Zusammenfassung
Die Inzidenz von Schlafstörungen nimmt mit steigendem Lebensalter zu, etwa 20 % der
Frauen und 10 % der Männer > 75 Jahre leiden unter Schlafstörungen. Schlaf ist ein
wesentlicher Faktor für subjektives Wohlbefinden und Lebensqualität, Schlafstörungen
sind außerdem assoziiert mit Krankheit und früherem Tod. Als Konsequenz der häufigen
Schlafstörungen steigt die Verschreibung von Hypnotika mit dem Alter an, die Verordnungsrate
bei Älteren liegt bei 10 - 15 %. Zahlreiche Faktoren können den Schlaf im Alter stören.
Zunehmenden somatischen und psychiatrischen Erkrankungen im Alter, die jeweils signifikant
mit Schlafstörungen assoziiert sein können, kommt ein bedeutender Stellenwert bei
bestehenden Schlafstörungen zu. Eine begleitende Depression stellt dabei den Haupteinflussfaktor
dar. Die Auswirkungen eines gestörten Schlafes im Alter sind mannigfach. Diese Arbeit
soll einen Überblick über die häufigsten Ursachen von Schlafstörungen im höheren Lebensalter
geben, über ihren Einfluss in Bezug auf die Lebenserwartung, die allgemeine Gesundheit
und die Lebensqualität sowie mögliche Therapieansätze aufzeichnen.
Abstract
The incidence of sleep disorders increases with age, about 20 % of the women and 10
% of the men > 75 years of age suffer from sleep disorders. Sleep has an important
impact on subjective well-being and quality of life, sleep disorders are associated
with medical diseases and earlier death. As a consequence of frequent sleep disorders,
the prescription rate of hypnotics increases with age and lies between 10 % and 15
% in the elderly. Numerous factors may disturb sleep in the elderly. Frequent somatic
and psychiatric diseases in the older population can significantly be associated with
sleep disorders, a concomitant depression is known to be the main predictor. Consequences
of sleep disorders in the elderly are manifold. The present paper gives an overview
of the most frequent reasons of sleep disorders in older age, their influence on life
expectancy, general health, and quality of life as well as possible treatment strategies.
Literatur
- 1
Kripke D F, Simon R N, Garfinkel L. et al .
Short and long sleep and sleeping pills.
Arch Gen Psychiatry.
1979;
36
103-116
- 2
Morgan K, Healey D W, Healey P J.
Factors influencing persistent subjective insomnia in old age: a follow-up study of
good and poor sleepers aged 65 - 74.
Age Ageing.
1989;
2
117-122
- 3
Wingard D L, Berkman P T.
Mortality risk associated with sleeping patterns among adults.
Sleep.
1983;
6
102-107
- 4
Diest R van.
Subjective sleep characteristics as coronary risk factors, their association with
type A behaviour an vital exhaustion.
J Psychosom Res.
1990;
34
415-426
- 5
Hoch C C, Dew M A, Reqnolds C F. et al .
Longitudinal changes in diary- and laboratory-based sleep measures in healthy „old
old” and „young old” subjects: a three-year follow-up.
Sleep.
1997;
20
192-202
- 6
Asplund R, Aberg H.
Health of the elderly with regard to sleep and nocturnal micturition.
Scand J Prim Health Care.
1992;
10
98-104
- 7
Giron M S, Forsell Y, Bernsten C. et al .
Sleep problems in a very old population: drug use and clinical correlates.
J Gerontol A Biol Sci Med Sci.
2002;
57
M236-240
- 8
Bellia V, Catalano F, Scichilone N. et al .
Sleep disorders in the elderly with and without chronic airflow obstruction: the SARA
study.
Sleep.
2003;
26
318-323
- 9
Rediehs M H, Ries J S, Creason N S.
Sleep in old age: focus on gender differences.
Sleep.
1990;
13
410-424
- 10
Polo-Kantola P, Saaresranta T, Polo O.
Aetiology and treatment of sleep disturbances during perimenopause and postmenopause.
CNS Drugs.
2001;
15
445-452
- 11
Asplund R.
Are sleep disorders hereditary? A questionnaire survey of elderly persons about themselves
and their parents.
Arch Gerontol Geriatr.
1995;
21
221-231
- 12
Quera Salva M A, Orluc A, Goldenberg F. et al .
Insomnia and use of hypnotics: study of a French population.
Sleep.
1991;
14
386-391
- 13
Swift C G, Shapiro C M.
Sleep and sleep problems in elderly people.
BMJ.
