Course No. 220422

Introduction

The increase in the number of people over 65 and the rise in the proportion of older people represent a marked change in the demographic patterns in this country that will have profound social, economic, medical, and personal consequences. Individuals over 65 constituted 4 percent of the American population in 1900 and nearly 10 percent in 1972. Today, there are over 25 million Americans are 65 years of age or older, approximately 12% of the national population.

Within ten years this number will approach 30 million and probably exceed 20% of the population by 2020. One of the major changes that commonly accompany the aging process is an often profound disruption of an individual’s daily sleep-wake cycle.

Such disturbance can lead to impaired daytime function and seriously compromise quality of life. Sleep disturbances, particularly those of older patients, are often multi-factorial phenomena. The sleep/wake disturbances of advancing age can be the result of:

Physiological changes that are part of normal, “non-pathological” aging

Sleep disturbance secondary to physical or mental illness

Primary sleep disorders, such as sleep apnea

Poor “sleep hygiene”

An individual’s appraisal of their sleep need and sleep quality

Some combination of these factors

A large proportion of older people are at risk for disturbances of sleep that may be caused by many factors such as retirement and changes in social patterns, death of spouse and close friends, increased use of medications, concurrent diseases and changes in circadian rhythms. While changes in sleep patterns have been viewed as part of the normal aging process, new information indicates that many of these disturbances may be related to pathological processes that are associated with aging.

Although the exact numbers are not yet known, it has been estimated that disturbances of sleep afflict more than half of the people 65 and older who live at home and about two-thirds of those who live in long-term care facilities. Problems in sleep and daytime wakefulness disrupt not only the lives of older persons but also those of their families and caregivers. People over 65 years of age now constitute around 12 percent of the American population but consume over 30 percent of all dispensed prescription drugs, as well as an unknown percentage of over-the-counter medicines. A large proportion of these drugs are sedatives and hypnotic agents, the safety and efficacy of which have not been established for older people. Nor has it been established to what extent drugs contribute to or alleviate problems of sleep. It is necessary to understand the causes of these disorders and to develop better treatment strategies, including non-pharmacological methods.

In addition to affecting the quality of life, troubled sleep has been implicated with excess mortality. Controversy also exists concerning the causes, diagnosis, assessment, and specific treatments.