Effective treatment of sleep disturbances in older adults

Sleep disturbance is a common and complex clinical problem, particularly in older adults. With advancing age, the normal sleep cycle begins to break down, resulting in a reduction in the deeper stages of sleep and an often-profound increase in the fragmentation of nighttime sleep by periods of intrusive wakefulness. Sleep disorders exacerbate these age-related changes, leading to reports of daytime fatigue, sleepiness, and impaired daily function. The resultant chronic sleep deprivation invariably leads to often-unsuccessful attempts by the patient to overcome the problem. Patients may stay in bed longer, take more naps during the day, or seek out agents that putatively restore normal sleep patterns. Paradoxically, these efforts often result in exacerbation of the sleep disturbance. This review delineates the common causes of disordered sleep in older persons. Further, it reviews effective diagnostic approaches and treatments for these conditions, including limitations of hypnotic medications and melatonin.