Sleep-related disorders are common in the general adult population.
A common misconception among patients and clinicians is that these disorders are a normal and expected phenomenon of aging. Given the high prevalence, complexity, and health implications associated with sleep disorders in older adults, increasing attention is now being focused on this topic as a multifactorial geriatric syndrome.
While older adults still require as much sleep as younger adults, normal changes in sleep and circadian rhythm with age lead to increased difficulty falling asleep, poorer sleep quality, and more time awake during the night.
Beyond normal physiological alternations, sleep complaints in older adults are due to multiple factors, including poor sleep hygiene, age-related increase in prevalence of chronic medical conditions, and psychosocial changes that accompany aging.
Lifestyle changes common in old age, such as retirement, reduced mobility, and reduced social interaction, can all be sources of sleep disruption.
The most common primary sleep disorders in older adults are insomnia
, obstructive sleep apnea
, restless leg syndrome
, and excessive daytime sleepiness
As many as 57% of older adults complain of significant sleep disruption, 45% have periodic limb movements during sleep, 29% suffer from insomnia, 24% have obstructive sleep apnea, 20% experience excessive daytime sleepiness, 19% complain of early morning awakening, and 12% have symptoms of restless leg syndrome. Individuals with cardiovascular disease, hypertension, cerebrovascular disease, dementia, Parkinson’s disease, and depression are more likely to suffer from sleep disturbance and poor health outcomes.
Patients with symptoms that tend to exacerbate in the evening, such as those with chronic pain, paresthesia, nighttime cough and dyspnea, gastroesophageal reflux, and nocturia, may experience increased difficulty with sleep.
also frequently interfere with sleep if taken in the evening, including diuretics, stimulating agents such as bronchodilators, anti-Parkinsonian agents, and antihypertensives. Sedating medications taken during the day, such as antihistamines and anticholinergics, will contribute to daytime drowsiness and further disrupt the sleep-wake cycle.
play a role as well. Up to 60% of patients report experiencing impaired sleep while in the hospital. For older adults who already suffer from sleep disturbance, hospitalization can cause these conditions to be more acute. Patients in hospitals and long-term care settings are often exposed to noise and light interruptions during the night, which interferes with circadian rhythms. Older adults who are institutionalized also spend extended periods of time in bed and tend to be physically inactive during the day, which can increase restlessness at night.
Adapted from Hartford Institute for Geriatric Nursing. ConsultGeri. Internet. Accessed on September 9, 2016.