Sleep, elderly population

Subsequently, several authors have tested SRT, either alone or as one component in multifactorial interventions. The majority of the studies evaluating SRT alone have focused on elderly populations. As sleep becomes fragmented, daytime alertness is reduced, and insomnia vulnerability increases with aging. Older adults often spend more time in bed to cope with these changes. Although this response is adaptive in the short term, it may also perpetuate/exacerbate sleep difficulties. The use of SRT is, therefore, very relevant for this segment of the pop-... 

Opioids are well tolerated and seem to have a long-term efficacy in the treatment of RLS for the elderly population [74, 78], Opioids such as propoxyphene (65-BO mg) are useful for mild cases of RLS and PLMD, whereas oxycodone (4-5 mg) and methadone (5-10 mg) are reserved for severe resistant symptoms of RLS and PLMD [61], A retrospective study by Grewal et al. [79] showed a significant decrease in the number of PLM per hour of total sleep time as shown by pre- and post-treatment overnight PSG studies in patients treated with selegiline (5, 10 and... 

Pathological conditions in which the VLPO system is weakened (i.e. less drive for sleep) could, therefore, result in more frequent changes between wakefulness and sleep, as has been demonstrated in animal models. Interestingly, elderly individuals have significantly reduced numbers - often by as much as 50% - of sleep-promoting VLPO neurones, an age-related loss of VLPO cells that may explain, at least partially, this population s characteristic difficulty in falling and staying asleep. 

A wide range of sleep disturbances has been documented in PD (Larsen, 2001). In a population-based survey of sleep disorders in PD, Tandberg et ah (1998) reported nocturnal sleeping problems in 60% of PD patients compared to 33% in healthy controls and 46% in elderly with diabetes mellitus. The most common problem reported was sleep fragmentation, which was found in 39% of PD and only 12% of normal elderly controls, whereas inability to fall asleep did not differ between the groups. 

Ramelteon is available in 8-mg tablets for oral administration. The current maximum dosage is 8 mg administered at night however, during trials, up to 16 mg was studied. Ramelteon should be used with caution in elderly patients because plasma levels were twice those in healthy adults in clinical trials. Ramelteon should not be used by patients with severe hepatic impairment. This medication has been evaluated in moderate sleep apnea and chronic obstructive pulmonary disease and appeared to be safe to administer in this population. Ramelteon was not studied in subjects with severe sleep... 

Table 12-7 lists considerations regarding sleep disruption in the elderly, and Table12-8 lists considerations regarding BZD hypnotics in this population.

Researchers used to think that older adults produced very little melatonin. Since the elderly tend to have more problems with insomnia and other sleeping disorders, scientists hypothesized that these lower levels of melatonin were the cause of sleeping problems in this population. 

Population-based studies examining the causes, incidence and persistence of sleep disturbances in AD patients are lacking consequently, little is known about the risk factors for their development. Therefore, one must look to the literature concerning sleep disturbance in the non-demented elderly and factor this with clinical assessment of individual AD patients to make informed inferences about the AD population in order to arrive at effective treatment interventions for individual patients [4],... 

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