Sleep in the elderly. What is normal?

Sleep is a basic biologic function that changes with normal aging and in many pathologic states. Some of the changes with aging are so profound that it is difficult to separate normal aging from disease. The problem is made worse by the difficulty of recognizing many common sleep disorders. Complaints of poor sleep or daytime somnolence are common in all adults but are more prevalent in elderly individuals. This article addresses normal sleep and the changes expected with aging, and reviews the more common sleep diseases in the elderly population, such as insomnia, sleep-disordered breathing, periodic limb movements of sleep, and the rapid eye movement sleep-behavior disorder.

[1]  M. Mahowald,et al.  REM sleep behaviour disorder: an update on a series of 96 patients and a review of the world literature , 1993 .

[2]  H. Wright,et al.  The effect of evening bright light in delaying the circadian rhythms and lengthening the sleep of early morning awakening insomniacs. , 1993, Sleep.

[3]  C. M. Lum,et al.  Sleep-related injury in the elderly--an epidemiological study in Hong Kong. , 2000, Sleep.

[4]  F. Schmitt,et al.  Sleep-disordered breathing in the healthy elderly. Clinically significant? , 1992, Chest.

[5]  A. King,et al.  Sleep complaints in older women who are family caregivers. , 1999, The journals of gerontology. Series B, Psychological sciences and social sciences.

[6]  K. Morgan Daytime activity and risk factors for late‐life insomnia , 2003, Journal of sleep research.

[7]  C. Morin,et al.  Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. , 2004, The American journal of psychiatry.

[8]  E. Lindberg,et al.  Snoring and sleep apnea. A study of evolution and consequences in a male population. Minireview based on a doctoral thesis. , 1998, Upsala journal of medical sciences.

[9]  M. Partinen,et al.  Sleep apnea and mortality in an aged cohort. , 1988, American journal of public health.

[10]  U. Keil,et al.  Prevalence and risk factors of RLS in an elderly population , 2000, Neurology.

[11]  E. F. Colecchia,et al.  Daily social and physical activity increases slow-wave sleep and daytime neuropsychological performance in the elderly. , 2000, Sleep.

[12]  M. Vitiello,et al.  Sleep complaints cosegregate with illness in older adults: clinical research informed by and informing epidemiological studies of sleep. , 2002, Journal of psychosomatic research.

[13]  D J Foley,et al.  Sleep complaints among elderly persons: an epidemiologic study of three communities. , 1995, Sleep.

[14]  N. Saunders,et al.  Four-year follow-up of mortality and sleep-related respiratory disturbance in non-demented seniors. , 1995, Sleep.

[15]  B. Boeve,et al.  Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients. , 2003, Sleep medicine.

[16]  Daniel J Buysse,et al.  Effects of afternoon "siesta" naps on sleep, alertness, performance, and circadian rhythms in the elderly. , 2001, Sleep.

[17]  G. Plazzi,et al.  REM sleep behavior disorders in multiple system atrophy , 1997, Neurology.

[18]  B. Leiby,et al.  Association of hypertension and sleep-disordered breathing. , 2000, Archives of internal medicine.

[19]  J. Stessman,et al.  The siesta in the elderly: risk factor for mortality? , 1999, Archives of internal medicine.

[20]  M. Linden,et al.  Differences in self-reported sleep complaints in elderly persons living in the community who do or do not take sleep medication. , 1998, The Journal of clinical psychiatry.

[21]  T Penzel,et al.  Sleep-related breathing disorder is an independent risk factor for systemic hypertension. , 1999, American journal of respiratory and critical care medicine.

[22]  M. Ohayon,et al.  Violent behavior during sleep. , 1997, The Journal of clinical psychiatry.

[23]  M. Ohayon,et al.  Terry: Violent Behavior During Sleep , 1997 .

[24]  C. Sullivan,et al.  Home treatment of obstructive sleep apnoea with continuous positive airway pressure applied through a nose-mask. , 1984, Bulletin europeen de physiopathologie respiratoire.

[25]  Terry Young,et al.  Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. , 2003, American journal of respiratory and critical care medicine.

[26]  C. Sullivan,et al.  Alcohol, snoring and sleep apnea. , 1982, Journal of neurology, neurosurgery, and psychiatry.

[27]  R. Godbout,et al.  The Treatment of the Restless Legs Syndrome with Clonazepam: A Prospective Controlled Study , 1986, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[28]  P. Sheedy,et al.  Fast-computed tomography evaluation of age-related changes in upper airway structure and function in normal men. , 1992, The American review of respiratory disease.

[29]  R. Petersen,et al.  REM sleep behavior disorder and dementia , 1999, Neurology.

[30]  B. Boeve,et al.  REM Sleep Behavior Disorder in Parkinson’s Disease and Dementia with Lewy Bodies , 2004, Journal of geriatric psychiatry and neurology.

[31]  D. Kripke,et al.  Natural history of sleep disordered breathing in community dwelling elderly. , 1993, Sleep.

[32]  S. Ancoli-Israel Epidemiology of sleep disorders. , 1989, Clinics in geriatric medicine.

[33]  T. Sand,et al.  The prevalence of delayed and advanced sleep phase syndromes , 1993, Journal of sleep research.

[34]  B. Boeve,et al.  Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. , 2000, Brain : a journal of neurology.

