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Sleep, Aging and Dementia

Sleep, Aging and Dementia. Josepha A. Cheong, MD University of Florida Departments of Psychiatry and Neurology Chief, Division of Geriatric Psychiatry . Normal Sleep. Average adult needs ~ 8.3 hrs Sleep latency: time between going to bed till onset of sleep Average is 10minutes

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Sleep, Aging and Dementia

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  1. Sleep, Aging and Dementia Josepha A. Cheong, MD University of Florida Departments of Psychiatry and Neurology Chief, Division of Geriatric Psychiatry

  2. Normal Sleep • Average adult needs ~ 8.3 hrs • Sleep latency: time between going to bed till onset of sleep • Average is 10minutes • 75% spent in Non-REM sleep • 25% spent in REM sleep

  3. Changes with Age • Decreased REM sleep • Increased awakenings and easy arousal

  4. Sleep Difficulties in the Elderly • Insomnia estimated to be in ½ of the Elderly • Women > Men • Risk factors for insomnia • Depression • Breathing difficulties • Poor health

  5. Sleep Disturbance in Dementia • May lead to injury from wandering • Leads to difficulty for the caregiver • Exacerbates any pre-existing behavioral difficulties • A common reason for initiating nursing home placement

  6. Assessment of Sleep Difficulty in Dementia • Careful review of all medications – prescription and over-the-counter meds • Examine the sleep environment • Review of recent events/changes that may be stressful to the patient • Evaluate for depression • Evaluate patient for obstructive sleep apnea

  7. Obstructive Sleep Apnea • Loud snoring • Nighttime restlessness • Increased daytime confusion • Daytime drowsiness • Waking up confused • 25% of elderly; 50% of dementia patients

  8. Treatment Continuous Positive Airway Pressure • A nosepiece connected to a hose • The hose is places positive pressure into the airway that keeps the airway open

  9. Treatment • Sleep Hygiene • Reduce intake of caffeine and fluids • Moderate exercise (walking) • Cool (68-72 degrees), dark and quiet room • Set times for sleeping and waking

  10. Treatment in Dementia • Frequent Orientation during the day • Restrict napping • Provide access to daylight • Moderate exercise

  11. Medication Management • Zolpidem or Sonata • Benzodiazepines: Ativan or Restoril • Monitor for falls • Stay away from anticholinergic medications – likely to exacerbating confusion

  12. Anticholinergic Medications • Atarax • Vistaril • Benadryl • Tylenol PM

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