Abstract
Older adults experience many physical and health-related changes, including normative changes in sleep patterns characterized by greater fragility of sleep and a tendency toward “lightening” of sleep. This altered sleep patterning combined with an accumulation of other age-related changes (such as illness, polypharmacy, institutionalization, and social role transitions) increases the likelihood of incident sleep complaints and chronic insomnia during older adulthood. This chapter will provide an overview of the foundational research literature on late-life insomnia integrated with up-to-date data on the prevalence and clinical presentation of insomnia symptoms among older adults. Guidelines for the assessment, diagnosis, and treatment of late-life insomnia will also be summarized.
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References
Abell JG, Shipley MJ, Ferrie JE, Kivimäki M, Kumari M. Association of chronic insomnia symptoms and recurrent extreme sleep duration over 10 years with well-being in older adults: a cohort study. BMJ Open. 2016;6(2):e009501.
Altena E, van der Werf Y, Strijers RLM, Van Someren EJW. Sleep loss affects vigilance: effects of chronic insomnia and sleep therapy. J Sleep Res. 2008;17(3):335–43.
American Academy of Sleep Medicine. International classification of sleep disorders. 2nd ed. Westchester: American Academy of Sleep Medicine; 2005. p. 1–31.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013.
Ancoli-Israel S, Ayalon L, Salzman C. Sleep in the elderly: normal variations and common sleep disorders. Harv Rev Psychiatry. 2008;16(5):279–86.
Asnis GM, Thomas M, Henderson MA. Pharmacotherapy treatment options for insomnia: a primer for clinicians. Int J Mol Sci. 2016;17(1):50.
Bao YP, Han Y, Ma J, Wang RJ, Shi L, Wang TY, et al. Cooccurrence and bidirectional prediction of sleep disturbances and depression in older adults: meta-analysis and systematic review. Neurosci Biobehav Rev. 2017;75:257–73.
Black DS, O’Reilly GA, Olmstead R, Breen EC, Irwin MR. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances. JAMA Intern Med. 2015;175(4):494–501.
Blackwell T, Yaffe K, Laffan A, Ancoli-Israel S, Redline S, Ensrud KE, et al. Associations of objectively and subjectively measured sleep quality with subsequent cognitive decline in older community-dwelling men: the MrOS sleep study. Sleep. 2014;37(4):655–63.
Boden-Albala B, Bazil C, Moon Y, De Rosa J, Elkind MS, Paik MC et al. Unplanned napping causes seniors vascular events. International Stroke Conference. New Orleans, USA. American Stroke Association; 2008.
Bonanni E, Tognoni G, Maestri M, Salvati N, Fabbrini M, Borghetti D, et al. Sleep disturbances in elderly subjects: an epidemiological survey in an Italian district. Acta Neurol Scand. 2010;122(6):389–97.
Bootzin RR, Epstein DR. Stimulus control. In: Lichstein KL, Morin CM, editors. Treatment of late-life insomnia. Thousand Oaks: Sage; 2000. p. 185–206.
Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, Morin CM. Recommendations for a standard research assessment of insomnia. Sleep. 2006;29(9):1155–73.
Campbell SS, Murphy PJ. The nature of spontaneous sleep across adulthood. J Sleep Res. 2007;16(1):24–32.
Campbell SS, Murphy PJ, Stauble TN. Effects of a nap on nighttime sleep and waking function in older subjects. J Am Geriatr Soc. 2005;53(1):48–53.
Carley DW, Farabi SS. Physiology of sleep. Diabetes Spectr. 2016;29(1):5–9.
Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL, et al. The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep. 2012;35:287–302.
Chen X, Wang R, Zee P, Lutsey PL, Javaheri S, Alcántara C, et al. Racial/ethnic differences in sleep disturbances: the multi-ethnic study of atherosclerosis (MESA). Sleep. 2015;38(6):877–88.
Cintron D, Lipford M, Larrea-Mantilla L, Spencer-Bonilla G, Lloyd R, Gionfriddo MR, et al. Efficacy of menopausal hormone therapy on sleep quality: systematic review and meta-analysis. Endocrine. 2017;55(3):702–11.
Cotroneo A, Gareri P, Nicoletti N, Lacava R, Grassone D, Maina E, et al. Effectiveness and safety of hypnotic drugs in the treatment of insomnia in over 70-year old people. Arch Gerontol Geriatr. 2007;44.(suppl:121–4.