[35]  W. B. Webb,et al.  A modified method for scoring slow wave sleep of older subjects. , 1982, Sleep.

[36]  C. Morin,et al.  Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. , 1999, JAMA.

[37]  G. Ferretti,et al.  Relationship between body mass index, age and upper airway measurements in snorers and sleep apnoea patients. , 1996, The European respiratory journal.

[38]  S. Redline,et al.  The effects of age, sex, ethnicity, and sleep-disordered breathing on sleep architecture. , 2004, Archives of internal medicine.

[39]  C. Czeisler,et al.  Association of sleep-wake habits in older people with changes in output of circadian pacemaker , 1992, The Lancet.

[40]  E. van Cauter,et al.  Age-related changes in slow wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men. , 2000, JAMA.

[41]  M. Schluchter,et al.  Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. , 2003, JAMA.

[42]  J. Straand,et al.  General practitioners' prescribing patterns of benzodiazepine hypnotics: Are elderly patients at particular risk for overprescribing? , 1997 .

[43]  M. Thorpy,et al.  Treatment of chronic insomnia by restriction of time in bed. , 1987, Sleep.

[44]  P. Enright,et al.  Correlates of daytime sleepiness in 4578 elderly persons: the Cardiovascular Health Study. , 1998, Sleep.

[45]  D. Kripke,et al.  Morbidity, mortality and sleep-disordered breathing in community dwelling elderly. , 1996, Sleep.

[46]  Daniel J Buysse,et al.  Comparison of sleep-disordered breathing among healthy elderly in the seventh, eighth, and ninth decades of life. , 1990, Sleep.

[47]  C. Guilleminault,et al.  Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. , 2004, Sleep.

[48]  D. Kripke,et al.  Delayed and advanced sleep phase symptoms. , 2002, The Israel journal of psychiatry and related sciences.

[49]  S D Ross,et al.  Systematic review and meta-analysis of the literature regarding the diagnosis of sleep apnea. , 2000, Sleep.

[50]  J. Avorn,et al.  Zolpidem Use and Hip Fractures in Older People , 2001, Journal of the American Geriatrics Society.

[51]  Terry Young,et al.  Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. , 2002, Archives of internal medicine.

[52]  Bonnie K. Lind,et al.  Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Community-Based Study , 2000 .

[53]  D. G. Lamb,et al.  Sleep-disordered breathing in healthy aged persons: one-year follow-up of daytime sequelae. , 1989, Sleep.

[54]  M W Mahowald,et al.  Rapid Eye Movement Sleep Behavior Disorder: A Treatable Parasomnia Affecting Older Adults , 1987 .

[55]  S. Campbell,et al.  Failure of Timed Bright Light Exposure to Alleviate Age‐Related Sleep Maintenance Insomnia , 2002, Journal of the American Geriatrics Society.

[56]  Phyllis C Zee,et al.  Morning or evening activity improves neuropsychological performance and subjective sleep quality in older adults. , 2004, Sleep.

[57]  E. Simonsick,et al.  The Impact of Insomnia on Cognitive Functioning in Older Adults , 2001, Journal of the American Geriatrics Society.

[58]  S. Ancoli-Israel,et al.  Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. , 2004, Journal of psychosomatic research.

[59]  D. Kripke,et al.  Sleep-disordered breathing in community-dwelling elderly. , 1991, Sleep.

[60]  J. Yesavage,et al.  Preliminary communication: intellectual deficit and sleep-related respiratory disturbance in the elderly. , 1985, Sleep.

[61]  R. Cumming,et al.  Benzodiazepines and Risk of Hip Fractures in Older People , 2003, CNS drugs.

[62]  A. Pack,et al.  Clinical significance of sleep apnea in the elderly. , 1987, The American review of respiratory disease.

[63]  T. Young,et al.  The occurrence of sleep-disordered breathing among middle-aged adults. , 1993, The New England journal of medicine.

[64]  D Dawson,et al.  Alleviation of Sleep Maintenance Insomnia with Timed Exposure to Bright Light , 1993, Journal of the American Geriatrics Society.

[65]  S. Campbell,et al.  Effects of a Nap on Nighttime Sleep and Waking Function in Older Subjects , 2005, Journal of the American Geriatrics Society.

[66]  A. King,et al.  Moderate-Intensity Exercise and Self-rated Quality of Sleep in Older Adults: A Randomized Controlled Trial , 1997 .

[67]  Daniel J Buysse,et al.  Sleep and morningness‐eveningness in the ‘middle’ years of life (20–59y) , 1997, Journal of sleep research.

[68]  H. Moldofsky,et al.  Treatment of a case of advanced sleep phase syndrome by phase advance chronotherapy. , 1986, Sleep.

[69]  J. Emeriau,et al.  Is sleep apnea syndrome in the elderly a specific entity? , 1996, Sleep.

[70]  M. Kryger,et al.  Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. , 1988, Chest.

[71]  S. Ancoli-Israel,et al.  Zaleplon, A Novel Nonbenzodiazepine Hypnotic, Effectively Treats Insomnia in Elderly Patients Without Causing Rebound Effects. , 1999, Primary care companion to the Journal of clinical psychiatry.

[72]  J. Baskett,et al.  Melatonin in older people with age-related sleep maintenance problems: a comparison with age matched normal sleepers. , 2001, Sleep.