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.

Christina S. McCrae, PhD, Assistant Professor, Center for Gerontological Studies, Institute on Aging, and Department of Psychology, University of Florida, Gainesville, FL, USA.

Candece Glauser, MA, Department of Psychology and Institute on Aging, University of Florida, Gainesville, FL, USA.

A variety of patient and environmental factors make nursing home residents particularly vulnerable to insomnia or poor sleep. Although precise estimates are not available, research suggests that up to 75% of institutionalized older adults suffer from disturbed sleep.^1-3 Identifying the contributory factors and intervening to resolve or limit their impact on sleep is the key to effective management. Frequently, these factors can be difficult to control, and as a result, standard sleep evaluation and treatment practices may need to be modified for use in long-term care settings.

Evaluation
Insomnia may be present if an individual has more than 30 minutes of unwanted awake time on six or more days during a two-week period. Evaluation involves having patients record various aspects of their sleep habits, such as bed and wake times, in a sleep diary, daily for two weeks. Polysomnographic (PSG) evaluation is not necessary to diagnose insomnia; however, it may be necessary in some cases in order to rule out other sleep disorders such as sleep apnea.

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.