Ragnar Asplund

Health of the Elderly with regard to Sleep and Nocturnal Micturition

A questionnaire study was carried out among pensioners in Jämtland County, Sweden. The questionnaire was answered by 1,115 persons, representing a response rate of 74%. It covered various aspects of health, with emphasis on sleep, fatigue, thirst, and other symptoms that may interfere with night-time sleep. The data were analysed with regard to the stated number of night-time disturbances due to urination. Nocturnal micturition was often associated with increased sleep disorders, a poorer quality of sleep, increased thirst, particularly at night, and increased fatigue in the daytime. All the relationships were clearer in women than in men. There was no relationship between reported enuresis in childhood and an increased frequency of voiding when the subject became older.

The nocturnal polyuria syndrome (NPS)

1. The nocturnal polyuria syndrome (NPS) is characterized by an increased nocturnal urine output. The diurnal rhythm in the antidiuretic hormone (ADH) system is absent, and often there is no detectable ADH in the plasma at all during the night. The 24-hr urine output is normal or only moderately increased. Men without nocturnal micturition, normally have a substantial increase in their nocturnal plasma ADH, while those with a need to micturate during the night have the same ADH level at night as in the daytime. Women have lower ADH levels than men, and no nocturnal increase in ADH irrespective of nocturnal voiding. Subjects with an increased nocturnal voiding frequency due to increased nocturnal urine output have an increased thirst, most markedly at night. They often avoid drinking in the evening, but they are unable to resist the impulse to drink during the night. People with polyuria at night wake up often because of the need to void, and accordingly are often tired during the day. 2. An increased nocturnal urine output can be reduced by administration of desmopressin at night. In a short-term study of elderly sufferers from NPS, treated with 20 micrograms desmopressin as nose drops in the evening the nocturnal urine output was reduced from 65 +/- 8% of the 24-hr urine output before treatment to 50 +/- 15% during treatment. In another study elderly with NPS were treated with 40 micrograms desmopressin as an intranasal aerosol in the evening.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral desmopressin for nocturnal polyuria in elderly subjects: a double‐blind, placebo‐controlled randomized exploratory study

To evaluate the decrease in nocturnal diuresis, nocturnal polyuria and the safety of oral desmopressin in elderly subjects with nocturia.

Nocturnal micturition, sleep and well-being in women of ages 40-64 years.

OBJECTIVE To study the relationship between sleep and nocturnal micturition in women 40-64 years old. METHODS A questionnaire study was carried out in 3669 (6000 invited) randomly selected women in the County of Jämtland in Sweden. Questions were asked about the general state of health, nocturnal micturition, sleep, menstruation and menopausal symptoms, and also about visits to doctors and the use of sleeping pills and hormone preparations. RESULTS The subjective evaluation of the general state of health and of a feeling of contentedness and of confidence in the future worsened with increasing numbers of nocturnal voiding episodes. Sleep was more strongly correlated to the number of nocturnal voiding episodes (R2 = 0.099; P < 0.0001) than to age (R2 = 0.021; P < 0.0001) or the menopause (R2 = 0.017; P < 0.0001). Daytime sleepiness was three times more common among women with three or more nocturnal voiding episodes than among those with no nocturnal micturition. Women who voided three or more times in the night consulted a doctor twice as frequently as those without nocturnal micturition and were treated with drugs 2.5 times as often. The corresponding figures for sick-listing were 75 and 15 days per year, respectively. CONCLUSION Frequent nocturnal micturition is common in 40-64-year-old women and impair sleep with subsequent decrease in daytime performance and general well-being.

