Use of Light Therapy for Insomnia in the Elderly: Role of Circadian Rhythm Disorders
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INSOMNIA AND PSYCHOTHERAPY (H ATTARIAN & M KAY-STACEY, SECTION EDITORS)
Use of Light Therapy for Insomnia in the Elderly: Role of Circadian Rhythm Disorders Joshua G. Cahan 1,2
&
Sabra M. Abbott 1,3
# Springer Nature Switzerland AG 2020
Abstract Purpose of Review Here, we review the unique mechanisms that underlie insomnia in elderly patients and how it relates to circadian dysfunction in order to provide a practical approach to light therapy in this population. Recent Findings While the connection between aging and insomnia has long been recognized, postmortem and recent biomarker studies have advanced our understanding of the underlying mechanisms. Most recently, studies utilizing PET tracers have supported an association of sleep disturbance with neurodegenerative changes prior to the onset of cognitive impairment. These changes may result in reduced circadian amplitude and other circadian disturbances. Recent studies added to a body of literature suggest that circadian dysfunction in elderly patients can be targeted with light therapy to improve sleep quality, timing, and duration. Summary Circadian dysfunction plays an important role in the etiology of insomnia in the elderly. Even in the absence of cognitive decline, neurodegenerative changes in the brain are a common consequence of aging that may contribute to circadian dysfunction and insomnia generally. Light therapy may be a useful tool in addressing the underlying impact of aging on sleep and can be used in varying ways depending on the patient’s unique presentation. Keywords Aging . Light therapy . Insomnia . Advancedsleep-wake phase disorder . Delayed sleep-wakephase disorder . Irregular sleep-wake rhythm disorder
Introduction Insomnia in the elderly is a common and challenging disorder. In one study, reporting questionnaires of over 9000 adults over the age of 65, 42% reported symptoms consistent with insomnia, far higher than the general population [1]. This increased incidence with age may be partly explained by several changes to sleep physiology that occur with aging. These changes affect sleep onset and maintenance, contributing to insomnia. This article is part of the Topical Collection on Insomnia and Psychotherapy * Joshua G. Cahan [email protected] 1
Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
2
Mesulam Center for Cognitive Neurology and Alzheimer Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
3
Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
Insomnia is defined as difficulty initiating or maintaining sleep despite the appropriate circumstances for sleep with impacts on daily functioning. While insomnia is no longer classified into primary or comorbid, in favor of acute and chronic [2], age may bring medical conditions that contribute to insomnia. Treatment of insomnia in the elderly is a challenge, in part, because of its frequent association with chronic medical conditio
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