Sleep in Older Adults

Abstract

1 Synopsis Sleep disorders are common in older adults: Approximately 5% of older adults meet criteria for clinically significant insomnia disorders and 20% for sleep apnea syndromes. When considering insomnia symptoms, it is important to distinguish age-appropriate changes in sleep from clinically significant insomnia, with the latter distinguished by the presence of significant daytime symptoms such as fatigue. Evaluation with a sleep diary and screening for comorbid conditions, especially mood disorders, is essential. Non-pharmacologic therapies, such as cognitive-behavioral therapy for insomnia, can be highly effective and have sustained benefit. A broad range of pharmacologic therapies are also available but can have unwanted psychomotor effects. If left untreated, insomnia can be associated with increased risk of depression and significant impairments in quality of life. In regards to sleep apnea, a high index of suspicion is crucial for effective diagnosis because symptoms commonly noted in younger patients, such as obesity or loud snoring, may not be present in older patients. Diagnosis and management is fairly similar across age groups, except that a more nuanced approach to weight loss is warranted in older adults. The increasing use of home-based portable polysomnography and auto-titrating positive-airway pressure therapy can reduce barriers to treatment.

Amyloid burden is associated with self-reported sleep in nondemented late middle-aged adults

“…We chose not to consider diagnosis of sleep disorders in this analysis because obstructive sleep apnea is underdiagnosed (Kapur et al, 2002). We measured self-reported symptoms, however sleep disordered breathing can be present without awareness or endorsement of symptoms (Gooneratne and Vitiello, 2014; Halász et al, 2004). Therefore it is likely that some participants who did not report symptoms of sleep-disordered breathing actually did suffer from the disorder.…”

Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches

“…For example, compared to younger patients with the same AHI, OSA in older patients is associated with less sleepiness [41] and often presents with enuresis, cognitive dysfunction, and mood impairments [42]. Additionally, with increasing age there is increased upper airway collapsibility as measured by pharyngeal critical closing pressure (P crit ), decreased lung volume and ventilatory chemosensitivity.…”

Sleep in the Aging Population

“…15 With respect to insomnia diagnosis, prevalence has been estimated to be around 5%. 46 It is thought that prevalence of insomnia diagnosis increases after 45 years of age but may remain the same in individuals after 65 years of age. 13 There are different theories about why the discrepancy between insomnia symptoms and diagnosis exists.…”