SLEEP
DISORDERS IN THE ELDERLY
Sleep disorders in the elderly involve any disrupted sleep pattern, such as problems falling or staying asleep, too much sleep, or abnormal behaviors with sleep.
Three common primary sleep disorders frequently seen in older adults ;
- Sleep disordered breathing (SDB)
- Restless legs syndrome (RLS/periodic limb movements in sleep (PLMS)
- REM sleep behavior disorder (RBD)
1.SLEEP-DISORDERED
BREATHING (SDB)
spectrum of breathing disorders ranging from benign snoring to obstructive sleep apneas .Patient experiences complete cessation of respiration (apneas) and partial respiration (hypopneas) during sleep.
SBD is diagnosed, when each event exceeds 10 sec and recurs throughout the night. Total number of apnea and hypopneas per hour of sleep is called the apnea-hypopnea index. AHI greater than or equal to 5-10 confirms a diagnosis of SBD.
symptoms of SDB
Snoring
Excess daytime sleepiness
Insomnia
Nocturnal confusion
Difficulty with concentration, attention
Short-term memory loss.
Management
Weight loss
Smoking cessation
Abstinence from alcohol
Avoid long-lasting benzodiazepines
2. RESTLESS LEGS SYNDROME
(RLS)/ PERIODIC LIMB MOVEMENTS IN SLEEP (PLMS)
Lt is characterized by dysesthesia in the legs usually described as "pin and needles " or "creepy and crawly" sensation in the legs,that is only relieved with movement . This dysesthesia occurs when the patient is in a relaxed or restful state.
Diagnosis more based on history . Prevalent among woman compared to men.
Management
PLMS and RLS are treated with dopamine agonists
3. RAPID EYE MOVEMENT (REM) SLEEPS BEHAVIOR DISORDER
Rapid eye movement sleep behavior disorder (RBD) is characterized by complex motoric behaviors that occur during REM sleep.These behaviors/movements can include walking, speaking, eating, and can also be violent and may harm the patient or the patient's bed partner. Oftentimes, patients are unaware of these actions. RBD is most prevalent among older adult males.
Etiology of RBD is unclear
Management
long-acting benzodiazepine ,to reduce or eliminate abnormal motor behavior
Melatonin has also been found to be effective in its treatment.
Sleep hygiene education
Injury-preventing techniques include making the bedroom environment safer by removing potentially dangerous heavy or breakable objects, using heavy curtains on bedroom windows, keeping doors locked at night, and sleeping on a mattress placed on the floor to prevent dangerous falls.
