of individuals aged ≥65 years report nightly awakenings2 • Insomnia has significant effects on daily lives of elderly • Impairments in problem solving and in working and episodic memory3 • Risk factor for cognitive decline and increases risk of falls4 Sleep Problems in the Elderly – Epidemiology and Impact Jaussent I et al. Am J Geriatr Psychiatry. 2011;19(1):88-97. Ohayon MM. J Psychiatr Res. 2008;43(1):48-54. Fortier-BrochuE et al. Sleep Med Rev. 2012;16(1):83-94. Kamel NS, Gammack JK. Am J Med. 2006;119(6):463-469.

  2. Primary Sleep Disorders in the Elderly REM = rapid eye movement Eckert DJ, MalhotraA. ProcAm Thorac Soc. 2008;5(2):144-153. Sforza E, Roche F. Frontiers in Neurology. 2012;3(87). Lurie A. AdvCardiol. 2011;46:1-42. Hornyak M et al. Sleep Med Rev. 2006;10(3):169-177. Gagnon J et al. Frontiers in Neurology. 2012;3(82):1-5. Sack RL et al. Sleep. 2007;30(11):1484-1501.

  3. Factors that Adversely Influence Sleep Quality in Older Individuals

  4. Changes in sleep schedule1 • Earlier bedtimes and wake-up times • Increased daytime sleep (naps) • Reduced nighttime sleep • Changes in sleep architecture2 • Less sleep efficiency • Lighter sleep • Changes in specific waves during non-REM sleep • Fewer slow waves (<4 Hz and >75 uV) and spindles (11–15 Hz), along with a decrease in their amplitude3,4 Sleep Changes are Normal with Aging Billiard M, ed. Sleep Physiology, Investigations, and Medicine. New York (NY): Kluwer Academic/Plenum Publishers; 2003: 297-332. OhayonMM et al. Sleep. 2004;27(7):1255-1273. Carrier J et al. EurJ Neurosci. 2011;33(4):758-766. Martin N et al. NeurobiolAging. 2012 July 16. [Epub ahead of print]

  5. Caffeine • Menopause • Enhanced sensitivity to stress Contributing Factors to Age-related Sleep Changes

  6. Establish whether the sleep problem is insomnia or due to the normal aging process Define the dominant sleep disturbance Ask about napping habits and daytime sleepiness Question the bed partner, where possible Identify any medical conditions that may contribute to the patient’s disturbed sleep Review your patient’s prescription/nonprescription medications Ask about daily caffeine and alcohol consumption Evaluate the patient’s stress and anxiety level and history of psychiatric and mood disorders Consider referral to a sleep specialist should there be any suspicion of a primary sleep disorder Evaluation

  7. Disproportionately high prescription rate in older adults • Hypnotic use: 3%–21% men and 7%-29% women ≥65 years1,2 • Prescription rates3 • Benzodiazepines: 61% among women and 52% for men • Z-drugs (zolpidem and zopiclone): ~25% for women and men • Elderly more vulnerable to hazards and adverse events1,4 • Melatonin • Results are inconsistent in younger and older patient groups5 Management – Pharmacological • StanerL. Sleep Med Rev. 2010;14(1):35-46. • Maggi S et al. J Am GeriatrSoc. 1998;46(2):161-168. • Jaussent I et al. Am J Geriatr Psychiatry. 2011;19(1):88-97. • Lichstein KL et al. Sleep Med Clin. 2006;1(2):221-229. • Billiard M, ed. Sleep Physiology, Investigations, and Medicine. New York (NY): Kluwer Academic/Plenum Publishers; 2003: 297-332.

  8. Management – Nonpharmacological • Cognitive behavioural therapy • Recommended in the elderly • Sustained improvements in sleep over time1 • Phototherapy2 • Mixed results for insomnia in the elderly Morin CM et al. JAMA. 1999;281(11):991-999. Friedman L et al. J Am Geriatr Soc. 2009;57(3):441-452.

  9. 12 Recommendations for Elderly Patients to Sleep More Soundly • Don’t panic. Age-related sleep changes are normal unless you feel a negative impact on your life. • Discuss sleep difficulties with your doctor and let him/her know if you suspect that you have a primary sleep disorder or if your medical/mental condition interferes with your sleep. • If your night sweats or hot flashes interfere with your sleep, discuss it with your doctor. • Discuss possible adverse events associated with your medications. • Adopt a regular sleep-wake cycle and sleep a sufficient number of hours every night. Older people may have more difficulty recovering following sleep deprivation. • Try to stay away from night-work.

  10. 12 Recommendations for Elderly Patients to Sleep More Soundly (cont.) • Reduce drug and stimulant intake, especially caffeine, nicotine, and alcohol. • Create an optimal environment for sleep, including a quiet and dark room and a comfortable ambient temperature. • Diminish stressful experiences and worries at bedtime as much as possible. • Don’t eat too much or exercise near bedtime. • A daytime walk with correctly timed daylight exposure is useful for insomnia. • Be active, eat well and exercise: good health is strongly associated with good sleep.1 1. Reid KJ et al. Sleep Med. 2010;11(9):934-940.

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