eMedicine Specialties > Psychiatry > Geriatric

Sleep Disorder, Geriatric: Differential Diagnoses & Workup

Author: Guy E Brannon, MD, Associate Clinical Professor of Psychiatry, Louisiana State University Health Sciences Center; Director, Adult Psychiatry Unit, Chemical Dependency Unit, Clinical Research, Brentwood Behavior Health Company
Coauthor(s): Subir Vij, MD, MPH, Assistant Professor, Department of Medicine, Eastern Virginia Medical School; Medical Director, Portsmouth Community Health Center; Angela Gentili, MD, Director of Geriatrics Fellowship Program, Associate Professor, Department of Internal Medicine, Virginia Commonwealth University Health System and McGuire Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Aug 3, 2009

Differential Diagnoses

Other Problems to Be Considered

Psychiatric disorders

CNS disorders Sleep-induced respiratory impairment Other medical disorders Movement disorders Drugs

Circadian rhythm sleep disorders

Many abnormalities of the sleep-wake cycle manifest as sleep-wake disorders. These conditions include the following:

  • Jet lag: A study performed on airline pilots operating on transmeridian routes found that the older the pilot, the greater the cumulative sleep loss.
  • Acute and chronic shift-work insomnia
  • Delayed sleep-phase syndromes
  • Advanced sleep-phase syndromes
  • Non–24-hour circadian rhythms
  • Disorganized circadian rhythms
Adjustment sleep disorder (transient insomnia)

Psychophysiological insomnia

This is associated with acute emotional conflicts or reactions and is transient in nature. If it is associated with frustration to fall asleep, thereby resulting in arousal, it can be persistent in nature.

Environmental sleep disorders

Workup

Laboratory Studies

Ferritin levels of less than 50 ng/mL were present in elderly patients with restless legs syndrome.

Other Tests

After a detailed history, a clinician may find it necessary to refer the patient to a sleep disorders center for evaluation of sleep apnea.

  • A full-night polysomnogram records brain waves, using electroencephalography (EEG); eye movement, using electrooculography (EOG); chin muscle tension and leg movements, using electromyography (EMG); heart rate, using ECG; and blood oxygen saturation levels, using pulse oximetry.
  • Portable recorders are also used as screening tools. These devices are placed on patients in the afternoon, and patients are then sent home to sleep on their beds at night. These systems are more convenient and less expensive than a laboratory polysomnogram.

More on Sleep Disorder, Geriatric

Overview: Sleep Disorder, Geriatric
Differential Diagnoses & Workup: Sleep Disorder, Geriatric
Treatment & Medication: Sleep Disorder, Geriatric
Follow-up: Sleep Disorder, Geriatric
References
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References

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Further Reading

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Keywords

sleep disturbances, sleep problems, sleep changes, sleep disorders, insomnia, sleep apnea, SA, hypersomnolence, sleep latency, sleep efficiency, periodic limb-movement disorder, PLMD, periodic limb-movement syndrome, periodic limb movement syndrome, periodic limb movements in sleep, PLMS, nocturnal myoclonus, rapid eye movement, REM, non-REM, paradoxical desynchronized sleep, slow-wave sleep, SWS, conjugate gaze, dreams, dreaming, nocturnal penile tumescence, NPT, electrooculography, EOG, circadian rhythms

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Contributor Information and Disclosures

Author

Guy E Brannon, MD, Associate Clinical Professor of Psychiatry, Louisiana State University Health Sciences Center; Director, Adult Psychiatry Unit, Chemical Dependency Unit, Clinical Research, Brentwood Behavior Health Company
Guy E Brannon, MD is a member of the following medical societies: American Medical Association, American Medical Writers Association, American Psychiatric Association, American Society of Addiction Medicine, Association of Clinical Research Professionals, Louisiana State Medical Society, and Southern Medical Association
Disclosure: AstraZeneca Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Janssen Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Coauthor(s)

Subir Vij, MD, MPH, Assistant Professor, Department of Medicine, Eastern Virginia Medical School; Medical Director, Portsmouth Community Health Center
Subir Vij, MD, MPH is a member of the following medical societies: American College of Physician Executives, American College of Physicians, and American Medical Association
Disclosure: Nothing to disclose.

Angela Gentili, MD, Director of Geriatrics Fellowship Program, Associate Professor, Department of Internal Medicine, Virginia Commonwealth University Health System and McGuire Veterans Affairs Medical Center
Angela Gentili, MD is a member of the following medical societies: American Geriatrics Society
Disclosure: Nothing to disclose.

Medical Editor

Sarah C Aronson, MD, Associate Professor, Departments of Psychiatry and Medicine, Case Western Reserve School of Medicine/University Hospitals of Cleveland
Sarah C Aronson, MD is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Iqbal Ahmed, MBBS, Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii
Iqbal Ahmed, MBBS is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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