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Sleep and Breathing

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01-12-2021 | Insomnia | Neurology • Review

Behavioral and exercise interventions for sleep dysfunction in the elderly: a brief review and future directions

Authors: Amy Gencarelli, Anne Sorrell, Cassandra M. Everhart, Taylor Zurlinden, D. Erik Everhart

Published in: Sleep and Breathing | Issue 4/2021

Abstract

Purpose

The impact of sleep-related changes and disorders in the geriatric populations are of utmost concern due to health consequences and increased risk of injury as well as injuring others as a result of poor sleep. The purpose of this paper is to provide a brief review of the current state of the literature with regard to sleep, aging, common non-pharmacological interventions, and the potential use of exercise in combination with behavioral interventions.

Methods

Initially, this manuscript focuses on a brief (nonsystematic) review of sleep parameters and physiology that are associated with the aging process. Subsequently, information regarding sleep disorders in the elderly in general, and insomnia in particular are discussed. Last, a brief review of current recommended interventions is provided.

Results

The current major nonpharmacological interventions are described including Cognitive Behavioral Therapy for Insomnia (CBT-I). The potential use of exercise as a safe intervention for poor sleep is discussed. Finally, a call is made for increased research that examines the combination of traditional behavioral interventions with exercise.

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Tubbs AS, Dollish HK, Fernandez F, Grandner MA (2019) The basics of sleep physiology and behavior. In Sleep and health (pp. 3-10). Academic Press

Chattu VK, Gholizadeh M, Shapiro CM (2019) Estimation of costs and cost-effectiveness of detecting undiagnosed sleep disorders among chronic disease patients: a typical gp setting in Toronto. Sleep Med 64:S345–S346. https://doi.org/10.1016/j.sleep.2019.11.964CrossRef

de Mello MT, Narciso FV, Tufik S, Paiva T, Spence DW, Bahammam AS, Verster JC, Pandi-Perumal SR (2013) Sleep disorders as a cause of motor vehicle collisions. Int J Prev Med 4:246–257PubMedPubMedCentral

Noh J, Kim K, Lee JH, Lee Y, Lee B, Kwon YD (2017) Association between sleep duration and injury from falling among older adults: a cross-sectional analysis of Korean community health survey data. Yonsei Med J 58:1222–1228. https://doi.org/10.3349/ymj.2017.58.6.1222CrossRefPubMedPubMedCentral

Espiritu JR (2008) Aging-related sleep changes. Clin Geriatr Med 24:1–14. https://doi.org/10.1016/j.cger.2007.08.007CrossRefPubMed

Allen J, Morelli V (2012) Aging and exercise. Succes Aging, Issue Clin Geriatr Med-E-Book 27(4):661–671

Foley DJ, Monjan A, Simonsick EM, Wallace RB, Blazer DG (1999) Incidence and remission of insomnia among elderly adults: an epidemiologic study of 6,800 persons over three years. Sleep 22(Suppl 2):S366–S372PubMed

Montgomery P (2002) Treatments for sleep problems in elderly people. BMJ 325(7372):1049. https://doi.org/10.1136/bmj.325.7372.1049CrossRefPubMedPubMedCentral

Patel D, Steinberg J, Patel P (2018) Insomnia in the elderly: a review. J Clin Sleep Med 14:1017–1024. https://doi.org/10.5664/jcsm.7172CrossRefPubMedPubMedCentral

10.

Cirelli C (2012) Brain plasticity, sleep and aging. Gerontology 58:441–445. https://doi.org/10.1159/000336149CrossRefPubMed

11.

Dijk D-J, Duffy JF, Czeisler CA (2000) Contribution of circadian physiology and sleep homeostasis to age-related changes in human sleep. Chronobiol Int 3:285–311. https://doi.org/10.1081/CBI-100101049CrossRef

12.

Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV (2004) Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 17:1255–1273. https://doi.org/10.1093/sleep/27.7.1255CrossRef

13.

Scullin MK (2017) Do older adults need sleep? A review of neuroimaging, sleep, and aging studies. Curr Sleep Med Rep 3(3):204–214. https://doi.org/10.1007/s40675-017-0086-zCrossRefPubMedPubMedCentral

14.

Loomis AL, Harvey EN, Hobart G (1935) Potential rhythms of the cerebral cortex during sleep. Science. 81:597–598. https://doi.org/10.1126/science.81.2111.597CrossRefPubMed

15.

