Issue

CME Information
Sleep Disorders in the Geriatric Population: Implications for Health
This activity is made possible by an educational grant from Takeda Pharmaceuticals North America, Inc.

Target Audience
This activity is based upon a symposium offered at the 2005 American Geriatrics Society Annual Meeting in Orlando, Florida. It is intended for internal medicine physicians, family practitioners, geriatricians, general practitioners, cardiologists, neurologists, psychiatrists, geriatric psychiatrists, and physician’s assistants.

Educational Objectives
Upon completion of this acti

The prevalence of sleep complaints rises with increasing age,1,2 and the consequences of sleep disturbance can be particularly troubling in the older population. Older individuals with disturbed sleep have difficulty sustaining attention, slower response times, and problems with memory on neuropsychological tests.3-5 They also report more daytime sleepiness, fatigue, low energy levels, and depression.6-8 Older adults with disturbed sleep are more likely to use over-the-counter (OTC) and prescription hypnotic medications inappropriately, and have a higher risk of nighttime falls. Overall, older

Melatonin is o-methylated and acetylated serotonin made in the pineal gland in vertebrates as a result of stimulation by norepinephrine.1 From the pineal gland, melatonin is secreted into the cerebrospinal fluid, and then to the hypothalamus where the suprachiasmatic nucleus, or the body clock, is located. Thus, blood levels of melatonin underrepresent the actual levels reaching receptors in the hypothalamus.2

Light regulates the suprachiasmatic nucleus, which, in turn, acts as a pacemaker to regulate the circadian rhythms including temperature, cortisol levels, sleep propensity, and melat

Sleep Apnea
The Centers for Medicare & Medicaid Services, which determines reimbursement for treatment, defines sleep apnea as an apnea-plus-hypopnea index (AHI) of 15 or more or an AHI of 5 or more with hypertension, stroke, sleepiness, ischemic heart disease, insomnia, or mood disorders—all common in the older population. Apnea is defined as cessation of breathing for 10 seconds or more. Obstructive sleep apnea (OSA) occurs when the patient continues trying to breathe during the cessation, usually indicating that the pharynx is occluded or obstructed. Central sleep apnea occurs when the

Sleep complaints in older adults are often associated with comorbid illnesses or medications rather than to aging per se (Figure 3). Chronic diseases become more prevalent as patients age, and it is not uncommon for older patients to have multiple concurrent medical conditions. Studies have found that patients with multiple health problems are more likely to have sleep difficulties as well, and that their sleep quality decreases with an increasing number of medical conditions. The 2003 “Sleep in America” survey found that 36% of people age 65 years and older with no comorbid illnesses had

As of the year 2000, approximately 4 million Americans had Alzheimer’s disease (AD), and it is projected that more than 14 million will have AD by the year 2050.1 As this population grows, increasing efforts must be made to improve quality of life, including improving sleep in these patients. Objective measurements of sleep in patients with dementia have shown increased sleep fragmentation, longer sleep onset latency, decreased sleep efficiency, decreased total sleep time, and decreased slow wave sleep.2 In addition, those with more severe dementia appear to have more severe sleep disruption

CME Examination & Evaluation
Sleep Disorders in the Geriatric Population: Implications for Health

To receive a certificate of completion, please complete the following CME Examination and Participant Information and fax both sides of this page or mail to:

American Geriatrics Society • The Empire State Building • 350 Fifth Ave, Suite 801 • New York, NY 10118
Fax: (212) 832-8646 • Attn: Dennise McAlpin

Please allow 4 weeks for processing. Program expiration is December 2006. Please phone (212) 308-1414 with any questions.

Please circle the correct answer.
1. T