Crowley K. Sleep and sleep disorders in older adults. Neuropsychol Rev. 2011;21(1):41–13.
De Almondes KM, Costa MV, Malloy-Diniz LF, Diniz BS. Insomnia and risk of dementia in older adults: systematic review and meta-analysis. J Psychiatr Res. 2016;77:109–15.
Dement W, Richarson G, Prinz P, Carskadon M, Kripke D, Czeisler C. Changes of sleep and wakefulness with age. In: Finch CE, Schneider EL, editors. Handbook of the biology of aging. 2nd ed. New York: Van Nostrand Reinhold; 1985. p. 692–717.
Dolder C, Nelson M, McKinsey J. Use of non-benzodiazepine hypnotics in the elderly: are all agents the same? CNS Drugs. 2007;21(5):389–405.
Dragioti E, Bernfort L, Larsson B, Gerdle B, Levin LA. Association of insomnia severity with well-being, quality of life and health care costs: a cross-sectional study in older adults with chronic pain (PainS65+). Eur J Pain. 2018;22(2):414–25.
Dragioti E, Levin LA, Bernfort L, Larsson B, Gerdle B. Insomnia severity and its relationship with demographics, pain features, anxiety, and depression in older adults with and without pain: cross-sectional population-based results from the PainS65+ cohort. Ann Gen Psychiatry. 2017;16:15.
Durrence HH, Lichstein KL. The sleep of African Americans: a comparative review. Behav Sleep Med. 2006;4(1):29–44.
Dzierzewski J, Williams JM, Roditi D, Marsiske M, McCoy K, McNamara J, et al. Daily variations in objective nighttime sleep and subjective morning pain in older adults with insomnia: evidence of covariation over time. J Am Geriatr Soc. 2010;58(5):925–30.
Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep. 1995;18(6):425–32.
Foley DJ, Monjan A, Simonsick EM, Wallace RB, Blazer DG. Incidence and remission of insomnia among elderly adults: an epidemiologic study of 6,800 persons over three years. Sleep. 1999;22(Suppl 2):S366–72.
Foley DJ, Ancoli-Israel S, Britz P, Walsh J. Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America survey. J Psychosom Res. 2004;56(5):497–502.
Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. JAMA. 1989;262(11):1479–84.
Garland SN, Carlson LE, Stephens AJ, Antle MC, Samuels C, Campbell TS. Mindfulness-based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: a randomized, partially blinded, noninferiority trial. J Clin Oncol. 2014;32(5):449–57.
Gillin JC, Ancoli-Israel S. The impact of age on sleep and sleep disorders. In: Salzman C, editor. Clinical geriatric psychopharmacology. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 483–512.
Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331(7526):1169.
Goldman SE, Hall M, Boudreau R, Matthews KA, Cauley JA, Ancoli-Israel S, et al. Association between nighttime sleep and napping in older adults. Sleep. 2008;31(5):733–40.
Gong H, Ni CX, Liu YZ, Zhang Y, Su WJ, Lian YJ. Mindfulness meditation for insomnia: a meta-analysis of randomized controlled trials. J Psychosom Res. 2016;89:1–6.
Gureje O, Kola L, Ademola A, Olley BO. Profile, comorbidity and impact of insomnia in the Ibadan study of ageing. Int J Geriatr Psychiatry. 2009;24(7):686–93.
Gureje O, Loadeji BD, Abiona T, Makanjuola V, Esan O. The natural history of insomnia in the Ibadan study of ageing. Sleep. 2011;34(7):965–73.
Haimov I, Hadad BS, Shurkin D. Visual cognitive function: changes associated with chronic insomnia in older adults. J Gerontol Nurs. 2007;33(10):32–41.
Haimov I, Hanuka E, Horowitz Y. Chronic insomnia and cognitive functioning among older adults. Behav Sleep Med. 2008;6(1):32–54.
Hara C, Stewart R, Lima-Costa MF, Rocha FL, Fuzikawa C, Uchoa E, et al. Insomnia subtypes and their relationship to excessive daytime sleepiness in Brazilian community-dwelling older adults. Sleep. 2011;34(8):1111–7.
Harvey AG. A cognitive model of insomnia. Behav Res Ther. 2002;40(8):869–93.
