Sleep disruption in older adults: Harmful and by no means inevitable, it should be assessed for and treated

University of Arkansas for Medical Sciences College of Nursing in Little Rock, USA.
The American Journal of Nursing (Impact Factor: 1.3). 06/2007; 107(5):40-9; quiz 50. DOI: 10.1097/01.NAJ.0000268167.48606.74
Source: PubMed


Insomnia is not a normal part of aging, but nighttime sleep in older adults is often disrupted, leading to excessive daytime sleepiness and other physical, psychological, and cognitive changes that affect overall health. Even so, clinicians often pay little attention to sleep in this population. The sleep of older adults tends to be less deep than that of younger people, and coexisting conditions and treatment effects can more easily disrupt sleep. This article reviews the current literature on sleep disruption in older adults and suggests ways that nurses can apply the information in intervening to improve sleep in their older patients.

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    • "Age-related changes in the SWS stage as well as decreased sleep duration could also contribute to the ability to tolerate sleep-deprived condition in older adults [7] [41]. Previous studies with PSG demonstrated a strong relationship between SWS and arousal during sleep, which results in reduced sleep efficiency and continuity [41]. Declined sleep duration and continuity in older adults slow the rate at which sleep needs build up during prolonged wakefulness, thus enable them to tolerate sleep loss [7] [13]. "
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    ABSTRACT: The present study utilized a population-based sample investigating the following aims: (1) compare the longitudinal course of insomnia in middle-aged and older adults and (2) examine age-related differences on subjective complaint and objective performance in middle-aged and older adults based on the course of insomnia. 1657 middle-aged adults (48.16% male, mean age=55.35±4.03years) and 405 older adults (48.40% male, mean age=70.13±3.88years) from the Korean Genome and Epidemiology Study (KoGES) were classified into 4 groups - no insomnia (NI), single episode insomnia (SEI), remitted persistent insomnia (PI-R), and ongoing persistent insomnia (PI-O) based on their course of insomnia over 5 time points spaced two years apart. Their performance on the psychomotor vigilance task (PVT) and subjective daytime sleepiness were compared across different insomnia groups, and the results were compared between middle-aged adults and older adults. Analysis of covariance indicated that subjective daytime sleepiness was significantly different across the insomnia groups in middle-aged adults based on insomnia group (P=<.0001), but, did not affect objective vigilance performance. In contrast, older adults displayed significantly different PVT response time, but not daytime sleepiness, based on insomnia group (P=0.03). Insomnia impacts psychomotor performance and subjective sleepiness differently, based on age group. There may be underlying processes associated with the aging that amplifies the impact of insomnia on vigilance performance, yet lessens perceived sleepiness in older adults.
    Journal of psychosomatic research 12/2013; 75(6):532-8. DOI:10.1016/j.jpsychores.2013.07.013 · 2.74 Impact Factor
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    • "After exclusion and treatment of any organic causes of EDS, the first step of treatment should be lifestyle interventions to improve the sleep pattern; this being a prerequisite for day-time alertness. This includes no caffeine, no intake of fluids after 6 pm, regular bedtime, normal room temperature, darkness and quietness in the bedroom.9 If EDS persists adjustment using dopaminergic and psychotropic drugs should be the next step, bearing in mind the balance between motor deterioration and alertness. "
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    ABSTRACT: Patients with Parkinson's disease (PD) or Parkinsonian syndromes often report excessive daytime sleepiness (EDS). The aim of this study was to evaluate the effects of the psychostimulant modafinil on elderly, institutionalized, severely impaired PD patients with EDS. A three-week open study on ten institutionalized PD patients scoring >10 points on the Epworth Sleepiness Scale (ESS) with modafinil eventually on 100 mg twice a day. Patients were assessed at the start, week 1, and week 3 with ESS, Clinical Global Impression (CGI) scale severity of PD and appetite. Reduction of ESS score and PD severity over time were found as well as a significant increase in appetite and reduction in CGI score. Modafinil 100 mg twice a day was safe and modestly effective for the treatment of EDS in elderly, institutionalized PD patients. Sustaining wakefulness throughout all stages of PD is crucial for participating in life, maintaining social life, and improving quality of life.
    Neuropsychiatric Disease and Treatment 04/2010; 6(1):93-7. · 1.74 Impact Factor
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    ABSTRACT: Purpose: The purpose of this secondary analysis was to explore the associations between the frequency of hot flashes and sleep disruptions experienced by post menopausal women with the diagnosis of breast cancer and received acupuncture treatments for hot flashes. Data Sources: Data were gathered for this secondary analysis from 47 African-American, Hispanic, and Caucasian women experiencing hot flashes after receiving treatment for breast cancer who were enrolled in an intervention study of acupuncture for menopausal hot flash reduction. Conclusions: Strong correlations were found between sleep disruptions, total hot flashes, daytime hot flashes, and night sweats at the conclusion of treatment and over the entire 12 weeks of follow-up. The results suggest that hot flashes and sleep disruptions are strongly correlated and that both acupuncture interventions resulted in a concomitant reduction in sleep disruptions. Implications for Clinical Practice: Nurses involved in holistic practice can recommend and/or provide the safe and effective alternative treatment of acupuncture for hot flash reduction and concomitant sleep disruptions. As a result, the quality of life for these women can be greatly improved.
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