First Aid for the Psychiatry Clerkship (9781260143409) by Ganti Latha; Kaufman Matthew S.; Blitzstein Sean M

Author:Ganti, Latha; Kaufman, Matthew S.; Blitzstein, Sean M.
Language: eng
Format: epub
Publisher: McGraw-Hill Global Education
Published: 2019-11-15T00:00:00+00:00

Sleep Disturbance

The incidence of sleep disorders increases with aging. Elderly people often report difficulty sleeping, daytime drowsiness, and daytime napping.

Outside of normal changes associated with aging (see Table 9-3), causes of sleep disturbances may include other medical conditions, drug/alcohol use, social stressors, and medications.

TABLE 9 - 3. Normal Sleep Changes in Geriatric Patients

Patients with movement disorders (Parkinson disease, progressive supranuclear palsy) have shallow sleep and may be more restless at night because of trouble turning in bed.

Restless leg movements during sleep, likely due to a dopamine imbalance, are called periodic leg movements (PLMs).

Nonpharmacological treatment approaches should be tried first (alcohol cessation, increased daily structure, elimination of daytime naps, treatment of underlying medical conditions that may be exacerbating sleep problems).

Sedative-hypnotic drugs are more likely to cause side effects when used by the elderly (memory impairment, ataxia, paradoxical excitement, and rebound insomnia).

If sedative-hypnotics must be prescribed, medications such as trazodone are safer than the more sedating benzodiazepines, but be careful of orthostasis.

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