Chapter 16.Sleep and Circadian Rhythm Sleep-Wake Disorders

More than half of persons age 65 years and older report some type of sleep disturbance (Foley et al. 1995), and sleep disturbance is associated with increased risk of significant health consequences in older adults such as increased emergency department use, hospitalization, falls, nursing home placement, and mortality (Spira et al. 2012; Stone et al. 2008; Tzuang et al. 2021; Wallace et al. 2019). Unfortunately, a widespread misconception is that increased sleep disturbance is a normal function of aging. Although some normative changes in sleep are related to aging (Ohayon et al. 2004), sleep disturbance in older adults is not normative and is more likely to occur when common medical and psychiatric issues are present (Foley et al. 1995). Moreover, historically, sleep disturbance has been considered a secondary symptom of medical and psychiatric issues (e.g., chronic pain, depression). However, epidemiological data have supported a comorbid model in which sleep disturbance and medical and psychiatric issues have bidirectional relationships (Afolalu et al. 2018; Bao et al. 2017; Finan et al. 2013). This model supports the idea that all issues may warrant clinical attention, including the often-ignored issue of sleep disturbance. Thus, sleep disturbance is a key area to consider within geriatric psychiatry. In this chapter, we review normative age-related changes in sleep and the most common sleep disorders, medical and psychiatric comorbidities, medications and substances, and psychosocial stressors associated with sleep disturbance in older adults (Table 16–1). We also consider sleep assessment and treatment approaches in older adults.