The analysis of age-related changes in sleep requires the accumulation of data on a healthy population over 65 years of age. However, increased age raises the risk of cardiovascular, metabolic, cognitive, psychiatric, musculoskeletal, renal, hepatic, and hematological conditions. Structural decline in the elderly, including reduced brain mass and numbers of neurons, might lead to functional brain loss. Certain primary sleep disorders affecting sleep in the elderly includes insomnia, sleep-disordered breathing (SDB), periodic limb movement disorder and restless legs syndrome, circadian rhythm sleep disorders, and sleep in dementia. This chapter provides the clinical presentation, diagnosis and treatment for each disorder. As sleep and its restorative function become more widely recognized for their impact on both medical conditions and quality of life in the elderly, the healthcare community has ever-increasing responsibility for translating the growing knowledge of sleep medicine into clinical practice in geriatric medicine.

This chapter helps clinicians to understand developmental changes in sleep patterns, screen for and identify common pediatric sleep disorders, know what tests and treatments to consider, and decide when to refer to a specialist. It describes the clinical presentation, basic evaluation, and management strategies for the most common sleep disorders in children in the following categories: insomnia, sleep-disordered breathing, hypersomnias, circadian rhythm sleep disorders, parasomnias, and sleep-related movement disorders. Obstructive sleep apnea (OSA) is a common health problem, affecting 2% of children. Onset of narcolepsy typically occurs between 15 and 25 years of age with a prevalence rate of 2 per 1000. Multiple physiologic processes of our bodies, including our sleep/wake cycle, follow circadian rhythms with a periodicity of roughly 24 hours. Sleep-related movement disorders involve restless legs syndrome (RLS) and rhythmic movement disorder (RMD).

This chapter discusses circadian rhythms and the known factors which influence them as well as provide an update on the evaluation and treatments of the six circadian rhythm sleep disorders. The six circadian rhythm sleep disorders include delayed sleep phase type, advanced sleep phase type, non-24-hour sleep/wake syndrome, irregular sleep/wake rhythm, shift work sleep disorder, and jet lag disorder. Zeitgebers such as light are entraining agents of the circadian system and the manipulation of zeitgebers can be used as a therapeutic tool for the circadian rhythm sleep disorders. Measurements of circadian phase can be obtained through various surrogate markers of circadian rhythms, including the core body temperature minimum and the dim light melatonin onset (DLMO). Circadian rhythm sleep disorders are commonly under recognized in clinical practice and should be a part of the differential diagnosis of people who present with symptoms of insomnia and daytime sleepiness.