1993;
306
1468-1471
- 14
Asplund R.
Sleep and hypnotics among the elderly in relation to body weight and somatic disease.
J Intern Med.
1995;
238
65-70
- 15
Asplund R.
Daytime sleepiness and napping amongst the elderly in relation to somatic health and
medical treatment.
J Intern Med.
1996;
239
261-267
- 16
Roth T, Roehrs T A.
Etiologies and sequelae of excessive daytime sleepiness.
Clin Ther.
1996;
18
562-576
- 17
Reynolds C F, Jennings J R, Hoch C C. et al .
Daytime sleepiness in the healthy „old old”: A comparison with young adults.
J Am Geriatr Soc.
1991;
39
957-962
- 18
Monk T H, Reynolds C F, Kupfer D J. et al .
Differences over the life span in daily life-style regularity.
Chronobiol Int.
1997;
14
295-306
- 19
Carskadon M A, Dement W C, Mitler M M. et al .
Self-reports versus laboratory findings in 122 drug-free subjects with complaints
of chronic insomnia.
Am J Psychiatry.
1981;
38
752-758
- 20 Partinen M, Kaprio J, Koskenvuo M, Langinvainio H.
Sleeping habits, sleep quality, and use of sleeping pills: a population study of 31140
adults in Finland. In: Guilleminault C, Lugaresi E (eds) Sleep/Wake Disorders: Natural History, Epidemiology,
and Long-Term Evaluation. New York; Raven Press 1983: 29-35
- 21
Gooneratne N S, Weaver T E, Cater J R. et al .
Functional outcomes of excessive daytime sleepiness in older adults.
J Am Geriatr Soc.
2003;
51
642-649
- 22
Morin C M, Gramling S E.
Sleep patterns and aging: comparison of older adults with and without insomnia complaints.
Psychol Aging.
1989;
4
290-294
- 23
Bliwise D L.
Sleep in normal ageing and dementia.
Sleep.
1993;
16
40-81
- 24
Crowley K, Colrain I M.
Self-reported sleep patterns and daytime sleepiness in the neurologically healthy
aged.
J Sleep Res.
2000;
9
97-98
- 25
Bastien C H, Fortier-Brochu E, Rioux I. et al .
Cognitive performance and sleep quality in the elderly suffering from chronic insomnia.
Relationship between objective and subjective measures.
J Psychosom Res.
2003;
54
39-49
- 26
Monk T H.
Circadian rhythm.
Clin Ger Med.
1989;
5
331-346
- 27
Monk T H, Reynolds C F, Machen M A, Kupfer D J.
Daily social rhythms in the elderly and their relation to objectively recorded sleep.
Sleep.
1992;
15
322-329
- 28
Chokroverty S.
Sleep and degenerative neurologic disorders.
Neurol Clin.
1996;
14
807-826
- 29
Appels A, Schoulten E.
Waking up exhausted as a risk indicator of myocardial infarction.
Am J Cardiol.
1991;
68
395-398
- 30
Fitzpatrick M F, Engleman H, Whyte K F. et al .
Morbidity in nocturnal asthma: sleep quality and daytime cognitive performance.
Thorax.
1991;
46
569-573
- 31
Janson C, Gislason T, Boman G. et al .
Sleep disturbances in patients with asthma.
Respir Med.
1990;
84
37-42
- 32
Moffitt P F, Kaluey E C, Kaluey R S. et al .
Sleep difficulties, pain and other correlates.
J Intern Med.
1991;
230
245-249
- 33
Gislason T, Almqvist M.
Somatic disease ans sleep complaints.
Acta Med Scand.
1987;
221
475-481
- 34
Wright V.
Measurement of outcome in rheumatic disease.
J R Soc Med.
1985;
78
985-994
- 35
Haskell S G, Fiebach N H.
Clinical epidemiology of nocturnal leg cramps in male veterans.
Am J Med Sci.
1997;
313
210-214
- 36
Diener H C, Dethlefsen U, Dethlefsen-Gruber S, Verbeek P.
Effectiveness of quinine in treating muscle cramps: a double-blind, placebo-controlled,
parallel-group, multicentre trial.
Int J Clin Pract.
2002;
56
243-246
- 37
Silverberg D S, Iaina A, Ocksenberg A.
Sleep-related breathing disturbances: their pathogenesis and potential interest to
the nephrologist.
Nephrol Dial Transplant.
1997;
12
680-683
- 38
Asplund R.
Nocturia in relation to sleep, somatic diseases and medical treatment in the elderly.
BJU Int.
