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  1. Home
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  3. Principles and Practice of Geriatric Sleep Medicine
  • Cited by 4
Publisher:
Cambridge University Press
Online publication date:
August 2010
Print publication year:
2009
Online ISBN:
9780511770661
DOI:
https://doi.org/10.1017/CBO9780511770661
Subjects:
Geriatrics, Neurology and Clinical Neuroscience, Medicine
Information

Book description

Sleep disorders cause considerable morbidity and distress in the aging population. By highlighting the clinical diagnosis and management of sleep disorders, this volume provides a valuable resource for all those involved in health care of older individuals. The changes in sleep patterns that occur during normal aging are described, followed by authoritative chapters on the presentation of various age-related sleep disorders. The book deals with the range of therapeutic measures available for managing these disorders and gives insight to potential areas of research that have emerged in the last few years, such as the study of circadian rhythms in later life, sleep patterns associated with co-morbidities and the use of quality-of-life measurement tools to determine sleep quality as we age. This volume is relevant to sleep disorders specialists, psychiatrists, geriatricians and gerontologists, and any professionals and researchers working in the interdisciplinary areas of sleep and aging.

Reviews

'… an excellent, comprehensive text on an increasingly relevant subject.'

Source: Sleep Medicine

'Principles and Practice of Geriatric Sleep Medicine is a comprehensive, and much needed book for medical practitioners … It is edited by leaders in the field, and has contributions from most of the eminent researchers and international experts in the field of sleep medicine. … this book is well written and a pleasure to read. The chapters are well structured and succinct, and present a wealth of up-to-date research. … The content is diverse and is thus likely to appeal to many experienced clinicians. … I would highly recommend this book for any clinicians and researchers working in the ageing and/or sleep disciplines.'

Source: Acta Neuropsychiatrica

'Its 41 chapters bring together the expertise of researchers and clinicians representing the full range of specialities currently working at the interface of sleep disorders and aging. … the text can serve as a useful reference for those interested in exploring the field or who are looking to improve their ability to understand and treat sleep disorders in this population.'

Source: Neurology

'… a worthwhile contribution to the field of sleep medicine. … a comprehensive review of recent developments in the field.'

Source: Doody's

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Contents

Page 1 of 2

Contents
  • 11 - Assessment and differential diagnosis of sleep disorders in the elderly
    pp 123-130
  • View abstract

    Summary

    This chapter shows that circadian rhythms have a tendency to become less robust with increasing age, i.e. they generally exhibit decreases in amplitude and less stability. Some obvious consequences of such reductions in rhythm amplitude are fragmentation of rhythms, complete loss of temporal order and structure, loss of stability of entrainment, and responsiveness to zeitgebers. Other consequences include changes in clock period and its stability, and inappropriate phase relationships among behavioral and metabolic oscillations. Age-related decreases in the amplitude of circadian rhythms in humans and other mammals have been linked to a deterioration of rhythmic behaviors such as those seen in locomotor activity, feeding and drinking. Anatomical and electrophysiological studies have shown that age-related changes occur within the biological clocks of mammals including humans. There is increasing evidence for age-related changes in the structure and neurochemistry of the suprachiasmatic nucleus (SCN), including alterations in cells producing vasopressin.
  • 12 - Circadian rhythm dysregulation in the elderly: advanced sleep phase syndrome
    pp 131-142
  • View abstract

    Summary

    The current evidence that aging is associated with a significant increase in sleep-wake cycle complaints has individual, social, and economic consequences. These age-related changes occur as early as the middle years of life, with over 35% of the population in their forties to sixties reporting sleep difficulties. Age effects on non-rapid eye movement (NREM) sleep electroencephalogram (EEG) differ between brain topographical sites in parallel with age-related changes in gray matter density of the brain. A precise interaction between the homeostatic and circadian processes is required for optimal sleep and vigilance. Age-related increase in wakefulness during sleep may be associated with a phase angle change between the signal from the circadian clock and sleep-wake cycles. Age-related changes in the neural correlates of NREM sleep oscillations may also underlie changes in memory and brain plasticity. There is need to determine the consequences of age-dependent changes to the sleep-wake cycle in middle-aged individuals.
  • 13 - Circadian rhythm dysregulation in the elderly: shift work
    pp 143-149
  • View abstract

    Summary

    This chapter presents the factors relevant to assessing sleep problems in the menopausal transition that have changed over time. Expectations regarding menopause have changed over time, particularly since the advent of hormone replacement therapy. Increasing interest in reproductive aging and the advent of women's health as a specialty has led to a great deal of research on the menopausal transition. It is possible that there has been an increase in sleep disturbances in women across all menopausal status categories, but that the rank order of increasing prevalence of sleep problems among pre-, peri-, and post-menopausal women prevails. Preliminary analyses from the "Sleep in Midlife Woman" sub study, with biannual in-home polysomnography, continue to support the hypothesis that the risk of sleep apnea increases with advancement through the menopausal transition. There are important clinical implications from current thinking on sleep in the menopausal transition.
  • 14 - Nocturia in the aging population
    pp 150-159
  • View abstract

    Summary

    With the establishment of sleep-dependent memory processing, an important and necessary step is to begin understanding how sleep loss in later life may contribute to the known deterioration of memory function, and how these factors may interact. The chapter outlines the key components: memory systems, memory stages, and sleep stages. The chapter describes the critical requirement of adequate sleep before learning for the initial formation or "encoding" of memory. A number of neuroimaging studies have shown decreased MTL involvement during memory formation in older adults, compared to young adults. Work across the neurosciences will be necessary to test this hypothesis at both a neural and behavioral level. The chapter addresses the most important horizon quest: translating basic findings into clinical action, and understanding how disease and pathology stemming from aging can be understood on the basis of sleep-dependent memory failure.
  • 15 - Sleep and fibromyalgia in the elderly
    pp 160-166
  • View abstract

    Summary

    The central research topic of this chapter is embedded within three major fields of research, that is, sleep, memory, and cognitive aging research. Sleep is further characterized by changes in cerebral activity across the sleep-wake cycle. At a global level, brain activity decreases from waking to non-REM (NREM) sleep and returns back to waking levels during rapid eye movement (REM) sleep. Like sleep, memory is not a unitary system. In fact, there are several different classification schemes for human memory. In the context of sleep-dependent memory consolidation, an important distinction is usually drawn between declarative and non-declarative memory systems. Age-related cognitive decline is characterized by healthy and pathological processes in adult brain development. In this context, an important distinction is drawn between normal aging, mild cognitive impairment (MCI), and Alzheimer's disease (AD). Several psychiatric disorders such as Alzheimer's disease and depression are associated with disturbances of both sleep and memory.
  • 16 - Sleep and pain management in the elderly
    pp 167-182
  • View abstract

    Summary

    The major confirmation of the relationship between sleep and autonomic nervous system (ANS) is the presence of dynamic synchronous fluctuations in sleep phases and autonomic functions. Nocturnal monitoring of breathing, pulse rate, systemic arterial pressure, and peripheral vasomotor activation discloses autonomic deactivation that, appearing at sleep onset, continues into deep sleep. The increased prevalence of sleep disorders with aging may be influenced by medical co-morbidities and medications that alter sleep architecture. Age-related changes in ANS function are linked to changes in body composition, neuronal loss, neurotransmitter underproduction or reduced receptor function, tissue damage, and hormonal changes. Autonomic function testing may be very helpful to evaluate the extent of autonomic involvement and to monitor the course of the disorder and the response to therapy. The effect of age on sudomotor pathway and control of core temperature is complex and involves different levels of ANS.

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