1. Sleep, Aging and Dementia Josepha A. Cheong, MD University of Florida Departments of Psychiatry and Neurology Chief, Division of Geriatric Psychiatry

2. Normal Sleep –Average adult needs ~ 8.3 hrs –Sleep latency: time between going to bed till onset of sleep Average is 10minutes –75% spent in Non-REM sleep –25% spent in REM sleep

3. Changes with Age –Decreased REM sleep –Increased awakenings and easy arousal

4. Sleep Difficulties in the Elderly –Insomnia estimated to be in ½ of the Elderly –Women > Men –Risk factors for insomnia Depression Breathing difficulties Poor health

5. Sleep Disturbance in Dementia May lead to injury from wandering Leads to difficulty for the caregiver Exacerbates any pre-existing behavioral difficulties A common reason for initiating nursing home placement

6. Assessment of Sleep Difficulty in Dementia Careful review of all medications – prescription and over-the-counter meds Examine the sleep environment Review of recent events/changes that may be stressful to the patient Evaluate for depression Evaluate patient for obstructive sleep apnea

7. Obstructive Sleep Apnea Loud snoring Nighttime restlessness Increased daytime confusion Daytime drowsiness Waking up confused 25% of elderly; 50% of dementia patients

8. Treatment Continuous Positive Airway Pressure -A nosepiece connected to a hose -The hose is places positive pressure into the airway that keeps the airway open

9. Treatment Sleep Hygiene –Reduce intake of caffeine and fluids –Moderate exercise (walking) –Cool (68-72 degrees), dark and quiet room –Set times for sleeping and waking

10. Treatment in Dementia Frequent Orientation during the day Restrict napping Provide access to daylight Moderate exercise

11. Medication Management Zolpidem or Sonata Benzodiazepines: Ativan or Restoril Monitor for falls Stay away from anticholinergic medications – likely to exacerbating confusion

12. Anticholinergic Medications Atarax Vistaril Benadryl Tylenol PM