3.10.1 Sleep Disorder in Later Life
Sleep Disorder in Later Life
Sleep disorders are common among older adults, with prevalence rates increasing with age (Foley, Ancoli-Israel, Britz, & Walsh, 2004). Sleep disturbances can significantly affect the quality of life and health outcomes in older adults. This essay will discuss the prevalence, clinical features, differential diagnosis, aetiology, management, and prognosis of sleep disorders in later life.
The International Classification of Sleep Disorders: In 2014, the American Academy of Sleep Medicine (AASM) released the third edition of the Global Categorization of Sleep Disorders (GCSD-3).
| Sleep Disorder Category | Short Description |
| Insomnias | Difficulty falling or staying asleep, leading to impaired daytime functioning. |
| Sleep-related respiratory disorders | Sleep disruptions are caused by breathing difficulties, such as sleep apnea or snoring. |
| Central disorders of excessive sleepiness | Excessive daytime sleepiness, such as hypersomnolence disorder or narcolepsy. |
| Circadian rhythm sleep-wake disorders | Sleep disturbances are due to disruptions in the body’s internal clock, affecting sleep timing. |
| Parasomnias | Abnormal behaviours, movements, or perceptions during sleep, like sleepwalking or night terrors. |
| Sleep-related movement disorders | Involuntary movements during sleep, such as restless leg syndrome or periodic limb movement disorder. |
| Other sleep disorders | Sleep disorders that do not fit into the other categories, or have unique or rare causes. |
Prevalence:
The prevalence of sleep disorders is high among older adults. A study found that about 50% of older adults report difficulties with sleep (National Sleep Foundation, 2018). Insomnia, sleep apnea, restless leg syndrome, and periodic limb movement disorder are some of the common sleep disorders in older adults (Ohayon et al., 2001).
Clinical Features:
The clinical features of sleep disorders in older adults may include difficulty falling asleep, difficulty staying asleep, early morning awakening, snoring, apnea, and excessive daytime sleepiness (Foley et al., 2004). Sleep disorders can also result in cognitive impairments, depression, anxiety, and an increased risk of falls (Ancoli-Israel et al., 2008).
Differential Diagnosis:
Sleep disorders can be misdiagnosed as depression, dementia, or other medical conditions, and it is important to perform a thorough differential diagnosis to accurately diagnose the sleep disorder (Ancoli-Israel et al., 2008).
Aetiology:
There are several factors that can contribute to the development of sleep disorders in older adults, including age-related changes in circadian rhythms, medical comorbidities, medications, lifestyle factors, and psychological factors (Foley et al., 2004). Age-related changes in the circadian rhythm can result in decreased sleep efficiency, leading to increased wakefulness during the night and excessive daytime sleepiness (Foley et al., 2004). Medical conditions such as chronic pain, respiratory disorders, and neurological disorders can also disrupt sleep in older adults (Ancoli-Israel et al., 2008).
Management:
The management of sleep disorders in older adults may include pharmacological and non-pharmacological interventions. Pharmacological interventions include sedative-hypnotic medications such as benzodiazepines and non-benzodiazepine hypnotics (Ancoli-Israel et al., 2008). However, these medications have potential side effects and may be associated with an increased risk of falls and cognitive impairments (Ancoli-Israel et al., 2008). Non-pharmacological interventions such as cognitive-behavioural therapy for insomnia, sleep hygiene education, and light therapy have also been found to be effective in treating sleep disorders in older adults (Foley et al., 2004).
Prognosis:
The prognosis of sleep disorders in older adults depends on the underlying cause and the effectiveness of the treatment. With appropriate treatment, sleep disorders in older adults can be effectively managed, leading to improved quality of life and health outcomes (Foley et al., 2004).
In conclusion, sleep disorders are common among older adults and can have a significant impact on their quality of life and health outcomes. It is important to perform a thorough differential diagnosis to accurately diagnose the sleep disorder and to consider non-pharmacological interventions when possible. With appropriate treatment, sleep disorders in older adults can be effectively managed.
Reference:
- Ancoli-Israel, S., Ayalon, L., & Salzman, C. (2008). Sleep in the elderly: normal variations and common sleep disorders. Harvard Review of Psychiatry, 16(5), 279-286.
- Foley, D. J., Ancoli-Israel, S., Britz, P., & Walsh, J. (2004). Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. Journal of Psych