Sleep in the Context of Healthy Aging and Psychiatric Syndromes

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Key points

  • Sleep disturbances in the context of psychiatric conditions in late-life creates an ambiguous and challenging scenario for researchers and clinicians.

  • Investigations of the potential shared biological substrates between sleep disorders and psychiatric conditions in late-life and randomized, controlled trials aimed at improving the sleep of older adults with concurrent psychiatric conditions are lacking.

  • An important caveat regarding treatment is that it may be difficult on occasion to determine

Sleep in aging

Both self-report and polysomnographic (PSG) studies of sleep document age-related changes in sleep architecture. Subjective sleep quality decreases with age. Shortened and less restorative sleep, more frequent nighttime awakenings (NTA), increased time awake in the night, and early morning awakenings1 are well documented with aging. Sleep is “structurally lighter” in the elderly. Cross-sectional studies using PSGs have shown that older adults spend less time in deep, slow-wave sleep (SWS),

Poor sleep in late-life

Epidemiologic estimates suggest that as many as 65% of older adults complain about at least one of several sleep disturbances.9 Poor sleep in the elderly relates to higher mental and physical morbidity, hospitalizations, mortality, and suicidality (reviewed in1). The most common complaints include frequent awakenings during the night, waking too early, and difficulty falling asleep.9 Of these, late-life insomnia is among the most costly and preventable health problems in the United States. The

Sleep and other conditions: primary versus secondary

The prevalence rate of sleep complaints among older adults drops to as low as ∼2% after eliminating all who complain of a comorbid mental/physical condition.13 However, calculating prevalence rates after controlling for potential comorbid conditions should be viewed with caution, because co-occurrence does not negate independence. Approximately 7 of 8 older adults who report sleep disturbances report at least one other major mental/psychological disorder, particularly depression, heart disease,

Sleep and psychiatric conditions

Across the lifespan, poor sleep is often comorbid with psychiatric disorders. More than 30% of older individuals with insomnia have an accompanying psychiatric disorder (reviewed in1) The relationship between sleep and mental health has long been recognized. In 1867, Wilhelm Griesinger17 outlined 4 major psychological conditions highly correlated with sleep disturbance: depression, hypochondriasis, mania, and psychosis. The basic relationship between depression, anxiety, mania, psychosis, and

Summary

Sleep disturbances in the context of psychiatric conditions in late-life create an ambiguous and challenging scenario for researchers and clinicians. Important research agenda and treatment implications abound. Investigations of the potential shared biological substrates between sleep disorders and psychiatric conditions in late-life and randomized, controlled trials aimed at improving the sleep of older adults with concurrent psychiatric conditions are lacking. An important caveat regarding

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      It is normal to hear the older complain of sleep problems such as difficulty falling asleep, premature waking, and drowsiness during the daytime, among others. Moreover, age-related diminutions in sleep quality and quantity are also associated with various diseases, including psychiatric conditions (dementia, depression, and anxiety) (Kay and Dzierzewski, 2015) or physical disorders (obstructive sleep apnea, systemic hypertension, and diabetes) (Edwards et al., 2010). Hence, it is essential to clarify the underlying mechanisms of how aging impacts sleep, which will greatly benefit developing novel treatments in the future.

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    Funding sources: Daniel B. Kay, PhD was support by T32 training grants (HL082610, PI: Daniel J. Buysse, MD and AG020499, PI: Michael Marsiski, PhD). Joseph M Dzierzewski, PhD was supported by UCLA Claude Pepper Center (5P30AG028748), UCLA CTSI (UL1TR000124), and VA Advanced Geriatrics Fellowship.

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