Sleep and Sleep Disorders

  • Joyce D. Kales
  • Michael Carvell
  • Anthony Kales


Elderly persons frequently complain of problems with their sleep.1–7 Actually, they often are very concerned about not obtaining enough sleep and/or not feeling refreshed after sleep.2,4,7 Physicians, however, may feel that some elderly patients are excessively preoccupied with their sleep in a hypochondriacal manner. Thus, not infrequently the elderly’s sleep complaints are not given proper attention or are simply dealt with through the hasty prescription of a hypnotic.2,4 Through such practices, a number of important issues related to the nocturnal as well as daytime life are overlooked, while there is an additional risk of creating certain iatrogenic complications.


Sleep Apnea Sleep Disorder Elderly Person Excessive Daytime Sleepiness Sleep Laboratory 
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  1. 1.
    Bixler EO, Kales A, Soldatos CR, et al.: Prevalence of sleep disorders in the Los Angeles metropolitan area. Am J Psychiatry 1979; 136: 1257–1262.PubMedGoogle Scholar
  2. 2.
    Cadieux RJ, Woolley D, Kales JD: Sleep disorders in the elderly, in Berlin RM, Soldatos CR (eds): Psychiatric Medicine. Sleep Disorders in Psychiatric Practice, 1986. Longwood, FL, Ryandic Publishing, 1987, pp 165–180.Google Scholar
  3. 3.
    Dement WC, Miles LE, Carskadon MA: “White paper” on sleep and aging. J Am Geriatr Soc 1982; 30: 25–50.PubMedGoogle Scholar
  4. 4.
    Kales A, Kales JD: Evaluation and Treatment of Insomnia. New York, Oxford University Press, 1984.Google Scholar
  5. 5.
    Kales JD: Aging and sleep, in Rochstein M, Goldman R (eds.): Physiology and Pathology of Human Aging. New York, Academic Press, Inc, 1975, pp 188–202.Google Scholar
  6. 6.
    Reynolds CF, Spiker DG, Hanin I, et al: Electroencephalographic sleep, aging, and psychopathology: New data and state of the art. Biol Psychiatry 1983; 18: 139–155.PubMedGoogle Scholar
  7. 7.
    Tune G: Sleep and wakefulness in 509 normal adults. BrJ Med Psychol 1969; 42: 75–80.CrossRefGoogle Scholar
  8. 8.
    Prinz PN: Sleep patterns in the healthy aged: Relationship with intellectual function. J Gerontol 1977; 32: 179186.Google Scholar
  9. 9.
    Aserinsky E, Kleitman N: Regularly occurring periods of eye motility and concomitant phenomena during sleep. Science 1953; 118: 273–274.PubMedCrossRefGoogle Scholar
  10. 10.
    Rechtschaffen A, Kales A: A Manual of Standardized Terminology, Techniques, and Scoring System for Sleep Stages of Human Subjects. NIH no. 204, National Institutes of Health, 1968.Google Scholar
  11. 11.
    William RL, Agnew HW Jr, Webb WB: Sleep patterns in young adults: An EEG study. Electroencephalogr Clin Neurophysiol 1964; 17: 376–381.CrossRefGoogle Scholar
  12. 12.
    Bixler EO, Vela-Bueno A: Normal sleep: Physiological, behavioral, and clinical correlates. Psych Annals 1987; 17: 437–445.Google Scholar
  13. 13.
    Bixler EO, Kales A, Jacoby JA, et al: Nocturnal sleep and wakefulness: Effects of age and sex in normal sleepers. Int J Neurosci 1984; 23: 33–42.PubMedCrossRefGoogle Scholar
  14. 14.
    Webb WB: Sleep in older persons: Sleep structures of 50-to 60-year-old men and women. J Gerontol 1982; 37: 58 1586.Google Scholar
  15. 15.
    Parmelee AH Jr, Wenner WH, Schulz HR: Infant sleep patterns: From birth to 16 weeks of age. J Pediatr 1964; 65: 576–582.PubMedCrossRefGoogle Scholar
  16. 16.
