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Can You Detect Sleep Disorders in Your Older Patients?

Older people are more likely to have sleep disorders, which can increase risks of cardiac disorders, daytime injury, and even death. Symptoms of sleep disorders are often hidden by other conditions, making accurate diagnosis difficult.

As many as half of all older adults may experience sleep disturbances, which can have serious consequences, such as increased risks of motor vehicle accidents. Additionally, sleep disorders are associated with a range of other health issues, including hypertension, diabetes mellitus, renal failure, respiratory diseases such as asthma, immune disorders, GERD, physical disability, dementia, pain, depression, and anxiety.

The most prevalent sleep disorders in the elderly are:

Circadian Rhythm Disorders

Circadian rhythms change with age, and affect the sleep/wake cycle. It becomes harder to fall asleep and to stay asleep. Sleep is less efficient, and people grow tired earlier and then wake very early.

Sleep Apnea

Sleep apnea in the elderly tends to develop in association with a range of chronic respiratory disorders, including heart failure. It is frequently seen in people who are obese, and is comorbid with conditions such as hypertension, hyperlipidemia, diabetes mellitus, and metabolic syndrome. Once identified and verified by a sleep study, sleep apnea is generally effectively managed by sleeping with a CPAP positive airway ventilation system.

Nocturnal Movement Disorders

This class of sleep disorders includes restless legs syndrome, periodic limb movement disorder, sleep-related leg cramps, sleep-related bruxism, and sleep-related rhythmic movement disorder, all of which can disrupt sleep.

Preliminary Evaluation

The first clues to sleep disorders are self-reported sleep disturbances and daytime sleepiness. When either of these are present, follow these steps for an initial evaluation:

  • Gather a complete history of sleep habits along with other comorbid symptoms.
  • Ask the patient to keep a sleep diary of sleep and wake times and how they feel during waking hours.
  • Screen for any changes to environmental conditions, physical and/or psychosocial stressors.
  • Chart all medications, and chronic and acute medical illnesses.
  • Conduct a psychiatric evaluation for depression, anxiety, and other conditions.
  • Rule out conditions such as hypoglycemia, night delirium, epilepsy, and metabolic disorders.

Suspicion of a primary sleep disorder is an indication for referral to a sleep specialist.

Last updated 9/22/19.

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