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Review
. 2014 Aug;30(3):591-627.
doi: 10.1016/j.cger.2014.04.007. Epub 2014 Jun 12.

Sleep in older adults: normative changes, sleep disorders, and treatment options

Nalaka S Gooneratne  1 , Michael V Vitiello  2
Affiliations
Review

Sleep in older adults: normative changes, sleep disorders, and treatment options

Nalaka S Gooneratne et al. Clin Geriatr Med. 2014 Aug.

Abstract

Approximately 5% of older adults meet criteria for clinically significant insomnia disorders and 20% for sleep apnea syndromes. It is important to distinguish age-appropriate changes in sleep from clinically significant insomnia, with the latter having associated daytime impairments. Non-pharmacologic therapies, such as cognitive-behavioral therapy for insomnia, can be highly effective with sustained benefit. Pharmacologic therapies are also available, but may be associated with psychomotor effects. A high index of suspicion is crucial for effective diagnosis of sleep apnea because symptoms commonly noted in younger patients, such as obesity or loud snoring, may not be present in older patients.

Keywords: Cognitive-behavioral therapy (CBT); Dementia; Depression; Insomnia; Polysomnography; Positive airway pressure; Sedative-hypnotic; Sleep apnea.

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Conflict of interest statement

Conflicts of Interest: There are no author conflicts of interest related to this manuscript

Figures

Figure 1
Figure 1
Adjustment of perception of “acceptable” health with aging. Black line: Acceptability of severe impairment with usual activities. Grey line: Acceptability of extreme pain or discomfort. Data from Brouwer WB, van Exel NJ, Stolk EA. Acceptability of less than perfect health states. Soc Sci Med. Jan 2005;60(2):237–246.
Figure 2
Figure 2
Diagnostic and treatment approach for sleep disorders in older adults. Adapted from: Bloom HG, Ahmed I, Alessi CA, et al. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc. May 2009;57(5):761–789.
Figure 3
Figure 3
This figure displays the three factor model of insomnia. The dashed line indicates the threshold above which clinically significant insomnia occurs. Data From: Spielman AJ, Caruso LS, Glovinsky PB. A behavioral perspective on insomnia treatment. Psychiatr Clin North Am. Dec 1987;10(4):541–553.
See this image and copyright information in PMC

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