Iber C. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specification. Westchester: American Academy of Sleep Medicine; 2007.
Irwin MR, Cole JC, Nicassio PM. Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol. 2006;25(1):3–14.
Jaussent I, Dauvilliers Y, Ancelin M, Darigues J, Tavernier B, Touchon J, et al. Insomnia symptoms in older adults: associated factors and gender differences. Am J Geriatr Psychiatry. 2011;19(1):88–97.
Jean-Louis G, Magai CM, Cohen CI, Zizi F, von Gizycki H, DiPalma J, et al. Ethnic differences in self-reported sleep problems in older adults. Sleep. 2001;24(8):926–33.
Jehan S, Masters-Isarilov A, Salifu I, Zizi F, Jean-Louis G, Pandi-Perumal SR, et al. Sleep disorders in postmenopausal women. J Sleep Disord Ther. 2015;4(5).
Kamal NS, Gammack JK. Insomnia in the elderly: cause, approach, and treatment. Am J Med. 2006;119(6):463–9.
Kaufmann CN, Mojtabai R, Hock RS, Thorpe RJ, Canham SL, Chen L. Racial/ethnic differences in insomnia trajectories among U.S. older adults. Am J Geriatr Psychiatry. 2016;24(7):575–84.
Kay DB, Dombrovski AY, Buysse DJ, Reynolds CF, Begley A, Szanto K. Insomnia is associated with suicide attempt in middle-aged and older adults with depression. Int Psychogeriatr. 2016;28(4):613–9.
Kim J, Stewart R, Kim S, Yang S, Shin I, Yoon J. Insomnia, depression, and physical disorders in late life: a 2-year longitudinal community study in Koreans. Sleep. 2009;39(9):1221–8.
Krishnan P, Hawranik P. Diagnosis and management of geriatric insomnia: a guide for nurse practitioners. J Am Acad Nurse Pract. 2008;20(12):590–9.
Li J, Cacchione PZ, Hodgson N, Riegel B, Keenan BT, Scharf MT, et al. Afternoon napping and cognition in Chinese older adults: findings from the China Health and Retirement Longitudinal Study baseline assessment. J Gerontol A Biol Sci Med Sci. 2017;65(2):373–80.
Lichstein KL. Relaxation. In: Lichstein KL, Morin CM, editors. Treatment of late-life insomnia. Thousand Oaks: Sage; 2000. p. 185–206.
Lichstein KL, Riedel BW, Wilson NM, Lester KW, Aguillard RN. Relaxation and sleep compression for late-life insomnia: a placebo controlled trial. J Consult Clin Psychol. 2001;69(2):227–39.
Lichstein KL, Durrence HH, Riedel BW, Taylor DJ, Bush AJ. Epidemiology of sleep: age, gender, and ethnicity. Mahwah: Lawrence Erlbaum Associates, Inc; 2004.
Lie JD, Tu KN, Shen DD, Wong BM. Pharmological treatment of insomnia. PT. 2015;40(11):759–68.
Littner M, Hirshkowitz M, Kramer M, Kapen S, Anderson WM, Bailey D, et al. Practice parameters for using polysomnography to evaluate insomnia: an update. Sleep. 2003;26:754–60.
Liu X, Liu L. Sleep habits and insomnia in a sample of elderly persons in China. Sleep. 2005;28(12):1579–87.
McCrae CS, Rowe MA, Tierney CG, Dautovich ND, DeFinis AL, McNamara JPH. Sleep complaints, subjective and objective sleep patterns, health, psychological adjustment, and daytime functioning in community-dwelling older adults. J Gerontol B Psychol Sci Soc Sci. 2005;60(4):182–9.
McCrae CS, Rowe MA, Dautovich ND, Lichstein KL, Durrence HH, Riedel BW, et al. Sleep hygiene practices in two community dwelling samples of older adults. Sleep. 2006;29:1551–60.
McCrae CS, Dzierzewski JM, Kay DB. Treatment of late-life insomnia. Sleep Med Clin. 2009;4(4):593–604.
McCurry SM, Logsdon RG, Teri L, Vitiello MV. Evidence-based psychological treatments for insomnia in older adults. Psychol Aging. 2007;22(1):18–27.
