Principles and Practice of Geriatric Sleep Medicine

Half title......Page 1
Title......Page 5
Copyright......Page 6
Dedication......Page 7
Contents......Page 9
Contributors......Page 11
Foreword......Page 15
Preface......Page 17
References......Page 18
Credits and acknowledgments......Page 19
Organization of the first edition......Page 21
About the editors......Page 23
Part 1 Sleep and normal aging......Page 25
Aging and circadian rhythms......Page 27
Entrainment and responsiveness to zeitgebers......Page 28
Discrepancies in the age-related changes in period length......Page 29
Summary......Page 30
References......Page 37
Age-related changes in NREM sleep microstructure......Page 46
Gender differences in sleep in middle age......Page 47
Periodic leg movements in sleep (PLMS) in middle-aged subjects......Page 48
Age-related changes in homeostatic regulation......Page 49
Age-related changes in circadian regulation in middle age......Page 50
Desynchronization of the brain: vulnerability to sleep–wake cycle challenges with aging......Page 51
References......Page 53
New definitions of the menopausal transition......Page 57
Sleep problems in the menopausal transition: highlights and conclusions from reviews of population-based research......Page 58
Cross-sectional analyses......Page 63
Preliminary data and new perspectives......Page 64
Ongoing cohort studies collecting detailed data on menopausal stage and sleep problems......Page 66
References......Page 67
Memory encoding......Page 69
Memory encoding in aging......Page 70
Sleep and memory encoding......Page 72
Mechanisms of sleep-dependent memory processing......Page 73
Sleep and aging......Page 76
Model conjectures......Page 77
References......Page 78
Sleep stages and sleep architecture......Page 81
Memory systems and memory consolidation......Page 82
The significance of sleep for memory consolidation in old age......Page 83
References......Page 86
Sleep and ANS interactions......Page 89
Sleep in the elderly......Page 90
Blood pressure......Page 92
Thermoregulation and sweating......Page 94
Gastrointestinal function......Page 95
Genitourinary function......Page 96
References......Page 97
Epidemiology......Page 99
OSA phenotypes......Page 100
UAW anatomy......Page 101
UAW muscle function and tissue characteristics......Page 102
Ventilatory control instability (loop gain) and arousal effects......Page 104
Summary......Page 105
References......Page 106
Part 2 Neuroendocrine and homeostatic  changes in the elderly......Page 109
HPA axis......Page 111
HPA axis changes with aging......Page 112
Somatotropin axis......Page 113
Hypothalamic-gonadal axis (females)......Page 115
Hypocretin-orexin system......Page 116
References......Page 117
Biosynthesis and catabolism of melatonin......Page 121
Melatonin's circadian rhythm and its regulation......Page 122
Biological activity of melatonin......Page 123
Melatonin and aging......Page 124
Melatonin and Alzheimer's disease (AD)......Page 125
References......Page 127
Introduction: the epidemic of diabesity......Page 131
Glucose regulation and the sleep–wake cycle: impact of age......Page 132
Neuroendocrine regulation of appetite and the sleep–wake cycle: impact of age......Page 133
Age-related alterations in sleep: hormonal implications......Page 135
Laboratory studies......Page 137
Epidemiological studies......Page 138
Assessment of leptin and ghrelin levels......Page 139
Epidemiological studies......Page 141
References......Page 142
Part 3 Sleep disorders in the elderly......Page 145
Sleep disordered breathing......Page 147
Periodic limb movements in sleep/restless leg syndrome......Page 148
Rapid eye movement (REM) sleep behavior disorder......Page 149
Insomnia......Page 150
References......Page 152
Delayed sleep phase syndrome......Page 155
Prevalence of ASPS......Page 156
Possible etiologies......Page 157
Early hints......Page 158
Discovery of FASPS......Page 159
Period......Page 160
Light exposure......Page 161
Melatonin......Page 162
Acknowledgments......Page 163
References......Page 164
What does shift work involve?......Page 167
Circadian phase adjustment in seniors......Page 168
Sleep in seniors after circadian phase shifts......Page 169
Night-time wakefulness in seniors......Page 170