Nocturia: consequences for sleep and daytime activities andassociated risks

Abstract The aetiology of nocturia (nocturnal voiding) includes several factors such as somatic disease, age-related endocrine alterations, sleep apnoea, detrusor overactivity, and benign prostatic obstruction with a significant postvoid residual. These conditions are mainly prevalent in the elderly. Indeed, nocturia is such a common condition in the older population that it is often regarded as a normal consequence of ageing and treated accordingly, i.e. left untreated. However, nocturia has a profoundly negative impact on life quality and well-being for many. The sleepdisruption associated with frequent nocturnal awakenings may induce excessive daytime fatigue, cognitive impairment, mood alterations, and increased susceptibility to disease. Nocturia is also associated with depression and an increased mortality rate. In addition, nocturnal voiding episodes increase the risk for falls and fractures during the trips to the toilet and back, especially in older, frail people with a decreased cognitive and motoric functioning. Nocturia imposes not only a significant burden on many nocturics and their partners, its costs for society may also be considerable. Nocturics tend to have a lower productivity at work compared to healthy people and have an increased use of healthcare services. The fatigue due to sleep deprivation further augments the risk for accidents on the road and at the workplace. Clearly, nocturia is not just another annoying condition associated with the ageing process. Rather, it is a serious disorder that, if not treated appropriately, may have far-reaching consequences, both for the patient and for society.

Nocturia in relation to sleep, health, and medical treatment in the elderly

Nocturia is a common condition in the elderly that profoundly influences general health and quality of life. It appears to predict a higher risk of death. One consequence of nocturia is sleep deterioration, with increased daytime sleepiness and loss of energy and activity. Accidents, e.g. falls, are increased both at night and during the day in elderly persons with nocturia. Nocturia is caused by nocturnal polyuria, reduced voided volumes, or a combination of the two. Nocturnal polyuria can be caused by numerous diseases, e.g. diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnoea. A disorder of the vasopressin system, with very low or undetectable vasopressin levels at night, is manifested as an increased nocturnal urine output, which in the most extreme cases reaches 85% of the 24‐h diuresis: the prevalence of low or undetectable vasopressin levels at night has been estimated to be 3–4% in those aged ≥ 65 years. Treatment of nocturia may include avoiding excessive fluid intake and use of diuretic medication in the afternoon rather than the morning, oral desmopressin at bedtime in cases of nocturnal polyuria, and antimuscarinic agents in the case of overactive bladder or impaired storage capacity of the bladder.

Nocturia and depression

To assess the possible relationship between major depression (MD) and nocturia.

Sleep Disorders in the Elderly

Sleep is important for health and quality of life at all ages, and poor sleep interacts with many medical conditions. Somatic and psychiatric diseases, and unfavourable habits and life-style factors, increase the propensity to insomnia in older persons. As health deteriorates with age, sleep becomes poorer. Heart disease and stroke, cancer, painful conditions, breathing disorders and nocturnal polyuria syndrome often disturb sleep. Dementia and depression, which are often associated with sleep disturbances, are also more prevalent in the elderly. Moreover, true age-related sleep deterioration occurs after the age of 75 years.Attempts to improve sleep should first and foremost be focused on elimination of somatic and psychiatric symptoms as far as possible, and on modification of lifestyle factors that may affect sleep quality. For short term treatment, hypnotics are appropriate; for longer periods, nonpharmacological methods, for example light therapy or behavioural modification techniques, should be considered, as many hypnotic drugs are less suitable for long term use. However, there are situations when sleep medication must continue for long periods, especially in elderly patients with severe diseases and poor quality of life. In these patients, careful individualisation of therapy is appropriate.

The development of sleep in persons undergoing cataract surgery

This study was undertaken in order to analyse sleep in a group of patients who were operated on for cataract. All patients (n=328) undergoing cataract surgery at the Department of Ophthalmology, Sundsvall Hospital during a 4-month period were asked to complete a questionnaire on the state and change of sleep and sleepiness 1 month after the operation. Twelve persons were unable or declined to participate. The response rate was 97.2%. The mean ages of the participating men and women were 74.5 and 76.3 years, respectively. Pre-operative visual acuity in the operated eye was 0.16 in men and 0.18 in women. After cataract extraction sleep was improved in 12.0% of the men and in 26.3% of the women. Nevertheless poor sleep 1 month post-operatively was reported by 29.3% of the men and 42.6% of the women (P<0.05). There was no age-related increase in sleep complaints. The results indicate that in elderly persons with cataract sleep is impaired, and that 1 month after cataract extraction improved sleep may be experienced.

Nocturia in relation to somatic health, mental health and pain in adult men and women

To assess the relationship of nocturia to somatic health, mental health and bodily pain.