Sleep

Disturbances of sleep are detrimental to the quality of life for the aging individual. Sleep disorder studies among adults above age 50 found that approximately 57% complained of significant sleep disruption; 45% reported periodic limb movements during sleep, 29% reported insomnia, 24% reported obstructive sleep apnea (OSA), 19% experienced early morning awakening, and 12% had restless legs syndrome (RLS) (Bloom et al. J Am Geriatr Soc 57(5): 761–789, 2009). Among over 9,000 participants aged 65 years and older, between 23% and 34% had symptoms of insomnia, and between 7% and 15% rarely or never felt rested after waking up in the morning (Foley et al. Sleep: 425–432, 1995). These sleep complaints were associated with an increasing number of respiratory symptoms, physical disabilities, nonprescription medications, depressive symptoms, and poorer self-perceived health (Foley et al. Sleep: 425–432, 1995). This chapter provides an overview of disorders of sleep and parasomnias and age-adjusted recommendations. Because patients often wish for an immediate solution, and clinicians have limited time to assess sleep problems in depth, a medication prescription is frequently the first and only clinical intervention. The result can be increasingly complicated medication regimens, which include potentially inappropriate medications (PIM) with redundant pharmacological properties, and a greater risk of adverse drug–drug interactions (Wastesson et al. Expert Opin Drug Saf 17(12): 1185–1196, 2018). Recommended interventions include first-line behavioral approaches such as cognitive behavior therapy for insomnia, (CBT-I), followed by second-line age-adjusted psychopharmacological approaches.