Tamaki M, Nittono H, Hayashi M, Hori T (2005) Examination of the first-night effect during the sleep-onset period. Sleep 28(2):195–202. https://doi.org/10.1093/sleep/28.2.195CrossRefPubMed

16.

Crowley K, Trinder J, Kim Y, Carrington M, Colrain IM (2002) The effects of normal aging on sleep spindle and K-complex production. Clin Neurophysiol 113(10):1615–1622. https://doi.org/10.1016/s1388-2457(02)00237-7CrossRefPubMed

17.

Martin N, Lafortune M, Godbout J, Barakat M, Robillard R, Poirier G, Bastien C, Carrier J (2013) Topography of age-related changes in sleep spindles. Neurobiol Aging 34:468–476. https://doi.org/10.1016/j.neurobiolaging.2012.05.020CrossRefPubMed

18.

Nelson PT, Abner EL, Scheff SW, Schmitt FA, Kryscio RJ, Jicha GA, Smith CD, Patel E, Markesbery WR (2009) Alzheimer’s-type neuropathology in the precuneus is not increased relative to other areas of neocortex across a range of cognitive impairment. Neurosci Lett 450:336–339. https://doi.org/10.1016/j.neulet.2008.11.006CrossRefPubMed

19.

Clawson BC, Durkin J, Aton SJ (2016) Form and function of sleep spindles across the lifespan. Neural Plasticity 6936381. https://doi.org/10.1155/2016/6936381

20.

Resnick SM, Pham DL, Kraut MA, Zonderman AB, Davatzikos C (2003) Longitudinal magnetic resonance imaging studies of older adults: a shrinking brain. J Neurosci 23(8):3295–3301. https://doi.org/10.1523/JNEUROSCI.23-08-03295.2003CrossRefPubMedPubMedCentral

21.

Thambisetty M, Wan J, Carass A, An Y, Prince JL, Resnick SM (2010) Longitudinal changes in cortical thickness associated with normal aging. Neuroimage 52(4):1215–1223. https://doi.org/10.1016/j.neuroimage.2010.04.258CrossRefPubMed

22.

Suzuki K, Miyamoto M, Hirata K (2017) Sleep disorders in the elderly: diagnosis and management. J Gen Fam Med 18(2):61–71. https://doi.org/10.1002/jgf2.27CrossRefPubMedPubMedCentral

23.

Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG (1995) Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 18:425–443. https://doi.org/10.1093/sleep/18.6.425CrossRefPubMed

24.

Li J, Vitiello MV, Gooneratne NS (2018) Sleep in normal aging. Sleep Med Clin 13(1):1–11. https://doi.org/10.1016/j.jsmc.2017.09.001CrossRefPubMed

25.

Albrecht U, Ripperger JA (2018) Circadian clocks and sleep: impact of rhythmic metabolism and waste clearance on the brain. Trends Neurosci 41(10):677–688CrossRef

26.

Vaz Fragoso CA, Gill TM (2007) Sleep complaints in community-living older persons: a multifactorial geriatric syndrome. J Am Geriatr Soc 55(11):1853–1866. https://doi.org/10.1111/j.1532-5415.2007.01399.xCrossRefPubMedPubMedCentral

27.

Roepke SK, Ancoli-Israel S (2010) Sleep disorders in the elderly. Indian J Med Res 131:302–310. https://doi.org/10.1016/S1389-9457(00)00083-6CrossRefPubMed

28.

Perlis M, Shaw P, Cano G, Espie C (2011) Models of insomnia. In: Kryger MH, Roth T, Dement WC (eds) Principles and Practices of Sleep Medicine. Elsevier, Philadelphia, pp 850–865CrossRef

29.

American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. APA, ArlingtonCrossRef

30.

Brewster GS, Riegel B, Gehrman PR (2018) Insomnia in the older adult. Sleep Med Clin 13(1):13–19. https://doi.org/10.1016/j.jsmc.2017.09.002CrossRefPubMed

31.

Shub D, Darvishi R, Kunik ME (2009) Non-pharmacologic treatment of insomnia in persons with dementia. Geriatrics 64:22PubMed

32.

Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M (2008) Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 4:487–504CrossRef

33.

Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL (2017) Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 13(2):307–349. https://doi.org/10.5664/jcsm.6470CrossRefPubMedPubMedCentral

34.

Montgomery P, Dennis J (2004) A systematic review of non-pharmacological therapies for sleep problems in later life. Sleep Med Rev 8:47–62. https://doi.org/10.1016/S1087-0792(03)00026-1CrossRefPubMed

35.

Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, Coleman J, Kapur V, Lee-Chiong T, Owens J, Pancer J, Swick T, American Academy of Sleep Medicine (2006) Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American academy of sleep medicine report. Sleep 29(11):1415–1419CrossRef

36.

Siebern AT, Suh S, Nowakowski S (2012) Non-pharmacological treatment of insomnia. Neurotherapeutics 9(4):717–727. https://doi.org/10.1007/s13311-012-0142-9CrossRefPubMedPubMedCentral

37.

Joshi S (2008) Nonpharmacologic Therapy for Insomnia in the Elderly. Clin Geriatr Med 24:107–119. https://doi.org/10.1016/j.cger.2007.08.005CrossRefPubMed

38.

Bootzin RR, Perlis ML (2011) Stimulus control therapy. In: Perlis ML, Aloia M, Kuhn B (eds) Behaviral treatments for sleep disorders: a comprehensive primer of behavioral sleep medicine interventions. Elsevier, Boston, pp 21–30CrossRef

39.

McCrae CS, Dzierzewski JM, Kay D (2009) Treatment of late-life insomnia. Sleep Med Clin 4(4):593–604. https://doi.org/10.1016/j.jsmc.2009.07.006CrossRefPubMedPubMedCentral

40.

Spielman AJ, Yang C, Glovinsky PB Sleep restriction therapy. In: Kuhn, Aloia, Perlis (eds) Behavioral treatments for sleep disorders: a comprehensive primer of behavioral sleep medicine interventions. Elsevier, Philadelphia, pp 9–19

41.

Halpern J, Cohen M, Kennedy G, Reece J, Cahan C, Baharav A (2014) Yoga for improving sleep quality and quality of life for older adults. Altern Ther Health Med 20(3):37–46PubMed

42.

Sivertsen B, Omvik S, Pallesen S, Bjorvatn B, Havik OE, Kvale G, Nielsen GH, Nordhus IH (2006) Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA. 295(24):2851–2858. https://doi.org/10.1001/jama.295.24.2851CrossRefPubMed

43.

Mitchell MD, Gehrman P, Perlis M, Umscheid CA (2012) Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract 13:40. https://doi.org/10.1186/1471-2296-13-40CrossRefPubMedPubMedCentral

44.

Buysse DJ, Germain A, Moul DE, Franzen PL, Brar LK, Fletcher ME, Begley A, Houck PR, Mazumdar S, Reynolds CF III, Monk TH (2011) Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med 171(10):887–895. https://doi.org/10.1001/archinternmed.2010.535CrossRefPubMedPubMedCentral

45.

Santos RD, Viana VAR, Boscolo RA, Marques VG, Santana MGD, Lira FSD et al (2012) Moderate exercise training modulates cytokine profile and sleep in elderly people. Cytokine 60(3):731–735CrossRef

46.

Banno M, Harada Y, Taniguchi M, Tobita R, Tsujimoto H, Tsujimoto Y, Kataoka Y, Noda A (2018) Exercise can improve sleep quality: a systematic review and meta-analysis. PeerJ 6:e5172. https://doi.org/10.7717/peerj.5172CrossRefPubMedPubMedCentral

47.

Baron KG, Reid KJ, Zee PC (2013) Exercise to improve sleep in insomnia: exploration of the bidirectional effects. J Clin Sleep Med 9(8):819–824. https://doi.org/10.5664/jcsm.2930CrossRefPubMedPubMedCentral

48.

Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC (2010) Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med 11(9):934–940. https://doi.org/10.1016/j.sleep.2010.04.014CrossRefPubMedPubMedCentral

49.

ACSM (2018) ACSM’s guidelines for exercise testing and prescription, 10th edn. Wolters Kluwer, Philadelphia

50.

Passos GS, Poyares D, Santana MG, Garbuio SA, Tufik S, Mello MT (2010) Effect of acute physical exercise on patients with chronic primary insomnia. J Clin Sleep Med 6(3):270–275CrossRef

51.

