Sleep Disorders
Sleeping problems constitute one of the most frequently voiced complaints in the elderly. Patients commonly complain about insomnia (i.e., the problem of either falling asleep or sleeping through the night). While increased need for sleep and abnormal day
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Implications for the Elderly, Epidemiology Sleeping problems constitute one of the most frequently voiced complaints in the elderly. Patients commonly complain about insomnia (i.e., the problem of either falling asleep or sleeping through the night). While increased need for sleep and abnormal daytime sleepiness are frequent phenomena in older people, patients themselves rarely consider this a relevant problem. The present chapter focuses on insomnia, the most important and frequent sleep disorder in the elderly. Epidemiological studies on the prevalence of insomnia have yielded differing results depending on study method, patient population, and the definition of insomnia (Ancoli-Israel and Cooke 2005). Overall, 30–60% of older people across industrialized nations report suffering from insomnia. Somatic and psychiatric comorbidity, frailty, low income, poor education, and loss of partner are predisposing factors (Bloom et al. 2009; Foley et al. 1999). Among the elderly, 30–60% of all persons complain about insomnia.
S. Schwarz (*) L. Fr€ olich Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159 Mannheim, Germany e-mail: [email protected]; [email protected]
The prevalence of insomnia is particularly high during inpatient hospital care. Hospitalized patients frequently receive hypnotics: On general wards, 31–41% of all patients are given hypnotics; on surgical wards, the percentage is at 33–88% (Flaherty 2008). These numbers alone point to the significance of insomnia. In everyday practice, sleep disorders in elderly patients are either frequently not treated at all or, even more often, not adequately treated. Among the most frequent treatment mistakes are – Long-term prescription of hypnotics – Lack of careful assessment of patients’ medical history – Failure to properly diagnose patients’ complaints. Often, all three mistakes are committed in combination. One reason for the lack of attention with regard to sleep disorders is the false belief that sleep disorders constitute only minor health problems. In fact, however, sleep disorders represent a complex, multifactorial geriatric syndrome (Vaz Fragoso and Gill 2007) with numerous causes that has considerable effects on the quality of life of patients as well as consequences on somatic disorders (Wolkove et al. 2007). Patients suffering from sleep disorders have a higher risk for developing high blood pressure and depression as well as cardiovascular and cerebrovascular disorders. Vice versa, these disorders predispose patients for developing sleep disorders. In addition, sleep disorders represent an important cause for reduced cognitive function.
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_17, # Springer-Verlag Wien 2013
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For example, patients suffering from sleep apnea will often visit their physician because of cognitive deficits instead of sleep problems. The majority of elderly patients with insomnia are not treated adequately. Indiscriminate
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