Insomnia (primary) in older people.
David Geffen School of Medicine at UCLA, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, USA. Clinical evidence
Up to 40% of older adults have insomnia, with difficulty getting to sleep, early waking, or feeling unrefreshed on waking. The prevalence of insomnia increases with age. Other risk factors include psychological factors, stress, daytime napping, and hyperarousal. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-drug treatments for insomnia in older people? What are the effects of drug treatments for insomnia in older people? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 34 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antidepressants, benzodiazepines, cognitive behavioural therapy (CBT), diphenhydramine, exercise programmes, timed exposure to bright light, zaleplon, zolpidem, and zopiclone.
Available from: Roxanne Sterniczuk
- "Nevertheless, roughly 10% to 16% of community-dwelling adults over 65 have been noted to report chronic (primary) insomnia in the absence of an obvious precipitant.36,37 Age-associated changes in circadian organization, a decline in health due to aging, and hyperarousal from abnormalities to the hypothalamic-pituitary-adrenal axis appear to be contributing factors.38,39 Other biologically associated causes, such as conditions like “insomnia with short sleep duration”, may play a role as well.40 "
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ABSTRACT: Maintaining a stable and adequate sleeping pattern is associated with good health and disease prevention. As a restorative process, sleep is important for supporting immune function and aiding the body in healing and recovery. Aging is associated with characteristic changes to sleep quantity and quality, which make it more difficult to adjust sleep–wake rhythms to changing environmental conditions. Sleep disturbance and abnormal sleep–wake cycles are commonly reported in seriously ill older patients in the intensive care unit (ICU). A combination of intrinsic and extrinsic factors appears to contribute to these disruptions. Little is known regarding the effect that sleep disturbance has on health status in the oldest of old (80+), a group, who with diminishing physiological reserve and increasing prevalence of frailty, is at a greater risk of adverse health outcomes, such as cognitive decline and mortality. Here we review how sleep is altered in the ICU, with particular attention to older patients, especially those aged 80 years. Further work is required to understand what impact sleep disturbance has on frailty levels and poor outcomes in older critically ill patients.
Clinical Interventions in Aging 06/2014; 9:969. DOI:10.2147/CIA.S59927 · 2.08 Impact Factor
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ABSTRACT: Approximately 5% of older adults meet criteria for clinically significant insomnia disorders and 20% for sleep apnea syndromes. It is important to distinguish age-appropriate changes in sleep from clinically significant insomnia, with the latter having associated daytime impairments. Non-pharmacologic therapies, such as cognitive-behavioral therapy for insomnia, can be highly effective with sustained benefit. Pharmacologic therapies are also available, but may be associated with psychomotor effects. A high index of suspicion is crucial for effective diagnosis of sleep apnea because symptoms commonly noted in younger patients, such as obesity or loud snoring, may not be present in older patients.
Clinics in Geriatric Medicine 08/2014; 30(3). DOI:10.1016/j.cger.2014.04.007 · 3.19 Impact Factor
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ABSTRACT: Exercise has been found to be associated with improved sleep quality. However, most of the evidence is based on resistance exercise, walking, or gym-based aerobic activity.
This study aimed to examine the effects of an 8-week aquatic exercise program on objectively measured sleep parameters among older adults with mild sleep impairment.
A total of 67 eligible older adults with sleep impairment were selected and randomized to exercise and control groups, and 63 participants completed the study. The program involved 2 × 60-min sessions of aquatic exercise for 8 weeks. Participants wore wrist actigraphs to assess seven parameters of sleep for 1 week before and after the intervention. Mixed-design analysis of variance (ANOVA) was used to assess the differences between groups in each of the sleep parameters.
No significant group differences on demographic variables, life satisfaction, percentage of body fat, fitness, seated blood pressure, and any parameter of sleep were found at baseline. Significant group × time interaction effects were found in sleep onset latency, F(1,58) = 6.921, p = .011, partial eta squared = .011, and in sleep efficiency, F(1, 61) = 16.909, p < 0.001, partial eta squared = .217. The exercise group reported significantly less time on sleep onset latency (mean difference = 7.9 min) and greater sleep efficiency (mean difference = 5.9 %) than the control group at posttest. There was no significant difference between groups in change of total sleep time, wake after sleep onset, activity counts, or number and length of awakenings.
An 8-week aquatic exercise has significant benefits on some sleep parameters, including less time for sleep onset latency and better sleep efficiency in older adults with mild sleep impairment.
International Journal of Behavioral Medicine 05/2015; DOI:10.1007/s12529-015-9492-0 · 2.63 Impact Factor
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