Sleep-Wake Disorders

An important part of geriatric psychiatry, and mental health in general, is sleep. Age-related physiological and pathological changes are underlying mechanisms associated with sleep difficulties in older adults. A combination of age-related changes in sleep architecture and primary sleep disorders along with systemic medical and psychiatric disorders accounts for most of the disturbed sleep in older adults. Sleep disturbance can be a clinical symptom in depressive, anxiety, and major or mild neurocognitive disorders, can be a prodromal phase of a neuropsychiatric disorder, and can be a risk factor for development of a neuropsychiatric disorder. When addressing sleep disturbances, the geriatric population is of particular importance given their high rates of insomnia, which result in poorer quality of life, increased healthcare costs, and increased burden to caregivers. Geriatric patients also pose some specific challenges when it comes to understanding and treating sleep disturbances; they have an increased number of comorbidities, take a number of medications which can contribute to poor sleep, may have cognitive impairments interfering with history taking, and are vulnerable to commonly prescribed sleep aids. This chapter describes diagnostic approaches, facilitates understanding of the differential diagnosis, identifies risk factors, and provides treatment approaches for common sleep-wake disorders in older adults.