Sleep disorders in the elderly

Introduction to sleep disorders in the elderly Sleep disorders refer to sleep dysfunction or sleep-induced respiratory function caused by neural uncontrolled or sleep-related neurotransmitter changes in the reticular activation system in the brain. The elderly do not need sleep reduction, but sleep loss. Sleep disorders can cause considerable morbidity (such as declining quality of life or even fatal damage), so it is currently the focus of geriatric research. basic knowledge The proportion of illness: 0.005% Susceptible people: the elderly Mode of infection: non-infectious Complications: high blood pressure, headache, arrhythmia, sudden death, pulmonary hypertension

The cause of sleep disorders in the elderly

(1) Causes of the disease

1. Many diseases that cause sleep disorders

Neuropsychiatric diseases (such as cerebrovascular disease, periodic limb movement, nocturnal tendon, AD, sputum, Parkinson's disease, depression, psychology, physiological insomnia, sleep apnea syndrome, etc.), systemic diseases (such as heart failure, Chronic obstructive emphysema, increased number of nocturia, pain, liver and kidney disease, thyroid function changes, alcohol dependence, nocturnal paroxysmal dyspnea, etc. and drug factors (such as sleeping pills, stimulants, hormones, thyroxine, theophylline) , quinolone antibiotics, central antihypertensive drugs can cause sleep disorders in the elderly, of which nighttime tendon (restless leg syndrome) is common in the elderly, accounting for about 5% of senile diseases; it is characterized by the calf after falling asleep The flexor contraction of the flexor muscles (about 30s), the deep muscles of the calves or the sensation of the calf caused a brief awakening of the patient. In patients with congestive heart failure over 65 years old, the apnea during sleep >10 times/h accounted for 21%.

2. Sleep is susceptible to interference

Due to degenerative changes in the elderly, the adaptability of nervous system function is significantly reduced, the tolerance to changes in sleep time is poor, poor sleep habits, emotional disorders, psychosocial factors, uncomfortable sleep environment or changes in sleep environment Can affect the normal sleep of the elderly.

(two) pathogenesis

The main manifestations are changes in sleep time and changes in sleep structure. The average bedtime of healthy elderly people aged 60-80 years is 7.5-8 hours, but the average sleep time is 6-6.5 hours; the number of wakes and time increases, the sleep latency increases, and the total sleep time and Sleep efficiency is reduced, stage I sleep (light sleep) is prolonged, and stage III and IV sleep (deep sleep) is shortened with age, and slow wave sleep for people over 60 years old accounts for less than 10% of total sleep time, 75 years old The above-mentioned non-rapid eye movement period and stage IV sleep of the elderly basically disappeared.

Elderly sleep disorder prevention

There are many factors affecting the sleep of the elderly. In addition to active treatment, it is also necessary to strengthen exercise to enhance physical fitness, adapt to the environment, feel comfortable, and always maintain psychological and physical health.

Complications of sleep disorders in the elderly Complications, hypertension, headache, arrhythmia, sudden pulmonary hypertension

Sleep disorders in the elderly can cause blood pressure to rise, and those who are mild are snoring (habitual snoring, even if it is not apnea, can aggravate heart disease or high blood pressure, is a common symptom of OSA), irritability, daytime sleepiness, depression, headache, Nocturia, impotence, severe cases can occur at night sleep arrhythmia, sudden death, stroke, pulmonary hypertension, convulsions and cognitive decline.

Symptoms of sleep disorders in the elderly Common symptoms Difficulty falling asleep, slow response, restlessness, restlessness, sleep, sleep, sleep, apnea, tension, fatigue, high blood pressure, snoring, sleep disorders, insomnia

1. Falling asleep and maintaining sleep difficulties

Due to a variety of etiology or interference factors, the elderly often have difficulty falling asleep and can not maintain sleep; manifested as prolonged sleep latency, shortened effective sleep time, shortened nighttime sleep-wake cycle due to reduced daytime activities or naps, early rise or owl-like Nocturnal activity is very common among the elderly. Furthermore, with the influence of age or disease, the circadian rhythm disorder of sleep is more obvious; it is characterized by ups and downs, time-lapse sleep disorders and circadian rhythm disorder caused by night work.

