The former is also called initial insomnia, and the later can be either middle or terminal insomnia. Insomnia is commonly defined as recurring problems in sleep initiation ( sleep onset insomnia) or maintaining asleep ( sleep maintenance insomnia). The common primary sleep disorders thatare seen in older adults include chronic insomnia disorder (CID), sleep-disordered breathing (SDB), restless legs syndrome(RLS)/periodic limb movements in sleep (PLMS), REM sleep behavior disorder (RBD) and advanced sleep-wake phase disorder (ASWPD). Furthermore, sleep problems increase mortality in older individuals lower sleep efficiency (<80%) almost doubles the risk of all-cause mortality. Cognitive deficits can appear because of chronic sleep problems in the elderly that include attentional impairment, difficulties in short-term memory, increase inresponse time and decreased performance. Those having sleep complaints report poor quality of life and higher rates of depression and anxiety. Among the elderly, the prevalence of initial insomnia are found in 15%–45%, middle insomnia in 20%–65%, late insomnia in 15%–54%, and 10% have poor sleep quality. Insomnia and daytime sleepiness are the common sleep complaints in older individuals ( table 2). The recommendations made as part of these guidelines are best available options that have to be modified as per the clinical needs of the individual patient and the treatment setting. However, these guidelines should not be considered as a substitute for professional knowledge and clinical judgment. Most of the recommendations made as part of the guidelines are evidence-based. These guidelines provide a broad framework for assessment and management of sleep problems in elderly patients.

The current version of the CPG for sleep disorders in elderly must be read in conjunction with the previous versions of CPG for sleep disorders in the adult population. The current version of the CPG is an update of the earlier versions which specifically focuses on management of sleep disorders in the elderly. Indian Psychiatric Society (IPS) published Clinical Practice Guideline (CPG) for management of sleep disorders, for the first time in the year 2006 and a revised version in the year 2017. However, these changes are not the common sleep complaints of the elderly population. The changes in sleep that occur with age are summarized in Table 1. Among the elderly, core body temperature, and cortisol and melatonin rhythms occur at an earlier time. They include sleeping before the desirable sleep and wake times, earlier clock hour of internal circadian time, alteration in the relationship between the internal circadian time and sleep, reduction in circadian amplitude, and reduced sensitivity to low to moderate light levels. Sleep in the elderly is fragmented, lighter and is characterized by episodes of arousals and awakenings.Ĭertain changes in circadian physiology occur with age. the duration of sleep relative to total time in bed, continue to decrease over time.

Slow-wave sleep does not change much from 60 to 90 years of age. With increasing age lighter stages of sleep becomes more, whereas, REM and slow-wave sleep reduce up to 6 years of age there is 2% decrease in slow-wave sleep every decade. higher the number of comorbidities, higher the rates of sleep problems.Įlderly subjects have initial insomnia, wake up earlier than usual, have higher time spent in bed, have nighttime awakenings, nap more, and have decreased total sleep as compared to younger adults. The comorbid disorders have additive effects on sleep disturbances, i.e. Higher rates of sleep problems are observed in those elderly with medical and psychiatric comorbidity.

It is estimated that 40-70% of elderly experience chronic sleep problems. Sleep disorders are common in the elderly.

Trazodone for insomnia in elderly