    Williams RL, Karacan I, Hursch CJ. EEG of Human Sleep: Clinical Applications. New York, John Wiley 0000 Sons, 1974.Google Scholar
  17. 17.
    Webb WB, Agnew HW Jr: Sleep cycling within twenty-four hour periods. J Exp Psychol 1967; 74: 158–160.PubMedCrossRefGoogle Scholar
  18. 18.
    Feinberg I, Koresko RL, Heller N: EEG sleep patterns as a function of normal and pathological aging in man. J Psychiatr Res 1967; 5: 107–144.PubMedCrossRefGoogle Scholar
  19. 19.
    Feinberg I, Carlson V. Sleep variables as a function of age in man. Arch Gen Psychiatry 1968; 18: 239–250.CrossRefGoogle Scholar
  20. 20.
    Kales A, Soldatos CR, Kales JD: Taking a sleep history. Am Fam Physician 1980; 22: 101–108.PubMedGoogle Scholar
  21. 21.
    Kales A, Soldatos CR, Kales JD: Sleep disorders: Insomnia, sleep-walking, night terrors, nightmares, and enuresis. Ann Intern Med 1987; 106: 582–592.PubMedGoogle Scholar
  22. 22.
    Kales A, Vela-Bueno A, Kales JD: Sleep disorders: Sleep apnea and narcolepsy. Ann Intern Med 1987; 106: 434–443.PubMedGoogle Scholar
  23. 23.
    Coleman RM, Pollak CP, Weitzman ED: Periodic movements in sleep (nocturnal myoclonus): Relation to sleep disorders. Ann Neurol 1979; 8: 416–421.CrossRefGoogle Scholar
  24. 24.
    Laugaresi E, Coccagna G, Ceroni GB.: Restless legs syndrome and nocturnal myoclonus, in Gastaut H, Lugaresi E, Bertini-Ceroni G,: The Abnormalities of Sleep in Man. Bologna, Aulo Gaggi, 1967, pp 285–294.Google Scholar
  25. 25.
    Culebras A, Magana R: Neurologic disorders and sleep disturbances. Seminars in Neurology’ 1987; 7: 277–285.PubMedCrossRefGoogle Scholar
  26. 26.
    Barker JC: Nocturia in the elderly. Gerontologist 1988; 28: 99–104.PubMedCrossRefGoogle Scholar
  27. 27.
    Williams ME, Pannill FC: Urinary incontinence in the elderly. Ann Intern Med 1982; 97: 895–907.PubMedGoogle Scholar
  28. 28.
    Modolfsky H, Scarisbrick P, England R, Smythe H: Musculoskeletal symptoms and non-REM sleep disturbance in patients with “fibrosistis syndrome” and healthy subjects. Psychosom Med 1975; 37: 341–351.Google Scholar
  29. 29.
    Wolfe F: Fibromyalgia in the elderly: Differential diagnosis and treatment. Geriatrics 1988; 43: 57–68.PubMedGoogle Scholar
  30. 30.
    Guilleminault C, Dement WC (eds): Sleep Apnea Syndromes. New York, Alan R. Liss, Inc., 1978.Google Scholar
  31. 31.
    Lugaresi E, Coccagna G, Mantovani M: Hypersomnia with periodic apneas, in, Weitzman ED (series ed): Advances in Sleep Research, vol 4, New York, Spectrum Publications, 1978.Google Scholar
  32. 32.
    Bliwise D, Carskadon, Carey E,: Longitudinal development ‘of sleep-related respiratory disturbance in adult humans. J Gerontol 1984; 39: 290–293.PubMedCrossRefGoogle Scholar
  33. 33.
    Kales A, Bixler EO, Vela-Bueno A, et al.: Effects of 578 Joyce D. Kales, Michael Carvell, and Anthony Kales nadolol on blood pressure, sleep efficiency, and sleep stages. Clin Pharmacol Ther 1988; 43: 655–662.PubMedCrossRefGoogle Scholar
  34. 34.