Age-related changes in mental and physical health......Page 171
References......Page 172
Nocturia and sleep......Page 174
Fall injuries......Page 175
Nocturia and burning mouth syndrome......Page 177
Nocturia and depression......Page 178
Diuretics......Page 179
Nocturia in elderly women......Page 180
References......Page 181
Epidemiology......Page 184
Clinical overview......Page 185
Association with other central sensitization syndromes and other illnesses......Page 186
Medication......Page 187
References......Page 188
Nature of pain......Page 191
Prevalence of sleep complaints with pain......Page 192
Suicide......Page 194
Barriers......Page 195
Pain management in older adults......Page 196
Non-pharmacological treatment......Page 197
Diagnose and treat primary sleep disorders......Page 198
Determine the adequacy of pain management in the context of best practice guidelines......Page 200
Identify and treat psychiatric co-morbidities......Page 201
Identify and treat co-morbid insomnia......Page 202
Conclusion......Page 203
References......Page 204
Effects on sleep......Page 207
Definition and epidemiology......Page 208
Effects on sleep......Page 209
Definition and epidemiology......Page 210
Definition and clinical presentation......Page 211
Subjective sleep symptoms......Page 212
Treatment of depression and sleep disorders......Page 213
References......Page 215
Sleep fragmentation in PD......Page 219
Pathophysiology......Page 220
Clinical features......Page 221
Sleep disordered breathing in PD......Page 222
Epidemiology......Page 223
Etiology and pathophysiology......Page 225
Evaluation......Page 230
Treatment......Page 231
Future directions......Page 232
References......Page 233
Regulation, consolidation, and architecture of sleep......Page 238
Sleep – what is it for?......Page 239
Cognitive impact of Alzheimer’s disease......Page 240
Activity and circadian studies......Page 241
Circadian treatment of sleep and AD symptoms......Page 243
Effects on sleep of pharmacological treatment of cognitive symptons in AD......Page 246
References......Page 247
Clinical features......Page 251
REM sleep behavior disorder (RBD)......Page 252
Excessive daytime sleepiness and sleep attacks......Page 253
References......Page 254
Diagnosis of restless legs syndrome......Page 257
Etiology of RLS......Page 259
Treatment of restless legs syndrome in the elderly......Page 260
References......Page 262
Pathogenesis of RBD......Page 265
Neurovegetative and olfactory functions in idiopathic RBD......Page 266
EEG activity in idiopathic RBD......Page 267
Dreams in RBD......Page 268
Conclusions......Page 269
References......Page 270
Prevalence of sleep apnea......Page 272
Chronic medical disorders that are associated with sleep apnea......Page 275
Clinical presentation of sleep apnea......Page 276
Neurocognitive function......Page 277
Mortality......Page 278
Central sleep apnea......Page 279
References......Page 280
Normal sleep and cardiovascular physiology......Page 284
Sleep disordered breathing and hypertension......Page 285
Sleep disordered breathing and ischemic heart disease......Page 286
Sleep disordered breathing, hypertension, and ischemic heart disease: pathogenesis......Page 287
Sleep disordered breathing and stroke......Page 290
Insomnia and other sleep disorders......Page 291
Conclusion......Page 292
References......Page 293
Sleep and aging......Page 295
Epidemiology......Page 296
Diagnosis......Page 297
Assessment......Page 298
Clinical features of late-life insomnia......Page 299
Conclusions......Page 300
References......Page 301
A description of sleep among nursing home residents......Page 304
Medications, medical illnesses, and psychiatric disorders......Page 305
Circadian rhythms in the nursing home......Page 306
Primary sleep disorders in the nursing home......Page 307
Medications for the treatment of sleep problems in the nursing home......Page 308
Non-pharmacological treatments of sleep problems in nursing homes......Page 309
Summary and conclusions......Page 310
References......Page 311
Sleep disorders......Page 313
Psychological considerations......Page 314
Age-specific considerations and disruption of circadian rhythms......Page 315
Chronic fatigue......Page 316