Middelkoop HA, Kerkhof GA, Smilde-van den Doel DA, Ligthart GJ, Kamphuisen HA. Sleep and ageing: the effect of institutionalization on subjective and objective characteristics of sleep. Age Ageing. 1994;23(5):411–7.
Monk TH. Aging human circadian rhythms: conventional wisdom may not always be right. J Biol Rhythm. 2005;20(4):366–74.
Monk TH, Germain A, Buysse DJ. The sleep of the bereaved. Sleep Hypn. 2009;11(1):219–29.
Morgan K. Sleep and aging. In: Lichstein KL, Morin CM, editors. Treatment of late-life insomnia. Thousand Oaks: Sage; 2000. p. 3–36.
Morgan K. Daytime activity & risk factors for late-life insomnia. J Sleep Res. 2003;12(3):231–8.
Morgan K, Clark D. Longitudinal trends in late-life insomnia: implications for prescribing. Age Aging. 1997;26(3):179–84.
Morgenthaler T, Alessi C, Friedman L, Owens J, Kapur V, Boehlecke B, et al. Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Sleep. 2007;30(4):519–29.
Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late life insomnia: a randomized controlled trial. JAMA. 1999;281(11):991–9.
Morin CM, Savard J, Blais FC. Cognitive therapy. In: Lichstein KL, Morin CM, editors. Treatment of late-life insomnia. Thousand Oaks: Sage; 2000. p. 185–206.
Neikrug AB, Ancoli-Israel S. Sleep disorders in the older adult−a mini review. Gerontology. 2010;56(2):181–9.
Ohayon M. Epidemiologic study on insomnia in the general population. Sleep. 1996;19(Suppl 1):S7–S15.
Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97–111.
Ohayon MM, Zulley J, Guilleminault C, Smirne S, Priest RG. How age and daytime activities are related to insomnia in the general population: consequences for older people. J Am Ger Soc. 2001;49(4):360–6.
Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004;27(7):1255–73.
Osorio R, Pirraglia E, Aguera-Ortiz LF, During EH, Sacks H, Ayappa I, et al. Greater risk of Alzheimer’s disease in older adults with insomnia. J Am Geriatr Soc. 2011;59(3):559–61.
Petrov ME, Lichstein KL. Differences in sleep between black and white adults: an update and future directions. Sleep Med. 2016;18:74–81.
Picarsic JL, Glynn NW, Taylor CA, Katula JA, Goldman SE, Studenski SA, et al. Self-reported napping and duration and quality of sleep in the Interventions and Independence for Elders Pilot Study. J Am Geriatr Soc. 2008;56(9):1674–80.
Pigeon WR, Hegel M, Unützer J, Fan MY, Sateia MJ, Lyness JM, et al. Is insomnia a perpetuating factor for late-life depression in the IMPACT cohort? Sleep. 2008;31(4):481–8.
Rechtschaffen A, Kales AA. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles: Brain Information Service; 1968.
Richards KC, Lambert C, Beck CK, Bliwise DL, Evans WJ, Kalra GK, et al. Strength training, walking, and social activity improve sleep in nursing home and assisted living residents: randomized controlled trial. J Am Geriatr Soc. 2011;59(2):214–23.
Riedel BW, Lichstein KL. Insomnia and daytime functioning. Sleep Med Rev. 2000;4(3):277–98.
Roux FJ, Kryger MH. Medication effects on sleep. Clin Chest Med. 2010;31(2):397–405.
Rowe M, McCrae C, Campbell J, Horne C, Tiegs T, Lehman B, et al. Actigraphy in older adults: comparison of means and variability of three different aggregates of measurement. Behav Sleep Med. 2008;6(2):127–45.
Ruiter ME, DeCoster J, Jacobs L, Lichstein KL. Sleep disorders in African Americans and Caucasian Americans: a meta-analysis. Behav Sleep Med. 2010;8(4):246–59.
Ruiter ME, Vander Wal GV, Lichstein KL. Insomnia in the elderly. In: Pandi-Peruman SR, Monti JM, Monjan A, editors. Principles and practice of geriatric sleep medicine. Cambridge: Cambridge University Press; 2010. p. 271–9.
Sadler P, McLaren S, Jenkins M. A psychological pathway from insomnia to depression among older adults. Int Psychogeriatr. 2013;25(8):1375–83.
Sateia MJ, Doghramji K, Hauri PJ, Morin CM. Evaluation of chronic insomnia: an American Academy of Sleep Medicine review. Sleep. 2000;23(2):237–41.
