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nocturnal incontinence, falls, agitation, and wandering,
can benefit patients and their caregivers. Appropriate and
judicious pharmacologic implementation, albeit still
limited by lack of trials of newer sedative-hypnotic medica-
tions, may be warranted in some cases. Treatments for
sleep apnea should also be considered; poor adherence
should never be assumed, especially in the presence of an
engaged spouse or caregiver. Furthermore, introduction of
knowledge at the institutional or staffing level regarding
not only specific sleep disorders (sleep apnea, RLS) but
also basic sleep hygiene and principles of nonpharmaco-
logic management of inadequate nocturnal sleep, can
enhance health and quality of life. Rudimentary under-
standings of basic principles of chronobiology should also
be sought. The sleep and well-being of the institutional-
ized dementia patient should not be considered beyond the
range of care of the sleep medicine specialist.
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tional impairment in Alzheimer's disease. Am J Geriatr Psychiatry
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Clinical Pearl
Patients residing in nursing homes can present with
many significant sleep-related problems that affect
the quality of life of those patients and those who
care for them. These issues should not be considered
beyond the range of care of the sleep medicine spe-
cialist. Consultative advice regarding appropriate
medication use, including drug interactions, may be
significant when issues arise involving falls, noctur-
nal agitation and wandering, and daytime sleepiness.
Sleep apnea and its treatment should not be consid-
ered beyond the realm of possibility for the nursing
home patient as long as expectations are clear and
warranted. The inevitable aging of the population
raises the likelihood that many sleep medicine spe-
cialists will be asked to provide input regarding sleep
in such patients.
The writing of this chapter is supported by the following
grants: NS-050595, AG-020269, and AG-025688.
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