Insomnia in the Elderly: A Review

Overview

Journal J Clin Sleep Med

Specialties Neurology
Psychiatry

Date 2018 Jun 2

PMID 29852897

Citations 178

Authors

Dhaval Patel

Joel Steinberg

Pragnesh Patel

Affiliations

Soon will be listed here.

Abstract

Background: Insomnia remains one of the most common sleep disorders encountered in the geriatric clinic population, frequently characterized by the subjective complaint of difficulty falling or maintaining sleep, or nonrestorative sleep, producing significant daytime symptoms including difficulty concentrating and mood disturbances.

Methods: A search of the literature was conducted to review the epidemiology, definition, and age-related changes in sleep, as well as factors contributing to late-life insomnia and scales utilized for the assessment of insomnia in older people. The aim is to summarize recent diagnostic guidelines and both nonpharmacological and pharmacological strategies for the management of insomnia in the older population.

Results: Insomnia remains a clinical diagnosis. There are several demographic, psychosocial, biologic, and behavioral factors that can contribute to late-life insomnia. Older adults are at higher risk for the medical and psychiatric effects of insomnia.

Conclusions: The most important aspect in evaluation of insomnia is detailed history taking and thorough physical examination. Nonpharmacological treatment options have favorable and enduring benefits compared to pharmacological therapy.

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References

Jansson-Frojmark M, Lindblom K . A bidirectional relationship between anxiety and depression, and insomnia? A prospective study in the general population. J Psychosom Res. 2008; 64(4):443-9. DOI: 10.1016/j.jpsychores.2007.10.016. View

Buysse D, Germain A, Moul D, Franzen P, Brar L, Fletcher M . Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011; 171(10):887-95. PMC: 3101289. DOI: 10.1001/archinternmed.2010.535. View

McCurry S, Logsdon R, Teri L, Vitiello M . Evidence-based psychological treatments for insomnia in older adults. Psychol Aging. 2007; 22(1):18-27. DOI: 10.1037/0882-7974.22.1.18. View

Buysse D, Ancoli-Israel S, Edinger J, Lichstein K, Morin C . Recommendations for a standard research assessment of insomnia. Sleep. 2006; 29(9):1155-73. DOI: 10.1093/sleep/29.9.1155. View

Shochat , Loredo . Sleep Disorders in the Elderly. Curr Treat Options Neurol. 2000; 3(1):19-36. DOI: 10.1007/s11940-001-0021-x. View

Hillman D, Murphy A, Pezzullo L . The economic cost of sleep disorders. Sleep. 2006; 29(3):299-305. DOI: 10.1093/sleep/29.3.299. View

Troxel W, Buysse D, Matthews K, Kip K, Strollo P, Hall M . Sleep symptoms predict the development of the metabolic syndrome. Sleep. 2010; 33(12):1633-40. PMC: 2982733. DOI: 10.1093/sleep/33.12.1633. View

Benloucif S, Orbeta L, Ortiz R, Janssen I, Finkel S, Bleiberg J . Morning or evening activity improves neuropsychological performance and subjective sleep quality in older adults. Sleep. 2005; 27(8):1542-51. DOI: 10.1093/sleep/27.8.1542. View

Sexton C, Storsve A, Walhovd K, Johansen-Berg H, Fjell A . Poor sleep quality is associated with increased cortical atrophy in community-dwelling adults. Neurology. 2014; 83(11):967-73. PMC: 4162301. DOI: 10.1212/WNL.0000000000000774. View

10.

Morin C, Vallieres A, Guay B, Ivers H, Savard J, Merette C . Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009; 301(19):2005-15. PMC: 3050624. DOI: 10.1001/jama.2009.682. View

11.

Bradley T, Logan A, Kimoff R, Series F, Morrison D, Ferguson K . Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med. 2005; 353(19):2025-33. DOI: 10.1056/NEJMoa051001. View

12.

Farkas R, Unger E, Temple R . Zolpidem and driving impairment--identifying persons at risk. N Engl J Med. 2013; 369(8):689-91. DOI: 10.1056/NEJMp1307972. View

13.

Altena E, Vrenken H, van der Werf Y, van den Heuvel O, van Someren E . Reduced orbitofrontal and parietal gray matter in chronic insomnia: a voxel-based morphometric study. Biol Psychiatry. 2009; 67(2):182-5. DOI: 10.1016/j.biopsych.2009.08.003. View

14.

Krystal A, Lankford A, Heith Durrence H, Ludington E, Jochelson P, Rogowski R . Efficacy and safety of doxepin 3 and 6 mg in a 35-day sleep laboratory trial in adults with chronic primary insomnia. Sleep. 2011; 34(10):1433-42. PMC: 3174845. DOI: 10.5665/SLEEP.1294. View

15.

Buysse D, Reynolds 3rd C, Monk T, BERMAN S, Kupfer D . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4. View

16.

Ohayon M . Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2003; 6(2):97-111. DOI: 10.1053/smrv.2002.0186. View

17.

Riemann D, Perlis M . The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Med Rev. 2009; 13(3):205-14. DOI: 10.1016/j.smrv.2008.06.001. View

18.

Vgontzas A, Liao D, Bixler E, Chrousos G, Vela-Bueno A . Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep. 2009; 32(4):491-7. PMC: 2663863. DOI: 10.1093/sleep/32.4.491. View

19.

. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015; 63(11):2227-46. DOI: 10.1111/jgs.13702. View

20.

Riemersma-van der Lek R, Swaab D, Twisk J, Hol E, Hoogendijk W, van Someren E . Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: a randomized controlled trial. JAMA. 2008; 299(22):2642-55. DOI: 10.1001/jama.299.22.2642. View