    Kales A, Soldatos CR, Bixler EO, et al: Rebound insomnia and rebound anxiety: A review. Pharmacology 1983; 26: 121–137.PubMedCrossRefGoogle Scholar
  35. 35.
    Kales A, Bixler EO, Tan TL, et al.: Chronic hypnotic-drug use: Ineffectiveness, drug-withdrawal insomnia, and dependence. JAMA 1974; 227: 513–517.PubMedCrossRefGoogle Scholar
  36. 36.
    Karacan I, Thornby JI, Anch AM, et al.: Dose-related sleep disturbances induced by coffee and caffeine. Clin Pharmacol Ther 1976; 20: 682–689.PubMedGoogle Scholar
  37. 37.
    Rundell OH, Lester BK, Griffiths WJ, et al.: Alcohol and sleep in young adults. Psychopharmacologia 1972; 26: 201–218.PubMedCrossRefGoogle Scholar
  38. 38.
    Soldatos CR, Kales JD, Scharf MB, et al.: Cigarette smoking associated with sleep difficulty. Science 1980; 207: 551–553.PubMedCrossRefGoogle Scholar
  39. 39.
    Kales JD, Kales A: Rest and sleep, in Taylor RB, Ureda JR, Denham JW (eds): Health Promotion. Principles and Clinical Applications. New York, Appleton-CenturyCrofts, 1982, pp 307–337.Google Scholar
  40. 40.
    Soldatos CR, Vela-Bueno A, Kales A: Sleep in psychiatric disorders, in Berlin RM, Soldatos CR (eds): Psychiatric Medicine. Sleep Disorders in Psychiatric Practice 1986. Longwood, FL, Ryandic Publishing, Inc, 1987, pp 119–132.Google Scholar
  41. 41.
    Rodin J, McAvay G, Timko C: A longitudinal study of depressed mood and sleep disturbances in elderly adults. J Gerontol 1988; 43: 45–53.CrossRefGoogle Scholar
  42. 42.
    Bixler EO, Robertson JA, Soldatos CR: Sleep laboratory assessment of normal sleep and sleep disorders, in Berlin RM, Soldatos CR (eds): Psychiatric Medicine. Sleep Disorders in Psychiatric Practice, 1986. Longwood, FL, Ryandic Publishing, Inc, 1987, pp 105–118.Google Scholar
  43. 43.
    Guilleminault C, Tilkian A, Dement WC: The sleep apnea syndromes. Annu Rev Med 1976; 27: 465–484.PubMedCrossRefGoogle Scholar
  44. 44.
    Kales A, Bixler EO, Soldatos CR, et al.: Biopsychobehavioral correlates of insomnia, I: Role of sleep apnea and nocturnal myoclonus. Psychosomatics 1982; 23: 589–600.PubMedGoogle Scholar
  45. 45.
    Lipowski ZJ: Delirium. Acute Brain Failure in Man. Springfield, IL, Charles S. Thomas, 1980.Google Scholar
  46. 46.
    Patterson J: Triazolam syndrome in the elderly. South Med J 1987; 80: 1425–1426.PubMedCrossRefGoogle Scholar
  47. 47.
    Prien RF: Problems and practices in geriatric psycho-pharmacology. Geriatric Drug Use 1980; 21: 213–223.Google Scholar
  48. 48.
    Johnson LC, Chernik DA: Sedative-hypnotics and human performance Psychopharmacology, 1982; 76: 10 1113.Google Scholar
  49. 49.
    Kales A, Soldatos CR, Bixler EO, et al.: Early morning insomnia with rapidly eliminated benzodiazepines. Science 1983; 220: 95–97.PubMedCrossRefGoogle Scholar
  50. 50.
    Vela-Bueno A, Soldatos CR, Kales A: Anxiety and disordered sleep, in Handbook of Anxiety, Volume 2: Classification, Etiological Factors and Associated Disturbances. Amsterdam, Elsevier, (in press), pp 507–543.Google Scholar
  51. 51.
