Sleep disorders in the elderly and their management

Sleep aging is a complex physiological process driven by changes in circadian regulation systems (phase advance, decreased melatonin secretion) while homeostatic drive remains largely preserved. In healthy older adults, sleep is characterized by sleep fragmentation, a decrease in deep slow-wave sleep, and reduced sleep efficiency, though adaptation mechanisms often prevent significant complaints. Nevertheless, approximately 50% of older adults report sleep disturbances, frequently linked to geriatric comorbidities (neurocognitive disorders, heart failure, chronic pain), polypharmacy, or changes in external synchronizers (institutionalization, sedentary lifestyle). Management must be comprehensive, prioritizing non-pharmacological approaches such as Cognitive Behavioral Therapy for Insomnia (CBT-I) as first-line treatment, while maintaining vigilance for specific conditions like Restless Legs Syndrome or REM Sleep Behavior Disorder, which are prevalent in alpha-synucleinopathies.