eMedicine Specialties > Psychiatry > Geriatric

Sleep Disorder, Geriatric: Follow-up

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

Follow-up

Deterrence/Prevention

  • Sleep disorders in older patients can arise from multiple and diverse factors.
  • Older patients with either short or long sleep duration need thorough evaluation. A careful review of sleep history and sleep hygiene, a comprehensive history of drug use, reports from spouse, sleep logs, and education regarding age-related sleep change should be integral parts of the evaluation of sleep disturbance.
  • Use hypnotics with extreme caution and only for transient sleep disturbances.
  • The most common primary sleep disorders in older people are sleep apnea, periodic limb movements in sleep, or both.
  • In summary, clinicians must reevaluate the approach to treating the widespread sleep complaints of the older population.

Patient Education

Health professionals must continually educate themselves on the topic of sleep disorders in the geriatric population so they can properly educate the patients and caregivers about insomnia. With the aid of clinical studies and various forms of research, a wealth of new information on insomnia is available. These data inform health professionals about the different types of insomnia, available treatments, and good sleep practices. However, if this information is not utilized, it will be a huge disservice to the elderly patient population.

When a person experiences significant and prolonged sleep disturbance, they will generally contact their primary care provider for an evaluation. This evaluation may consist of a medical history review, concomitant medications, physical examination, lab work, and a Mental Status Examination. If the provider is unable to determine the underlying causality of the sleep disturbance, referral to a psychiatrist or sleep specialist may be necessary. At this point, a more in-depth examination is performed to rule out other potential contributing factors and to reach a diagnosis. Determining the causality of the sleep disturbance is imperative to be able to educate patients and caregivers about treatment alternatives.

Individuals should be made aware that obtaining 8 hours of sleep a night is not crucial. Sleep needs are individualized. Although one person may need 10 hours of sleep, another person may only need 5 hours. The amount of sleep we require tends to change with age. If a significant change in amount of sleep occurs, yet there are no disturbances in daily functioning, there shouldn't be a cause for worry. When significant disturbance in daily functioning has occurred, it is time to educate the patient about available treatment options. 

Today, a variety of options are available that do not necessarily include the use of prescription medications.  However, if prescription medications are warranted, there are many to choose from. Certain medications should be avoided in the elderly population (see Medication section for further information). If medication is not preferred, healthcare professionals can educate patients about other alternatives.
 
Experts suggest stimulus control, which means using the bed for only sleep and sex. If people are used to reading or watching television in bed, they are encouraged to leave the bedroom and engage in a relaxing activity elsewhere until they are sleepy and ready to return to bed. Teaching patients muscular relaxation techniques to reduce tension and promote sleep is also useful. Regardless of the underlying causes of insomnia, general habits should be practiced for good sleep. Patients should be instructed to go to bed at the same time, wake up at the same time, and avoid daytime napping, caffeine, heavy meals, nicotine, alcohol, and exercise at bedtime. Another useful tool is to turn the bedroom into an environment that is quiet, dark, cool, and one that ultimately promotes sleep.

Please visit the following Web sites for further education on insomnia. These sites have information on signs and symptoms, causality, preventive measures, complications, treatments, and even current enrolling clinical trials for insomnia.

For other excellent patient education resources, visit eMedicine's Mental Health and Behavior Center and Sleep Disorders Center. Also, see eMedicine's patient education articles Sleep Disorders and Aging, Insomnia, REM Sleep Behavior Disorder, Understanding Insomnia Medications, Periodic Limb Movement Disorder, and Sleeplessness and Circadian Rhythm Disorder.

Miscellaneous

Medicolegal Pitfalls

Failure to diagnose sleep apnea and periodic limb movements in sleep

 


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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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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