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Sleep, Aging and Dementia
Josepha A. Cheong, MD
University of Florida Departments of Psychiatry and
Neurology
Chief, Division of Geriatric Psychiatry
Normal Sleep
– Average adult needs ~ 8.3 hrs
– Sleep latency: time between going to bed till
onset of sleep
• Average is 10minutes
– 75% spent in Non-REM sleep
– 25% spent in REM sleep
Changes with Age
–Decreased REM sleep
–Increased awakenings and easy
arousal
Sleep Difficulties in the Elderly
– Insomnia estimated to be in ½ of the Elderly
– Women > Men
– Risk factors for insomnia
• Depression
• Breathing difficulties
• Poor health
Sleep Disturbance in Dementia
• May lead to injury from wandering
• Leads to difficulty for the caregiver
• Exacerbates any pre-existing behavioral
difficulties
• A common reason for initiating nursing
home placement
Assessment of Sleep Difficulty in
Dementia
• Careful review of all medications –
prescription and over-the-counter meds
• Examine the sleep environment
• Review of recent events/changes that may
be stressful to the patient
• Evaluate for depression
• Evaluate patient for obstructive sleep apnea
Obstructive Sleep Apnea
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Loud snoring
Nighttime restlessness
Increased daytime confusion
Daytime drowsiness
Waking up confused
25% of elderly; 50% of dementia patients
Treatment
Continuous Positive Airway Pressure
- A nosepiece connected to a hose
- The hose is places positive pressure into the
airway that keeps the airway open
Treatment
• Sleep Hygiene
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Reduce intake of caffeine and fluids
Moderate exercise (walking)
Cool (68-72 degrees), dark and quiet room
Set times for sleeping and waking
Treatment in Dementia
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Frequent Orientation during the day
Restrict napping
Provide access to daylight
Moderate exercise
Medication Management
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Zolpidem or Sonata
Benzodiazepines: Ativan or Restoril
Monitor for falls
Stay away from anticholinergic medications
– likely to exacerbating confusion
Anticholinergic Medications
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Atarax
Vistaril
Benadryl
Tylenol PM