Sleeping Pills, Insomnia, and Medical Practice Report of a Study (1979) / Chapter Skim
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Chapter 5: Sleep Disturbance in the Elderly
Chapter 5: Sleep Disturbance in the Elderly
Pages 119-136
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From page 119... ...
A Prevalence of Sleep Disturbance in the Elderly There is some uncertainty about the incidence of sleep complaints in the general population, but it is widely conceded that elderly people have a greater incidence of sleep complaints than the young or middle aged.
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From page 120... ...
Although aged women have a greater incidence of subj ective sleep complaints, men show a greater change in obj ective sleep parameters with advancing age. Much less information exists concerning the nature and incidence of significant sleep pathology in the elderly.
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From page 121... ...
27/ Little or no study has been made of many other factors: daytime sedation with major and minor tranquilizers, chronic bedrest, organic brain disease, changes in circadian rhythms. The etiology of sleep problems in the aged is usually viewed as a mixture of medical, psychological, social, and developmental factors: medical disorders, pain, depression, loneliness, absence of regular activities and interests, the imposition of living alone or in a nursing home environment, long daytime naps, worry about financial problems or health, loss of self-esteem and social rewards associated with work, and the normal ag ing process .
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From page 122... ...
when giving patients additional psychoactive medication. 32/ A second cause for the increased incidence of toxic reactions in older patients- is the decreased ability to metabolize and excrete drugs in old age.
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From page 123... ...
_ / C Pharmacologic Treatment of Insomnia in Elderly Patients Efficacy and Safety of Hypnotics Pharmacologic problems of aging result from changes in body composition, such as decreased percentage of fatty tissue to absorb lipid-soluble drugs, decreased plasma albumin (a major source of drug binding)
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56/ As noted above, those few studies that are performed on the elderly typically examine a special population -- nursing home or chronic care patients. Thus the possibility of sampling error when -124
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From page 125... ...
(b) If the insomniac patient is confirmed as suffering from senile brain disease or some other organic brain syndrome, then the sleep disturbance probably will not respond to hypnotic medication.
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From page 126... ...
hypnotic drug use is often mistakenly diagnosed as irreversible "dementia" or "senility" because physicians and nurses do not attribute the symptoms to the drug. (A patient is more fortunate when adverse drug reactions develop promptly, because family members and health care personnel naturally will be more alert to the possible association with a newly started medication.)
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From page 127... ...
Physicians prescribing sleeping pills to the elderly must be clear in their own minds whether they are treating the patient, or treating his family or the hospital/nursing home staff who are disturbed by the patient's awakening during the night. The physician, even when recognizing that normal sleep is a problem for the elderly, that hypnotics cease to be an effective solution to the problem, and that the elderly are vulnerable to adverse drug reactions, often may decide that prescription of sleeping medication is appropriate because of lack of alternatives.
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From page 128... ...
Studies of the doctor-patient relationship have demonstrated that for some problems the personal qualities of the health care provider and the mode of interaction utilized have greater therapeutic value than technolog ical interventions such as drugs . 65 /-66/ The milieu in senior citizen residences, extended care homes, or similar group-living arrangements, often promotes behaviors such as daytime naps, and an understimulated, sedentary life style; such behavior impairs overall adj ustment and daytime functioning, and contributes to the emergence of nocturnal sleep disturbance.
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From page 129... ...
and Williams, R.L., Sleep patterns in late middle aged males; An BEG study. Electroencephalography and Clinical Neurophysiology 23:168-171, 1967.
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From page 130... ...
Kales A., Wilson T., Kales J.D., Jacobson, A., Paulson, M.J., Kollar, E., and Walter, R.D., Measurements of all-night sleep in normal elderly persons: effects of aging. Journal of the American Geriatric Society 15:405-414.
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From page 131... ...
and Toidze, O., Sh., (Clinical sleep patterns of long living males.) Soobshenheniya Akademii Nauk Cruzinskoy SSR (Tbilisi)
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From page 132... ...
Fracchia, Jo ~ Sheppard, Ce ~ Canale, D., Ruest, E., Cambria, E.' and Merlis, Se ~ Combination drug therapy for the psychogeriatric patient: Comparison of dosage levels of the same psychotropic drugs, used singly and in combination. Journal of the American Geriatric Society XXIII(11)
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From page 133... ...
British Medical Journal 2: 1037-1040, 1963. Fisher, S., Gal, P., Flurazepam versus amobarbital as a sedative/ hypnotic for geriatric patients: double blind study.
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Journal of the American Pharmaceutical Association 17:692-695, 1977. Boston Collaborative Drug surveillance Program (1973~: Clinical depression of the central nervous system due to diazepam and chlordiazepoxide in relation to cigarette smoking and age.
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From page 135... ...
, 1970. Modol fsky , H., Scarisbrick, P., Eng land, R., and Smythe, H., Musculoskeletal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subj ects .
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