2002;
90
533-536
- 39
Cwikel J.
Falls among elderly people living at home: medical and social factors in a national
sample.
Isr J Med Sci.
1992;
28
446-453
- 40
Asplund R, Aberg H.
Desmopressin in elderly subjects with increased nocturnal diuresis: a two-month study.
Scand J Urol Nephrol.
1993;
27
77-82
- 41
Asplund R, Aberg H.
Desmopressin in elderly women with increased nocturnal diuresis. A short-term study.
Br J Urol.
1993;
72
42-45
- 42
Happe S, Trenkwalder C.
Movement disorders in sleep: Parkinson's disease and restless legs syndrome.
Biomed Eng.
2003;
48
62-67
- 43
Fish D R, Sawyers D, Allen P J. et al .
The effect of sleep on the dyskinetic movements of Parkinson's disease, Gilles de
la Tourette syndrome, Huntington's disease, and torsion dystonia.
Arch Neurol.
1991;
48
210-214
- 44 Rothenberger A, Kostanecka T, Kinkelbur J. et al .
Sleep and Tourette syndrome. In: Cohen DJ, Goetz CG, Jankovic J (eds) Tourette Syndrome. Philadelphia; Lippincott
Williams and Wilkins 2001: 245-259
- 45
Boeve B F, Silber M H, Ferman T J. et al .
Association of REM sleep behavior disorder and neurodegenerative disease may reflect
an underlying synucleinopathy.
Mov Disord.
2001;
16
622-630
- 46
Eisensehr I, Lindeiner H, Jäger M. et al .
REM sleep behavior disorder in sleep-disordered patients with versus without Parkinson's
disease: is there a need for polysomnography?.
J Neurol Sci.
2001;
186
7-11
- 47
Lees A J, Blackburn N A, Campbell V L.
The nighttime problems of Parkinson's disease.
Clin Neuropharmacol.
1988;
11
512-519
- 48
Tandberg E, Larsen J P, Karlsen K.
Excessive daytime sleepiness and sleep benefit in Parkinson's disease: a community
based study.
Mov Disord.
1999;
14
922-927
- 49
Factor S A, McAlarney T, Sanchez-Ramoz J R. et al .
Sleep disorders and sleep effect in Parkinson's disease.
Mov Disord.
1990;
5
280-285
- 50
Tan E K, Lum S Y, Fook-Chong S M. et al .
Evaluation of somnolence in Parkinson's disease. Comparison with age- and sex-matched
controls.
Neurology.
2002;
58
465-468
- 51
Happe S, Berger K.
The association of dopamine agonists with daytime sleepiness, sleep problems and quality
of life in patients with Parkinson's disease. A prospective study.
J Neurol.
2001;
248
1062-1067
- 52
Happe S, Trenkwalder C.
Movement disorders in sleep: Gilles de la Tourette syndrome, Huntington's disease,
and dystonia.
Somnologie.
2002;
6
63-67
- 53
Bourke S C, Shaw P J, Gibson G J.
Respiratory function vs sleep-disordered breathing as predictors of QOL in ALS.
Neurology.
2001;
57
2040-2044
- 54
Barthlen G M, Lange D J.
Unexpectedly severe sleep and respiratory pathology in patients with amyotrophic lateral
sclerosis.
Eur J Neurol.
2000;
7
299-302
- 55
Bassetti C, Aldrich M S.
Sleep apnea in acute cerebrovascular diseases. Final report on 128 patients.
Sleep.
1999;
22
217-223
- 56
Qureshi A I, Giles W H, Croft J B. et al .
Habitual sleep patterns and risk for stroke and coronary heart disease. A 10-year
follow-up from NHANES I.
Neurology.
1997;
48
904-911
- 57
Happe S, Zeitlhofer J, Evers S.
Schlafgebundene Kopfschmerzen.
Wien Klin Wochenschr.
2001;
113
259-265
- 58
Raskin N H.
The hypnic headache syndrome.
Headache.
1988;
28
534-536
- 59
Evers S, Goadsby P J.
Hypnic headache: clinical features, pathophysiology, and treatment.
Neurology.
2003;
60
905-909
- 60
Newman L C, Lipton R B, Solomon S.
The hypnic headache syndrome: a benign headache disorder of the elderly.
Neurology.
1990;
40
1904-1905
- 61
Benca R M.
Sleep in psychiatric disorders.
Neurol Clin.
1996;
14
739-764
- 62
Mehta K M, Simonsick E M, Penninx B W. et al .
