Evidence‐Based Recommendations for the Assessment and Management of Sleep Disorders in Older Persons
Open accessAbstract
Sleep‐related disorders are most prevalent in the older adult population. A high prevalence of medical and psychosocial comorbidities and the frequent use of multiple medications, rather than aging per se, are major reasons for this. A major concern, often underappreciated and underaddressed by clinicians, is the strong bidirectional relationship between sleep disorders and serious medical problems in older adults. Hypertension, depression, cardiovascular disease, and cerebrovascular disease are examples of diseases that are more likely to develop in individuals with sleep disorders. Conversely, individuals with any of these diseases are at a higher risk of developing sleep disorders. The goals of this article are to help guide clinicians in their general understanding of sleep problems in older persons, examine specific sleep disorders that occur in older persons, and suggest evidence‐ and expert‐based recommendations for the assessment and treatment of sleep disorders in older persons. No such recommendations are available to help clinicians in their daily patient care practices. The four sections in the beginning of the article are titled, Background and Significance, General Review of Sleep, Recommendations Development, and General Approach to Detecting Sleep Disorders in an Ambulatory Setting. These are followed by overviews of specific sleep disorders: Insomnia, Sleep Apnea, Restless Legs Syndrome, Circadian Rhythm Sleep Disorders, Parasomnias, Hypersomnias, and Sleep Disorders in Long‐Term Care Settings. Evidence‐ and expert‐based recommendations, developed by a group of sleep and clinical experts, are presented after each sleep disorder.
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Reinforcing sleep hygiene behaviors (consistent sleep-wake schedules, limiting caffeine or stimulating activities before bed) enhances treatment efficacy and supports long-term sleep-wake regulation.
“Meta-analyses support that reinforcing sleep hygiene behaviors, including maintaining consistent sleep-wake schedules and limiting caffeine or stimulating activities before bed, enhances treatment efficacy and supports long-term sleep-wake regulation [105,106].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [105]
The insomnia sections recommend stable bed and rising times and avoiding caffeine and stimulating activities; they also say sleep hygiene can be useful alongside other treatments. The reported sustained benefit, however, is for multicomponent CBT-I, not specifically for reinforcing sleep hygiene, and the paper does not establish that those behaviors independently enhance treatment efficacy or provide long-term sleep-wake regulation. Page numbers were not available in our copy. (LLM, conf=0.85)
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Tran, H.-P. T., & Leonard, S. D. (2017) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2017.05.001 · Cited by 35 · see citing works
Comparing sleep quality in institutionalized and non-institutionalized elderly individuals
da Silva, R. M., Afonso, P., Fonseca, M., & Teodoro, T. P. (2019) · Aging & Mental Health · doi:10.1080/13607863.2019.1619168 · Cited by 36 · see citing works
Kwon, C., Lee, B., Cheong, M. J., Kim, T., Jang, B.-H., Chung, S.-Y., & Kim, J. W. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.608896 · Cited by 36 · see citing works
Ravindran, K. K. G., della Monica, C., Atzori, G., Lambert, D., Hassanin, H., Revell, V. L., & Dijk, D. (2023) · JMIR mhealth and uhealth · doi:10.2196/46338 · Cited by 35 · see citing works
Guarnieri, B., Musicco, M., Caffarra, P., Adorni, F., Appollonio, I. M., Arnaldi, D., Bartoli, A., Bonanni, E., Bonuccelli, U., Caltagirone, C., et al. (2014) · Neurological Sciences · doi:10.1007/s10072-014-1873-7 · Cited by 33 · see citing works
A 3-year longitudinal study of sleep disordered breathing in the elderly
Sforza, E. A., Gauthier, M., Crawford-Achour, É., Pichot, V., Maudoux, D., Barthélemy, J., & Roche, F. (2012) · European Respiratory Journal · doi:10.1183/09031936.00133011 · Cited by 33 · see citing works
- Authors
- Bloom, H. G., Ahmed, I., Alessi, C. A., Ancoli‐Israel, S., Buysse, D. J., Kryger, M. H., Phillips, B. A., Thorpy, M. J., Vitiello, M. V., & Zee, P. C.
- Affiliations
- International Longevity Centre (US)
- Albert Einstein College of Medicine (US)
- University of California, Los Angeles (US)
- University of California San Diego (US)
- University of Pittsburgh (US)
- University of Connecticut (US)
- University of Kentucky (US)
- University of Washington (US)
- Northwestern University (US)
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2009-04-28
- Volume
- 57
- Issue
- 5
- Pages
- 761-789
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC2748127
- OpenAlex
- W1740055240
- Cited by
- 464
- References
- 339
- Citations by year
- 2026: 14 · 2025: 13 · 2024: 23 · 2023: 21 · 2022: 35 · 2021: 33 · 2020: 21 · 2019: 33 · 2018: 32 · 2017: 26 · 2016: 25 · 2015: 32 · 2014: 36 · 2013: 23 · 2012: 37
- FWCI
- 4.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG008415)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- sleep disorders, older adults, insomnia, sleep apnea, restless legs syndrome, circadian rhythm sleep disorders, parasomnias, hypersomnia, long-term care, comorbidities, hypertension, depression, cardiovascular disease, cerebrovascular disease, sleep disorder treatment, clinical guidelines
- MeSH terms
- Aged, Humans, Risk Factors, Sleep Wake Disorders, Geriatric Assessment, Practice Guidelines as Topic, Evidence-Based Medicine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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