Schmidt C, Peigneux P, Cajochen C. Age-related changes in sleep and circadian rhythms: impact on cognitive performance and underlying neuroanatomical networks. Front Neurol. 2012;3(118).
Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487–504.
Schnelle JF, Cruise PA, Alessi CA, Al-Samarrai N, Ouslander JG. Sleep hygiene in physically dependent nursing home residents. Sleep. 1998;21(5):515–23.
Sivertsen B, Omvik S, Pallesen S, Bjorvatn B, Havik OE, Kvale G, et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA. 2006;295(24):2851–8.
Smagula SF, Stone KL, Fabio A, Cauley JA. Risk factors for sleep disturbances in older adults: evidence from prospective studies. Sleep Med Rev. 2016;25:21–30.
Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev. 2004;8(2):119–32.
Smith MT, Perlis ML, Smith MS, Giles DE, Carmody TP. Sleep quality and presleep arousal in chronic pain. J Behav Med. 2000;23(1):1–13.
Smith MT, Perlis ML, Park A, Smith MA, Pennington J, Giles DE, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry. 2002;159(1):5–11.
Spira AP, Kaufmann CN, Kasper JD, Ohayon MM, Rebok GW, Skidmore E, et al. Association between insomnia symptoms and functional status in U.S. older adults. J Gerontol B Psychol Sci Soc Sci. 2014;69(Suppl 1):S35–41.
Stone KL, Ancoli-Israel S, Blackwell T, Ensrud KE, Cauley JA, Redline S, et al. Actigraphy-measured sleep characteristics and risk of falls in older women. Arch Intern Med. 2008;168(16):1768–75.
Taylor SR, Weiss JS. Review of insomnia pharmacotherapy options for the elderly: implications for managed care. Popul Health Manag. 2009;12(6):317–23.
The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60:616–31.
Varrasse M, Li J, Gooneratne N. Exercise and sleep in community-dwelling older adults. Curr Sleep Med Rep. 2015;1(4):232–40.
Wilt J, MacDonald R, Brasure M, Olson CM, Carlyle M, Fuchs E, et al. Pharmacologic treatment of insomnia disorder: an evidence report for a Clinical Practice Guideline by the American College of Physicians. Ann Intern Med. 2016;165(2):103–12.
Wohlgemuth WK, Edinger JD. Sleep restriction therapy. In: Lichstein KL, Morin CM, editors. Treatment of late-life insomnia. Thousand Oaks: Sage; 2000. p. 185–206.
Wolkove N, Elkholy O, Baltzan M, Palayew M. Sleep and aging: sleep disorders commonly found in older people. CMAJ. 2007;176(9):1299–04.
World Health Organization. The ICD-10 Classification of mental and behavioral disorders. Geneva: World Health Organization; 1993.
Yokoyama E, Saito Y, Kaneita Y, Ohida T, Harano S, Tamaki T, et al. Association between subjective well-being and sleep among the elderly in Japan. Sleep Med. 2008;9(2):157–64.
Yokoyama E, Kaneita Y, Saito Y, Uchiyama M, Matsuzaki Y, Tamaki T, et al. Association between depression and insomnia subtypes: a longitudinal study on the elderly in Japan. Sleep. 2010;33(12):1693–702.
Zhang B, Wing Y. Sex differences in insomnia: a meta-analysis. Sleep. 2006;29(1):85–93.
Zhang JX, Lui HX, Xie XH, Zhao D, Shan MS, Zhang XL, et al. Mindfulness-based stress reduction for chronic insomnia in adults older than 75 years: a randomized, controlled, single-blind clinical trial. Explore. 2015;11(3):180–5.
Zhong G, Wang Y, Tao T, Ying J, Zhao Y. Daytime napping and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis of prospective cohort studies. Sleep Med. 2015;16(7):811–9.
Petrov MER, Vander Wal GS, Lichstein KL. Late-life insomnia. In: Pachana NA, Laidlaw K, editors. The Oxford handbook of clinical geropsychology. Oxford: Oxford University Press; 2015. p. 527–48.
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Molzof, H.E., Petrov, M.E., Lichstein, K.L. (2020). Late-Life Insomnia. In: Chun, A. (eds) Geriatric Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-19625-7_22
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