Management of Primary Sleep Disorders Among Elderly Persons

Sleep complaints are common in geriatric patients. The clinician’s first task is to separate sleep prob-lems originating in the physiologic changes ofaging from those origi-nating in pathological processes. Normal elderly persons have greater difficulty falling asleep and staying asleep, compared with youngerpersons, andsleep is quail-tativdy more shallow with mote involuntary movements and ab-normal breathing. Sleep com-plaints reach apathological level as elders begin to experience deterio-ration offunction during theirpe-dod ofnormal wakefulness, mani-f ested as excessive sleepiness, con-centration deficits, and mood changes, or the emergence of hi-zarre or dangerous behavior dur-ing sleep. Sleep disorders are asso-ciated with excess physical and psychiatric morbidity and are treatable. An approach focused on sleep-related syndromes is a useful basis for rational treatment, and the treatment ofmany sleep disor-giet-s can be provided without ex-pensive sleep laboratory testing. Age-related deterioration of sleep occurs in a gradual rather than step-wise progression throughout adult life. Table 1 summarizes changes in the quality of sleep that can be ex-Dr. McCall is medical director of the sleep center in the department of psychiatry and behavioral medicine at the Bowman Gra