Sleep disorder in later life

Question 1

Sleep disorders

Answer 1

• common in the elderly

- but not a normal part of ageing

Question 2

Sleep changes in the elderly

Answer 2

• reduced total sleep time
• increased daytime napping
• increased nighttime arousals and recalled awakenings
• longer sleep latency
• increased stage 1 and 2 sleep
• reduced slow wave sleep
• shorter REM latency
• reduced REM sleep

Question 3

Insomnia

Answer 3

-associated with depression, heart disease, pain and memory problems

Question 4

Common sleep disorders

Answer 4

• isnomnia
• circadian rhythm disorders
• restless legs syndrome
• REM sleep behaviour disorder
• obstructive sleep apnoea

Question 5

Drug induced sleep disorders

Answer 5

• TCAs can reduce REM sleep
• cholinesterase inhibitors increase REM sleep
• Ascending reticular activating system is involved

Question 6

Dopamine deficiency

Answer 6

• leads to sleep related movement disorders e.g restless legs syndrome and periodic limb movement disorder
• RAS affected

Question 7

SSRIs

Answer 7

-increase slow wave sleep but reduce REM

Question 8

Insomnia

Answer 8

• includes difficulties in initiating and maintaining sleep
• commonest sleep disorder in old age
• non-restorative sleep
• need to persist for over 2 weeks and contribute to impaired functioning before interventions can be prescribed
• transient symptoms are common in older adults (W>M)

Question 9

Psychiatric disorders and insomnia

Answer 9

-mania
-depression
-OCD
-panic disorder
-PTSD
common in neurodegenerative disorders

Question 10

Treatment of insomnia

Answer 10

• treat underlying cause and advise re driving (No need to tell DVLA)
• sleep hygiene advice
• short acting benzos, Z drugs, melatonin agonists
• sedating antidepressants

Question 11

Symptoms lasting over 2 weeks

Answer 11

-refer to IAPT for CBT or other therapy

Question 12

Circadian rhythm disorder

Answer 12

• common in nursing homes due to inadequate light exposure
• degeneration of the SCN contributes
• early morning wakening is very common- advanced sleep phase syndrome
• bright light therapy and early evening administration of melatonin

Question 13

Chronotherapy

Answer 13

-advancing sleep times gradually each day

Question 14

Sleep related breathing disorders

Answer 14

• include sleep hypopnea and apnoea
• need bed partner history
• high morbidity and mortality
• polysomnography is used
• treated with weight reduction, CPAP uvulopalatopharyngoplasty (UPPP), oral appliances

Question 15

REM behaviour disorder

Answer 15

• parasomnia
• lack of normal muscle atonia during REM sleep
• enactment of dream activity
• high prevalence in PD, MSA and LBD
• can predate dementia
• safe sleeping environment
• clonazapam
• melatonin and pramipexole sometimes used