MDNews - Cleveland-Akron-Canton

S LEEP DISORDERS ARE on the rise. It is estimated that nearly 75 percent of adult Americans experience sleep disorder symp- toms at least a few nights per week. These disorders can affect the quality and quantity of sleep or cause difficulty maintaining normal wakefulness – both of which can lead to impaired daytime functioning and a host of medical, psychiatric and psychosocial problems. There are more than 80 different types of sleep disorders that afflict about 70 million Americans. Sleep naturally changes with age. You become tired earlier in the evening and get up earlier in the morning (advance sleep cycle). The quality of sleep is decreased because there is increased nocturnal awakening and less time is spent is restorative delta wave sleep. It also takes longer to fall asleep. As a result, there is an increase in daytime somnolence leading to napping. Sleep disorders do occur in the elderly and can be broken down into two catego- ries – primary and secondary insomnia. The latter is insomnia caused by another medical problem. This is the most com- mon cause of insomnia in the elderly. Diagnosis is initiated via review of the individual's medical history and admin- istration of a physical exam to identify possible medical causes and determine what type of sleep disorder is causing the problem. Common causes include: + A l z hei mer's d i s e a s e, dement i a and depression + Medication use + Sleep apnea (breathing interrupted during sleep) + Urinary problems resulting in the need to go frequently at night + Chronic diseases (including congestive heart failure) + Chronic pain + Neurological conditions + Diet and caffeine consumption + Alcohol intake + Circadian rhythm disorders (changes in the body's internal clock) + Sedentary lifestyle Following a comprehensive evaluation of possible conditions and medication use that may be affecting the quality or quantity of sleep an older adult is experiencing, the next step is to treat medical problems and administer or adjust medications. Simple solutions include exercising regu- larly (but not in the evening), maintaining a consistent sleep pattern (same time to bed each night, same time to wake each morning), and limiting caffeine intake especially in late afternoon and evening. Napping is okay as long as it is earlier in the afternoon and no longer than 20 minutes. If the sleep disorder is primary insom- nia, sometimes a short term treatment with medication may be needed if behav- ioral modifications fail. If treatment is needed for more than three months, a referral to a sleep specialist may need to be considered. Benzodiazepines are commonly used to treat insomnia but are contraindicated in the elderly due to risk of increased confusion. Generally it is recommended to treat with either melatonin or Trazodone. Due to the detrimental effect sleep loss can have on quality of life and medical conditions, the importance of treating sleep disorders properly ca nnot be minimized. W hen more traditional treatment options are not successful, then a referral to a specialist is needed. If there is concern that the sleep disorder is being caused from polypharmacy, multiple co-morbidities or dementia, then referral to a geriatric evaluation management program should be made. If there is concern that there is sleep apnea or an unknown sleep disorder, a referral to a sleep specialist is warranted. Dr. Ami Hall is board-certified in fam- ily practice and geriatric medicine, and is the Medical Director of the Geriatric Evaluation and Management (GEM) program at Euclid Hospital, a Cleveland Clinic hospital. The GEM program, which provides comprehensive assessments of the health issues facing older adults, is a resource for older adults, family members, caregivers and physicians. ■ By Ami Hall, DO Sleep Disorders in the Elderly +++++++++++++++++++++++++++++++++++++++ + +++ + +++ +++++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: SENIOR HEALTH 2 4 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ J U LY/AU G U S T 2 0 1 4

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