Treating excessive sleepiness and fatigue......Page 317
References......Page 320
What is known about the causes of falls?......Page 323
Potential mechanisms by which age-associated sleep disorders might affect balance and contribute to falls......Page 325
Gaps in knowledge and opportunities for further research......Page 326
References......Page 328
Dream recall......Page 331
Aggressive interactions......Page 333
Sexual interactions......Page 334
Affect......Page 335
Regression......Page 336
Dreaming style......Page 337
Charcot-Wilbrand syndrome......Page 338
Conclusion......Page 339
References......Page 340
On-the-road driving tests......Page 343
Discussion......Page 346
References......Page 347
Part 4 Treatment of sleep disorders in the  elderly......Page 349
The available data on the therapeutic effects of insomnia medications in the elderly......Page 351
Conclusions......Page 353
References......Page 354
Study population......Page 356
Issues with information on sleep medication......Page 357
Sleep medication use......Page 358
WHO are the people most likely to use SM and/or BZD&Z?......Page 359
Where do people live?......Page 361
Why do people use sleep medication?......Page 362
Dependence, addiction, and abuse......Page 364
Conclusions......Page 365
References......Page 366
Prevalence of insomnia in the adult population......Page 368
Primary insomnia......Page 369
Site and mechanism of action......Page 370
Pharmacokinetic aspects......Page 371
Overview of the effects of non-BZD......Page 372
Effects of non-BZD hypnotics on sleep of elderly patients......Page 374
Adverse events in adult and elderly patients......Page 376
References......Page 383
Clinical issues......Page 386
Medium-acting BZD hypnotics......Page 387
Clomethiazole......Page 388
Comparative studies......Page 389
The Glass et al. meta-analyses [1]......Page 390
Adverse drug reactions......Page 391
References......Page 392
Introduction......Page 395
Hypnotic drugs acting through GABAA receptors......Page 396
Zolpidem......Page 397
Zopiclone......Page 398
Others GABAergic drugs......Page 399
Antidepressant drugs......Page 400
Antidementia drugs......Page 401
References......Page 402
Background......Page 408
Sleep hygiene......Page 409
Stimulus control......Page 410
Sleep restriction......Page 411
Behavioral experiments......Page 412
Models of implementation......Page 413
Safety considerations......Page 414
Evidence for the efficacy of CBT-I......Page 415
References......Page 416
Introduction......Page 418
Self-help and primary insomnia......Page 419
Self-help for co-morbid insomnia in older adults......Page 422
Summary......Page 423
References......Page 424
Complementary and alternative medicine......Page 427
Use of CAM in the elderly......Page 428
Melatonin......Page 429
Safety of exogenous melatonin......Page 431
Evidence of effectiveness......Page 432
Relaxation techniques......Page 433
Music therapy......Page 434
References......Page 435
Defining therapeutic naps......Page 437
Napping as a biological rhythm......Page 438
Effects of naps on sleepiness/alertness and waking function......Page 439
Effects of naps on night-time sleep......Page 440
Sleep inertia......Page 441
Caveats and remaining questions......Page 442
Optimal nap timing......Page 443
References......Page 444
Circadian physiology and light......Page 447
Ocular light transmission......Page 448
Increased ambient light......Page 449
Conditions for which light therapy may be beneficial......Page 450
Resources......Page 451
References......Page 452
Building a model of functional neuroanatomical alterations in sleep related to the aging process......Page 455
Neuronal basis of REM sleep: core structures involved in REM sleep generation......Page 456
Neuronal basis of REM sleep: evidence from functional brain imaging studies......Page 457
Candidate brain structures that may function abnormally during sleep in the aged......Page 458
Effects of age on NREM sleep-related functional neuroanatomy across young adulthood......Page 459
Functional neuroimaging studies in older subjects......Page 460
Summary:a functional neuroanatomical model of the effects of aging on sleep......Page 462
References......Page 463
Index......Page 465