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213CrossRef

52.

Johns MW (1991) A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep: J Sleep Res Sleep Med 14:540–545CrossRef

53.

Radloff LS (1977) The CES-D Scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401. https://doi.org/10.1177/014662167700100306CrossRef

54.

Dzierzewski JM, Buman MP, Giacobbi PR et al (2014) Exercise and sleep in community-dwelling older adults: evidence for a reciprocal relationship. J Sleep Res 23:61–68. https://doi.org/10.1111/jsr.12078CrossRefPubMed

55.

Ferris LT, Williams JS, Shen CL, O’Keefe KA, Hale KB (2005) Resistance training improves sleep quality in older adults: A pilot study. J Sports Sci Med 4:354–360PubMedPubMedCentral

56.

Herrick JE, Bliwise DL, Puri S, Rogers S, Richards KC (2014) Strength training and light physical activity reduces the apnea-hypopnea index in institutionalized older adults. J Am Med Dir Assoc 15:844–846. https://doi.org/10.1016/j.jamda.2014.08.006CrossRefPubMedPubMedCentral

57.

Herrick JE, Puri S, Richards KC (2018) Resistance training does not alter same-day sleep architecture in institutionalized older adults. J Sleep Red 27(4):e12590. https://doi.org/10.1111/jsr.12590CrossRef

58.

Kapsimalis F, Basta M, Varouchakis G, Gourgoulianis K, Vgontzas A, Kryger M (2008) Cytokines and pathological sleep. Sleep Med 9(6):603–614CrossRef

59.

Li J, Yang B, Varrasse M, Li K (2018) Sleep among long-term care residents in China: a narrative review of literature. Clin Nurs Res 27(1):35–60. https://doi.org/10.1177/1054773816673175CrossRefPubMed

60.

Morin CM, Belleville G, Bélanger L, Ivers H (2011) The insomnia severity index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 34(5):601–608CrossRef

61.

Mercier J, Ivers H, Savard J (2018) A non-inferiority randomized controlled trial comparing a home-based aerobic exercise program to a self-administered cognitive-behavioral therapy for insomnia in cancer patients. Sleep 41(10). https://doi.org/10.1093/sleep/zsy149

62.

Berger BG, Motl RW (2000) Exercise and mood: A selective review and synthesis of research employing the profile of mood states. J Appl Sport Psychol 12:69–92. https://doi.org/10.1080/10413200008404214CrossRef

63.

Richter K, Myllymaeki J, Scharold-Schaefer S, Tomova I, Mayrer R, Niklewski G (2014) Treating comorbid insomnia in older adults via cognitive-behavioural treatment, bright light and exercise. Health 6:960–968. https://doi.org/10.4236/health.2014.610121CrossRef

64.

Guthrie KA, Larson JC, Ensrud KE, Anderson GL, Carpenter JS, Freeman EW, Joffe H, LaCroix AZ, Manson JAE, Morin CM, Newton KM, Otte J, Reed SD, McCurry SM (2018) Effects of pharmacologic and nonpharmacologic interventions on insomnia symptoms and self-reported sleep quality in women with hot flashes: a pooled analysis of individual participant data from four MsFLASH trials. Sleep 41. https://doi.org/10.1093/sleep/zsx190

65.

Varrasse M, Li J, Gooneratne N (2015) Exercise and sleep in community-dwelling older adults. Curr Sleep Med Rep 1:232–240. https://doi.org/10.1007/s40675-015-0028-6CrossRefPubMedPubMedCentral

66.

Cheng SK, Dizon J (2012) Computerised cognitive behavioural therapy for insomnia: a systematic review and meta-analysis. Psychother Psychosom 81:206–216. https://doi.org/10.1159/000335379CrossRefPubMed

67.

Hsieh C, Rezayat T, Zeidler MR (2020) Telemedicine and the management of insomnia. Sleep Med Clin 15:383–390. https://doi.org/10.1016/j.jsmc.2020.05.004CrossRefPubMed

Title: Behavioral and exercise interventions for sleep dysfunction in the elderly: a brief review and future directions
Authors: Amy Gencarelli
Anne Sorrell
Cassandra M. Everhart
Taylor Zurlinden
D. Erik Everhart
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keyword: Insomnia
Published in: Sleep and Breathing / Issue 4/2021
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02329-9

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