Dr. Colin M. Shapiro, MBBCh, PhD, MRCPsych, FRCPC,¹ Co-author: Sharon A. Chung, PhD ²

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Abstract: Nocturia, or the condition where the patient wakes two or more times per night to void the bladder, is linked to a multiplicity of physical and mental health disorders. Whether causal or caused by these disorders, treatment of nocturia and the associated slow-wave sleep disruption is essential to avoid long-term health issues and increased mortality in the individual.

Key Words: nocturia, sleep, physical health, mental health, slow-wave sleep.

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Nocturia is a condition that causes the patient to wake two or more times per night to void the bladder.

Nocturia results in a disruption of restorative slow-wave sleep.

Nocturia results in a disruption of restorative slow-wave sleep.

Desmopressin can prolong or even eliminate time to first awakening, thereby augmenting slow-wave sleep and the associated improved physical and mental health.

Nocturia is associated with a multiplicity of physical and mental disorders.

Nocturia is more prevalent in aging patients.

Physicians should include screening for sleep disorders , particularly in elderly patients who report waking twice or more per night to void the bladder.

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Jason Strauss, MD, Departments of Psychiatry and Medicine, Division of Gerontology, Harvard Medical School; Beth Israel Deaconess Medical Center, Boston, MA; Hebrew Rehabilitation Center, Roslindale, MA; Cambridge Health Alliance, Cambridge, MA, USA.

Sleep disturbances are frequently seen among older adults with dementia, leading to significant distress for both patients and their caregivers. It is likely that neuronal loss in key areas of the brain contributes to sleep disturbances in this population. When evaluating older adults with dementia and insomnia, try to obtain information regarding all details of their sleep, and determine whether medical, psychiatric, or environmental factors may be contributors. In treating sleep disturbances in older adults with dementia, behavioural interventions should first be used to improve sleep hygiene. At the present time, there are not enough data to standardize recommendations for pharmacological treatment of insomnia in this population, so treatment should be guided by attempting to minimize potential side effects and interactions with other medications.
Key words: sleep, dementia, older adults, sleep hygiene, pharmacological treatment of insomnia.

Jennifer L. Martin, PhD, Assistant Research Professor, University of California, Los Angeles; Department of Medicine and Research Health Scientist, VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California, USA.

Caregivers often report sleep disturbances in persons with dementia. Older adults with dementia have more nighttime awakenings, less deep sleep, more daytime sleepiness and napping, and experience changing in the timing of sleep. Sleep disorders such as sleep disordered breathing, restless legs syndrome, periodic limb movement disorder, and REM behaviour disorder are more common among individuals with some types of dementia. Sleep problems are associated with difficulties in caregiving and quality of life. As a result, sleep problems should be evaluated and treated. Treatment should always consider nighttime environmental and daytime lifestyle factors.
Key words: sleep, dementia, Alzheimer’s disease, circadian rhythms, sleep disorders.

Amit Morris, BSc, School of Medicine, Queen's University, Kingston, ON; Department of Psychiatry, Sleep and Alertness Clinic, Toronto Western Hospital, University of Toronto, Toronto, ON.

Colin M. Shapiro, MBBCh, PhD, FRCP(C), Department of Psychiatry, Sleep and
Alertness Clinic, Toronto Western Hospital, University of Toronto, Toronto, ON.

Insomnia is very common among older adults and may have serious consequences. The assessment of insomnia can be challenging, given the number of possible causes and the fact that insomnia is often not a presenting complaint. Inquiring about patients’ sleep and performing a thorough evaluation of any concerns will allow a rational and targeted approach to treatment.

Key words: insomnia, sleep, older adults, aging, diagnosis.

It is well known that many elderly individuals have difficulty sleeping, and it is also known that aging is associated with a decrease in growth hormone (GH) levels. Changes in sleep patterns drastically affect endocrine function, especially pituitary-dependent hormonal release, which may impact on nighttime levels of GH. An interesting question then, is whether the age-related decrease in the quality of sleep is responsible for the age-related decline in GH hormone secretion or, alternatively, whether the reverse is true and the age-related decline in GH secretion may be responsible for the age-related changes in sleep patterns. A recent study published in the Journal of American Medical Association has taken a step towards determining this relationship, by closely examining the correlation between various stages of sleep and levels of GH, in healthy men between 16 and 83 years of age. The association between the two is striking. Not only does it raise the possibility of using GH supplementation to conquer yet another marker of biological aging--reduced sleep--but it also presents sleep enhancement as a potential way of increasing GH levels.

Previous studies have shown that aging is associated with increases in the number and duration of awakenings during the night and decreases in the amount of slow-wave (SW) sleep. There is also a decrease in the amount of rapid eye movement sleep (REM) but this change is moderate by comparison. This earlier data was based on a comparison of two age groups young and aged persons.

Lilia Malkin, MSc

Sleep is a necessary physiologic break that gives the human body the opportunity to relax and revitalize itself. Unfortunately, getting "a good night's rest" frequently proves challenging, particularly for the elderly. As many as twenty-five percent of otherwise healthy older adults complain of chronic sleep difficulties.^1,2 When seniors with medical and/or psychiatric co-morbidity are taken into consideration, the proportion of the elderly who suffer from chronic insomnia and excess daytime somnolence may actually exceed fifty percent.³ Since adequate sleep makes a substantial contribution to one's quality of life, it is important to determine the etiology of a sleep disorder, so that the primary sleep problem and/or the underlying condition may be treated appropriately. This article will discuss the physiologic changes in the sleep pattern of healthy older adults, common geriatric sleep disorders, as well as assessment and treatment strategies for insomnia in the elderly.

Sleep Changes in Healthy Elderly
Aging is associated with a multitude of physiologic alterations in healthy seniors, and sleep is no exception. Age-related sleep changes occur apart from primary sleep disorders, or medical and/or psychiatric conditions.