    Kales A, Bixler EO, Vela-Bueno A, et al.: Comparison of short and long half-life benzodiazepine hypnotics: Triazolam and quazepam. Clin Pharmacol Ther 1986; 40: 378–386.PubMedCrossRefGoogle Scholar
  52. 52.
    Bixler EO, Kales A, Brubaker BH, et al.: Adverse reactions to benzodiazepine hypnotics: Spontaneous reporting system. Pharmacology 1987; 35: 286–300.PubMedCrossRefGoogle Scholar
  53. 53.
    Young JR, Humphries AQ, DeWolfe VG: Restless leg syndrome. Geriatrics 1969; 24: 167–171.PubMedGoogle Scholar
  54. 54.
    Guilleminault C, Raynal D, Takahashi S, et al.: Evaluation of short-term and long-term treatment of the narcolepsy syndrome with clomipramine hydrochloride. Acta Neurol Scand 1976; 54: 71–87.PubMedCrossRefGoogle Scholar
  55. 55.
    Kales A, Soldatos CR, Vela-Bueno A: Clinical comparison of benzodiazepine hynotics with short and long elimination half-lives, in Smith DE, Wesson DR (eds): The Benzodiazepines. Current Standards for Medical Practice. Lancaster, England, MTP Press Limited, 1985, pp 121–147.CrossRefGoogle Scholar
  56. 56.
    Tan TL, Bixler EO, Kales A, Cadieux RJ, Goodman AL: Early morning insomnia, daytime anxiety, and organic mental disorder associated with triazolam. J Fam Pract, 1985; 20: 592–594.PubMedGoogle Scholar
  57. 57.
    Morris HH, Estes ML: Traveler’s amnesia: transient global amnesia secondary to triazolam. JAMA, 1987; 258: 945–946.PubMedCrossRefGoogle Scholar
  58. 58.
    Van der Koref C: Reactions to triazolam. Lancet, 1979; 2: 256.Google Scholar
  59. 59.
    5 mg Halcion withdrawn in FRG, Scrip, 1988; 1296: 3.Google Scholar
  60. 60.
    Kales A, Cadieux RJ, Bixler EO, et al: Severe obstructive sleep apnea-I: onset, clinical course, and characteristics. J Chron Dis 1985; 38: 419–425.PubMedCrossRefGoogle Scholar
  61. 61.
    Guilleminault C, Dement WC, Passouant P: Narcolepsy, in Wietzman ED (ed): Advances in Sleep Research, vol3. New York, Spectrum Publications, 1976.Google Scholar
  62. 62.
    Roth B. Narcolepsy and Hypersomnia. (Prague, Avicenum-Czechloslovak Medical Press) Revised and edited by R Broughton, Basel, Karger, 1980.Google Scholar
  63. 63.
    Kales A, Jacobson A, Paulson MJ, et al: Somnambulism: Psychophysiological correlates, I. All-night EEG studies. Arch Gen Psychiatry 1966; 14: 586–594.PubMedCrossRefGoogle Scholar
  64. 64.
    Kales A, Soldatos CR, Caldwell AB, et al.: Somnambulism: Clinical characteristics and personality patterns. Arch Gen Psychiatry 1980; 37: 1406–1410.PubMedCrossRefGoogle Scholar
  65. 65.
    Kales A, Soldatos CR, Caldwell AB, et al: Nightmares: Clinical characteristics and personality patterns. Am J Psychiatry 1980; 137: 1197–1201.PubMedGoogle Scholar
  66. 66.
    Kales JD, Kales A, Soldatos CR, et al.: Night terrors: Clinical characteristics and personality patterns. Arch Gen Psychiatry 1980; 37: 1413–1417.PubMedCrossRefGoogle Scholar
  67. 67.
    Starfield B: Enuresis: Its pathogenesis and management. Clin Pediatr (Phila) 1972;11:343–350.Google Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • Joyce D. Kales
  • Michael Carvell
  • Anthony Kales

There are no affiliations available

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