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Secondary sleep disorders in the elderly

Views: 1     Author: Site Editor     Publish Time: 2019-07-31      Origin: Site

With the increase of age, the quality of sleep in the elderly gradually decreases, but the demand for sleep does not decrease and the distribution of sleep physiological rhythm has changed. The ability to sleep is reduced, although bed-rest time prolonged,  the number of awakenings is increased and the time is prolonged. During the day, snoring is often performed to supplement the lack of sleep at night, and the total sleep time remains unchanged.  In terms of sleep structure, the proportion of shallow sleep increased, while the proportion of deep sleep decreased. The REM sleep time was reduced, the latency was shortened, but the percentage of REM sleep was only slightly reduced or unchanged. On the polysomnography, the integrity and amplitude of the sleep spindle decrease with age.


Secondary Sleep Disorder

1. Secondary Sleep Disorder to Physical Illness

Many physical illnesses can damage normal sleep, such as various pains, respiratory, heart and nervous system diseases. Proper use of analgesics can help relieve sleep disorders caused by pain. Older people often have cardiopulmonary and neurological disorders that can affect patients' sleep. For example, heart failure can cause sitting breathing and awakening from time to time. Treatment of body diseases can also lead to sleep disorders, such as diuretics and sympathomimetic bronchodilators, which can affect sleep. Long-term bed rest due to illness may cause daytime snoring, and the normal sleep awakening cycle is destroyed.

2. Secondary Sleep Disorder to Mental Disorders

Mental disorders, including depression reactions to severe and chronic physical illnesses, are also common causes of sleep disorders in the elderly. The incidence of severe depression in the elderly living in the community is about 2.0%, of which 50.0% of patients have sleep disorders. And the incidence of severe depression in hospitalized elderly is higher, from 10.0% to 20.0%. Because sleep disorder is a symptom of depression, treatment should be both into account. With the treatment of antidepressants, sleep disorders will ease. All kinds of grief events in life can often cause sleep disorders in the elderly, such as the death of a spouse, children, colleagues or friends. For long-lasting grief, short-term sedatives can be applied. If depressive symptoms and psychological conflicts are significant, antidepressants and psychotherapy can be used.

3. Secondary Sleep Disorder to Dementia and Delirium

Sleep disorders also occur in dementia patients. Although the patient's daytime function is normal, nighttime paroxysmal roaming, delirium or both can occur. In AD patients, the number of awakenings at night increases, time prolongs, slow wave sleep and REM sleep decrease, light sleep increases, daytime naps increase. It has been suggested that the degenerative lesions of the superficial nucleus in the hypothalamus are the pathological basis of sleep abnormalities in elderly and AD patients. The crossover nucleus is a pacemaker for human circadian rhythm. Because of the degeneration of crossover nucleus, sleep awakening tends to disintegrate and fragmented sleep occurs. In addition, the cholinergic system of AD patients is significantly impaired, and the cholinergic system is associated with REM sleep. The same changes occur in other types of dementia patients. Effective treatment, pay attention to the role of drugs, develop good sleep habits can promote sleep at night.

4. Drugs and Sleep Disorders

Older people often combine various diseases to take a variety of drugs, and some drugs can affect each other, such as anti-allergic drugs, antipsychotics, antihypertensive drugs and central stimulants. In addition, patients with sleep disorders may use a variety of hypnotic drugs, both prescription drugs and over-the-counter drugs, some of which can cause secondary insomnia or aggravate apnea syndrome. Long-term application of hypnotics and alcohol can cause drug-induced insomnia. Due to the slowing of drug metabolism in the elderly, long-term use of hypnotics can lead to excessive daytime sleepiness, memory impairment, and mental motor impairment.  Untimely or excessive consumption of coffee, tea, caffeinated beverages and other products can cause sleep disorders due to the excitatory and diuretic effects of these products.

So how to solve sleep disorders? In addition to the medication and psychotherapy mentioned above, it can also be solved by improving the sleep environment. For example, using memory foam mattress instead of ordinary mattress, or using memory foam pillow instead of ordinary pillow, these can change our sleep environment. Finally, I hope that every elderly person can get away from sleep disorders and have a good sleep.

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