Prevalence and correlates of anxiety symptoms in well-functioning older adults: findings
from the health aging and body composition study.
J Am Geriatr Soc.
2003;
51
499-504
- 63
Loewenstein R J, Weingartner H, Gillin J C. et al .
Disturbances of sleep and cognitive functions in patients with dementia.
Neurol Aging.
1982;
3
371-377
- 64
Montplaisir J, Petit D, Lorrain D. et al .
Sleep in Alzheimer's disease: further considerations to the role of brainstem and
forebrain cholinergic populations of sleep-wake mechanism.
Sleep.
1995;
18
145-148
- 65 Kinkelbur J, Hajak G.
Unterteilung der primären Insomnien nach ICSD. In: Schulz H (Hrsg) Kompendium Schlafmedizin für Ausbildung, Klinik und Praxis. Landsberg/Lech;
ecomed 1997: IV-2.1
- 66
Olson L G, King M T, Hensley M J. et al .
A community study of snoring and sleep-disordered breathing: health outcomes.
Am J Respir Crit Care Med.
1995;
152
717-720
- 67
Shochat T, Pillar G.
Sleep apnoea in the older adult: pathophysiology, epidemiology, consequences and management.
Drugs Ageing.
2003;
20
551-560
- 68
Ancoli-Israel S, Kripke D F.
Prevalent sleep problems in the aged.
Biofeedback Self Regul.
1991;
16
349-359
- 69
He J, Kryger M H, Zorick F J. et al .
Mortality and apnea index in obstructive sleep apnea: experience in 385 male patients.
Chest.
1988;
94
9-14
- 70
Lindblom S S.
Adults who snore.
Postgrad Med.
1997;
101
171-172
- 71
Wiegand L, Zwillich C W.
Obstructive sleep apnea.
Dis Mon.
1994;
40
197-252
- 72
Thalhofer S, Dorow P.
Central sleep apnea.
Respiration.
1997;
64
2-9
- 73
Good D C, Henkle J Q, Gelber D. et al .
Sleep-disordered breathing and poor functional outcome after stroke.
Stroke.
1996;
27
252-259
- 74
Rothdach A J, Trenkwalder C, Haberstock J. et al .
Prevalence and risk factors of RLS in an elderly population. The MEMO study.
Neurology.
2000;
54
1064-1068
- 75
Phillips B, Young T, Finn L. et al .
Epidemiology of restless legs symptoms in adults.
Arch Intern Med.
2000;
160
2137-2141
- 76
Barthlen G M.
Sleep disorders. Obstructive sleep apnea syndrome, restless legs syndrome, and insomnia
in geriatric patients.
Geriatrics.
2002;
57
34-39
- 77
Allen R P, Picchietti D, Hening W A. et al .
Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology.
A report from the restless legs syndrome diagnosis and epidemiology workshop at the
National Institutes of Health.
Sleep Med.
2003;
4
101-119
- 78
Atlas Task Force of the American Sleep Disorders Association .
Recording and scoring of leg movements.
Sleep.
1993;
16
748-759
- 79
Montplaisir J, Boucher S, Poirier G. et al .
Clinical, polysomnographic, and genetic characteristics of restless legs syndrome:
a study of 133 patients diagnosed with new standard criteria.
Mov Disord.
1997;
12
61-65
- 80
Ancoli-Israel S, Kripke D M, Klauber M R. et al .
Periodic limb movements in sleep in community dwelling elderly.
Sleep.
1991;
14
496-500
- 81
Chesson A L, Wise M, Davila D. et al .
Practice parameters for the treatment of restless legs syndrome and periodic limb
movement disorder. An American Academy of Sleep Medicine Report. Standards of Practice
Committee of the Academy of Sleep Medicine.
Sleep.
1999;
22
961-968
- 82
Buysse D J, Reynolds C F, Monks T H. et al .
The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and
research.
Psychiatry Res.
1989;
28
193-213
- 83
Petit L, Azad N, Byszewski A. et al .
Non-pharmacological management of primary and secondary insomnia among older people:
review of assessment tools and treatments.
Age Ageing.
2003;
32
19-25
- 84
Morin C M, Culbert J P, Schwartz S M.
Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy.
Am J Psychiatry.
1994;
151
1172-1180
- 85
Gustafson R.
Treating insomnia with a self-administered muscle relaxation training program. A follow-up.
Psychol Rep.
1992;
70
124-126
- 86
Murphy P J, Campbell S S.
Enhanced performance in elderly subjects following bright light treatment of sleep
maintenanceinsomnia.
J Sleep Res.
