Sleep and aging: prevalence of disturbed sleep and treatment considerations in older adults

Abstract

Although sleep patterns change with age, it is the change in the ability to sleep that precipitates sleep complaints in older adults. Waking not rested, waking too early, trouble falling asleep, daytime napping, nocturnal waking, and difficulty initiating or maintaining sleep are among the chief sleep complaints of older adults. The consequences of poor sleep include difficulty sustaining attention, slowed response time, difficulty with memory, and decreased performance. Both medical and psychiatric conditions as well as the medications used to treat them lead to sleep complaints in older adults. Circadian rhythm disturbances and primary sleep disorders may also result in sleep complaints. Appropriate treatment may be dictated by severity of symptoms and concurrent medications. Efficacious pharmacologic interventions are the nonbenzodiazepine hypnotics zolpidem, zaleplon, and eszop-iclone. Two new agents, ramelteon, which was recently approved by the U.S. Food and Drug Administration for use in adults with insomnia, and immediate release and modified release indiplon, which is currently under investigation, have been effective in clinical trials. Cognitive-behavioral therapy alone and in combination with medication have been effective in improving sleep in older adults. Sleep disturbance is not a natural consequence of aging, but rather a treatable condition.