Care of the Patient with a Sleep Disorder

  • Thomas A. Johnson
  • James J. Deckert


Sleep is a periodically recurring physiologic state of lessened responsiveness from which one can be readily awakened. Quality and quantity of sleep vary with age. Newborns sleep an average of 16 hours each day in randomly fragmented fashion. As an individual matures, sleep usually coalesces into a single prolonged nighttime period, with an average length of 7 to 8 hours in adults. A few individuals function well with as little as 4 hours per day, whereas others require 10 hours or more. Transition into older adulthood produces a gradual increase in total daily sleep time. By age 90 the average is nearly 9 hours per day. In addition, older adults often take longer to fall asleep, take daytime naps, experience more frequent awakenings, and spend less time in the deep states of sleep.1 A wide variety of disorders can interfere with normal sleep patterns.


Obstructive Sleep Apnea Sleep Apnea Continuous Positive Airway Pressure Sleep Disorder Obstructive Sleep Apnea Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Roth T, Roehrs TA. Sleep disorders in the elderly. Clin Geriatr Med 1989;5:275–87.Google Scholar
  2. 2.
    Regestein QR, Monk TH. Delayed sleep phase syndrome: a review of its clinical aspects. Am J Psychiatry 1995;152:602–8.PubMedGoogle Scholar
  3. 3.
    Bootzin RR, Perlis ML. Nonpharmacologic treatments of insomnia. J Clin Psychiatry 1992;53 Supp1:37–41.PubMedGoogle Scholar
  4. 4.
    Morin CM, Culbert JP, Schwartz SM. Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry 1994;151:1172–80.PubMedGoogle Scholar
  5. 5.
    Friedman L, Bliwise DL, Yesavage JA, Salom SR. A preliminary study comparing sleep restriction and relaxation treatments for insomnia in older adults. J Gerontol 1991;46:1–8.CrossRefGoogle Scholar
  6. 6.
    Lichstein KL, Johnson RS. Relaxation for insomnia and hypnotic medication use in older women. Psychol Aging 1993; 8:103–11.PubMedCrossRefGoogle Scholar
  7. 7.
    Guilleminault C, Clerk A, Black J, et al. Nondrug treatment trials in psychophysiologic insomnia. Arch Intern Med 1995; 155:838–44.PubMedCrossRefGoogle Scholar
  8. 8.
    Walsh JK, Schweitzer PK, Anch AM, et al. Sleepiness/alertness on a simulated night shift following sleep at home with triazolam. Sleep 1991;14:140–6.PubMedGoogle Scholar
  9. 9.
    Pagel JF. Treatment of insomnia. Am Fam Physician 1994;49: 1417–21.PubMedGoogle Scholar
  10. 10.
    Hartmann PM. Drug treatment of insomnia: indications and newer agents. Am Fam Physician 1995;51:191–4.PubMedGoogle Scholar
  11. 11.
    Langtry HD, Benfield P. Zolpidem, a review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential. Drugs 40:291–313.Google Scholar
  12. 12.
    Garfinkel D, Laudon M, Nof D, Zisapel N. Improvement of sleep quality in elderly people by controlled-release melatonin. Lancet 1995;346:541–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Haimov I, Lavie P, Laudon M, et al. Melatonin replacement therapy of elderly insomniacs. Sleep 1995;18:598–603.PubMedGoogle Scholar
  14. 14.
    Grad RM. Benzodiazepines for insomnia in communitydwelling elderly: a review of benefit and risk. J Fam Pract 1995;41:473–81.PubMedGoogle Scholar
  15. 15.
    Aldrich MS, Desforges JF. Narcolepsy. Curr Concepts 323: 389–93.Google Scholar
  16. 16.
    Chaudhary BA, Husain I. Narcolepsy. J Fam Pract 1993;36: 207–13.PubMedGoogle Scholar
  17. 17.
    Garma L, Marchand F. Non-pharmacological approaches. Sleep 1994;17:S97–102.PubMedGoogle Scholar
  18. 18.
    Miller MM, Aldrich MS, Koob GF, Zarcone VP. Narcolepsy and its treatment with stimulants. Sleep 1994;17:352–71.Google Scholar
  19. 19.
    Young T, Palta M, Dempsey J, et al. The occurrence of sleepdisordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Partinen M, Guilleminault C. Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients. Chest 1990;97:27–32.PubMedCrossRefGoogle Scholar
  21. 21.
    He J, Kryger MR, Zorick FJ, et al. Mortality and apnea index in obstructive sleep apnea: experience in 385 male patients. Chest 1988;94:9–14.PubMedCrossRefGoogle Scholar
  22. 22.
    Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea patients, mortality. Chest 1988;94:1200–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Strollo PJ Jr, Rogers RM. Obstructive sleep apnea. N Engl J Med 1996;334:99–104.PubMedCrossRefGoogle Scholar
  24. 24.
    Reeves-Hoche MK, Hudger DW, Meck R, et al. Continuous versus bilevel positive airway pressure for obstructive sleep apnea. Am J Respir Crit Care Med 1995;151:443–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Hanzel DA, Proia NG, Hudger DW. Response of obstructive sleep apnea to fluoxetine and protriptyline. Chest 1991;100: 416–21.PubMedCrossRefGoogle Scholar
  26. 26.
    Practice parameters for the use of laser-assisted uvulopalatoplasty. Sleep 1994;17:744–8.Google Scholar
  27. 27.
    Okeefe ST. Restless legs syndrome, a review. Arch Intern Med 1996;156:243–8.CrossRefGoogle Scholar
  28. 28.
    Walters AS, Hening W. Clinical presentation and neuropharmacology of restless legs syndrome. Clin Neuropharmacol 1987;10:225–37.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Thomas A. Johnson
  • James J. Deckert

There are no affiliations available

Personalised recommendations