1996;
5
165-172
- 87
Fetveit A, Skjerve A, Bjorvatn B.
Bright light treatment improves sleep in institutionalised elderly. An open trial.
Int J Geriatr Psychiatry.
2003;
18
520-526
- 88
Lin Y.
Acupuncture treatment for insomnia and acupuncture analgesia.
Psychiatry Clin Neurosci.
1995;
49
119-120
- 89 Montgomery P, Dennis J. Bright light therapy for sleep problems in adults aged
60+. Cochrane Database Syst Rev 2002 2, CD003403
- 90 Montgomery P, Dennis J. Cognitive behavioural interventions for sleep problems
in adults aged 60+. Cochrane Database Syst Rev 2002 2, CD003161
- 91 Montgomery P, Dennis J. Physical exercise for sleep problems in adults aged 60+. Cochrane Database Syst Rev 2002 4, CD003404
- 92
Montgomery P.
Treatments for sleep problems in elderly people.
BMJ.
2002;
325
1049
- 93
Lawlor D A, Patel R, Ebrahim S.
Association between falls in elderly women and chronic diseases and drug use: cross
sectional study.
BMJ.
2003;
327
712-717
- 94
Carlsten A, Waern M, Holmgren P, Allebeck P.
The role of benzodiazepines in elderly suicides.
Scand J Publ Health.
2003;
31
224-228
- 95
Wortelboer U, Cohrs S, Rodenbeck A, Rüther E.
Tolerability of hypnosedatives in older patients.
Drugs Aging.
2002;
19
529-539
- 96
Sproule B A, Busto U E, Buckle C. et al .
The use of non-prescription sleep products in the elderly.
Int J Geriatr Psychiatry.
1999;
14
851-857
- 97
Moran M G, Thompson T L, Nies A S.
Sleep disorders in the elderly.
Am J Psychiatry.
1988;
145
1369-1378
- 98
Parrino L, Terzano M G.
Polysomnographic effects of hypnotic drugs: a review.
Psychopharmacology (Berl).
1996;
126
1-16
- 99
Lader M.
Zopiclone: is there any dependence and abuse potential?.
J Neurol.
1997;
244, Suppl 1
S18-S22
- 100
Roth T, Hajak G, Ustun T B.
Consensus for the pharmacological management of insomnia in the new millenium.
Int J Clin Pract.
2001;
55
42-52
- 101
Inman W, Kubota K, Pearce G, Wilton L.
PEM report number 10. Zopiclone.
Pharmacoepid Drug Safety.
1993;
2
499-521
- 102
Terzano M G, Rossi M, Palomba V. et al .
New drugs for insomnia: comparative tolerability of zopiclone, zolpidem and zaleplon.
Drug Saf.
2003;
26
261-282
- 103 Benkert O, Hippius H. Psychiatrische Pharmakotherapie. Berlin, Heidelberg, New
York; Springer 1996
- 104
Riemann D, Voderholzer U, Cohrs S. et al .
Trimipramine in primary insomnia: results of a polysomnographic double-blind controlled
study.
Pharmacopsychiatry.
2002;
35
165-174
- 105
Skene D J, Swaab D F.
Melatonin rhythmicity: effect of age and Alzheimer's disease.
Exp Gerontol.
2003;
38
199-206
- 106
Garfinkel D, Laudon M, Nof D. et al .
Improvement of sleep quality in elderly people by controlled-release melatonin.
Lancet.
1995;
346
541-544
- 107
Haimov I, Lavie P, Laudon M. et al .
Melatonin replacement therapy of elderly insomniacs.
Sleep.
1995;
18
598-603
- 108
Olde Rikkert M G, Rigaud A S.
Melatonin in elderly patients with insomnia. A systematic review.
Z Gerontol Geriatr.
2001;
34
491-497
- 109 Hajak G, Rodenbeck A, Rüther E.
Sleep-inducing effects of L-Tryptophan. In: Kochen W, Steinhart H (eds) L-Tryptophan. Current Prospects in Medicine and Drug
Safety. Berlin; De Gruyter 1994: 63-83
- 110 Hajak G, Rodenbeck A.
Medikamentöse Therapieverfahren. In: Schulz H (Hrsg) Kompendium Schlafmedizin. Landsberg/Lech; ecomed Verlag 2002:
XIII
Dr. med. Svenja Happe
Abteilung für Klinische Neurophysiologie · Universitätsklinikum Göttingen
Robert-Koch-Straße 40
37075 Göttingen
Email: shappe@gwdg.de