2. Sleep disordered breathing

More common in people over the age of 50, respiratory disorders may occur after sleep, such as sleep apnea, sleep aggravated respiratory disease, nocturnal inhalation or nocturnal paroxysmal dyspnea, sleep apnea syndrome (SAS) is the most common in the elderly Sleep-disordered breathing accounts for 70% of sleep disorders, and the incidence increases with age. The ratio of male to female incidence is 5:1 to 10:1, and SAS is divided into 3 types, namely obstructive sleep apnea (OSA). Nasal airflow stops, but chest-abdominal breathing exercises exist), central sleep apnea (CSA, which means that the air is stopped, while chest-abdominal breathing is also suspended) and mixed sleep apnea (MSA), which refers to an apnea. The first appearance of CSA, followed by OSA), airway obstructive sleep apnea (OSA) is characterized by snoring, breathing after breathing > 10s, wheezing or nasal sounds, obstruction relief, OSA repeated, can significantly reduce blood oxygen levels Increased blood pressure, mild manifestations of snoring (habitual snoring, even if not apnea, can also aggravate heart disease or high blood pressure, is a common symptom of OSA), irritability, daytime sleepiness, depression, headache, Urine, impotence, severe cases can occur at night sleep arrhythmia, sudden death, stroke, pulmonary hypertension, convulsions and cognitive decline, etc., with SAS, the incidence of cerebrovascular disease is elevated, especially ischemic stroke There are more opportunities.

3. Drowsiness is common

Drowsiness is another common phenomenon of sleep disorders in the elderly. The causes are brain diseases (brain atrophy, cerebral arteriosclerosis, cerebrovascular disease, brain tumors, etc.), systemic diseases (lung infection, heart failure, hypothyroidism, etc.) Drug factors (hypnotics) and environmental factors, because the elderly are slow to respond to physical changes or symptoms are not obvious, sometimes only manifest as drowsiness, therefore, the significance of understanding the elderly sleepiness is to determine the cause of lethargy, and make it Treat as soon as possible.

Elderly sleep disorders check

Patients with severe complications may have abnormal blood gas analysis.

Multiple nap latency test, apnea physiological recorder, blood gas analysis, Holter, laryngoscope, head imaging examination, etc. contribute to the diagnosis of sleep disorders and their causes.

Diagnosis and diagnosis of sleep disorders in the elderly

diagnosis

Sleep disorder is a symptom. The diagnosis should focus on the time of sleep, the time and frequency of awakening, the total sleep time, the quality of sleep, and other systemic symptoms. After analysis, the cause is determined. Generally speaking, effective sleep is caused by any cause. Reduced time, increased sleep arousal, decreased sleep quality, PSG (polysomnography) showed sleep latency >30 min, wakefulness time >30 min per night, actual sleep time <6 h per night or sleep apnea >10 s, each An hour of apnea more than 30 times can be diagnosed as a sleep disorder, the elderly sleep disorders should be judged due to physiological phenomena caused by aging or disease or drugs, multiple nap latency test, apnea physiological recorder, blood gas analysis Holter, laryngoscope, head imaging examination, etc. contribute to the diagnosis of sleep disorders and their causes. The course of sleep disorders is also helpful in judging the cause. Transient insomnia only shows occasional sleep difficulties, nervous situation. Timely difference, sudden change in work is the main reason; physical illness and psychological factors (such as asthma, heart failure, sadness) and lasting Situational tension often leads to short-term insomnia (<1 month); primary sleep disorders (such as sleep apnea, periodic limb pain, depression, multiple chronic diseases, bad sleep hygiene habits, drug or alcohol effects) are chronic sleep The reason for the difficulty (> 1 month).

Differential diagnosis

Should distinguish between psychophysiological insomnia, exogenous insomnia, drug-dependent insomnia, physical illness leading to insomnia.

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