As described in more detail in the first issue of Insomnia Rounds, insomnia is defined as a subjective complaint of insufficient or nonrestorative sleep whose prevalence increases with age.5 In a large sample of community-dwelling elderly (2673 men and 3213 women) aged 65 years and older from which patients diagnosed with dementia were excluded, 70% reported frequently or regularly having at least 1 insomnia symptom.6 Of the 3 insomnia symptoms assessed (difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening), difficulty with main- taining sleep was the most prevalent symptom in both men and women. Difficulty initiating sleep was more frequent in women, who also more frequently experienced 2–3 symptoms. In men, diffi- culty maintaining sleep was associated with snoring, which suggests that sleep-related breathing disorders might be associated with their insomnia symptom.
Insomnia has significant consequences on the daily lives of elderly individuals. A recent meta- analysis has shown impaired problem solving, working memory, and episodic memory in individ- uals with insomnia, compared to those who do not report insomnia-related symptoms.7 Insomnia appears to have more detrimental effects on elderly compared to young adults; sleep disturbance is a risk factor for cognitive decline in older adults, and is also associated with increased risk of falls and a higher rate of mortality.8
Are primary sleep disorders more common with increasing age?
The prevalence of some primary sleep disorders such as sleep apnea, periodic leg movements, rapid eye movement (REM) sleep behaviour disorder, and advanced sleep phase starts to increase significantly in the middle years of life, from about age 40 years (Table 1).9-14