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Herbal Medicine for Sleep Disturbances in the Elderly

This presentation discusses the characteristics of sleep in the elderly and the treatment of sleep disturbances through herbal prescriptions. Topics include polysomnography sleep stages, periodic limb movements during sleep, and prescriptions for sleep disturbances. The potential benefits and contraindications of benzodiazepines and other medications are also explored.

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Herbal Medicine for Sleep Disturbances in the Elderly

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  1. Traditional Medicine-2015Birmingham, UKAugust 03 – 05, 2015 Traditional Medicine 2015 HIDETO SHINNO

  2. Herbal Medicine for Sleep Disturbances in the Elderly Hideto SHINNO Kagawa University School of Medicine Japan The 3rd International Conference and Exhibition on Traditional & Alternative Medicine August 3, 2015 Birmingham, UK

  3. Sleep Disturbances in the Elderly • Characteristics of sleep in the elderly 2. Treatment of sleep disturbances in the elderly Herbal prescription for sleep disturbances

  4. Sleep Disturbances in the Elderly • Characteristics of sleep in the elderly 2. Treatment of sleep disturbances in the elderly Herbal prescription for sleep disturbances

  5. Polysomnography sleep stages W REM I II III IV Subjects in the Elderly

  6. Polysomnography sleep stages W REM I II III IV Subjects in the Elderly

  7. Polysomnography sleep stages W REM I II III IV Subjects in the Elderly

  8. Polysomnography sleep stages W REM I II III IV Subjects in the Elderly non-REM sleep

  9. Polysomnography sleep stages W REM I II III IV Subjects in the Elderly

  10. Polysomnography sleep stages W REM I II III IV Subjects in the Elderly A prolonged sleep latency

  11. Polysomnography sleep stages W REM I II III IV Subjects in the Elderly Decrease in slow wave sleep (stages III +IV)

  12. Polysomnography sleep stages W REM I II III IV Subjects in the Elderly frequent arousals

  13. Polysomnography Decrease in REM sleep sleep stages W REM I II III IV Subjects in the Elderly

  14. Sleep in the Elderly Polysomnography Relatively increased stage I A decrease in slow wave sleep A shortened total sleep time A shortened REM sleep time Sleep fragmentation (frequent arousals) Increase in PLMs Increase in apnea-hypopnea index Increased Wake time after sleep onset Periodic limb movements during sleep

  15. Periodic Limb Movement during Sleep (PLMs) Repetitive, stereotyped movements of the lower extremities in sleep Rhythmic extensions of the big toe and dorsiflexions of the ankle

  16. Periodic Limb Movement during Sleep (PLMs) Repetitive, stereotyped movements of the lower extremities in sleep Rhythmic extensions of the big toe and dorsiflexions of the ankle Followed by Accelerated heart rates

  17. Periodic Limb Movement during Sleep (PLMs) Repetitive, stereotyped movements of the lower extremities in sleep Rhythmic extensions of the big toe and dorsiflexions of the ankle Increase in PLMs frequent arousals sleep disruption Followed by Accelerated heart rates

  18. Periodic Limb Movement during Sleep (PLMs) Repetitive, stereotyped movements of the lower extremities in sleep Rhythmic extensions of the big toe and dorsiflexions of the ankle Increase in PLMs frequent arousals sleep disruption PLM Disorder PLMs > 15 / hour American Academy of Sleep Medicine (2005)

  19. Periodic Limb Movement during Sleep (PLMs) Repetitive, stereotyped movements of the lower extremities in sleep Rhythmic extensions of the big toe and dorsiflexions of the ankle Increase in PLMs frequent arousals sleep disruption After awakenings PLMs disappears

  20. Periodic Limb Movement during Sleep (PLMs) Repetitive, stereotyped movements of the lower extremities in sleep Rhythmic extensions of the big toe and dorsiflexions of the ankle Increase in PLMs frequent arousals sleep disruption Patients are usually unaware of PLMs. After awakenings PLMs disappears

  21. Sleep in the Elderly Polysomnography Relatively increased stage I A decrease in slow wave sleep A shortened total sleep time A shortened REM sleep time Sleep fragmentation (frequent arousals) Increase in PLMs Increase in apnea-hypopnea index Increased Wake time after sleep onset Periodic limb movements during sleep

  22. Sleep Disturbances in the Elderly • Characteristics of sleep in the elderly 2.Treatment of sleep disturbances in the elderly Herbal prescription for sleep disturbances

  23. Prescriptions for sleep disturbances

  24. Prescriptions for sleep disturbances Benzodiazepines

  25. Prescriptions for sleep disturbances Benzodiazepines hangover effects prolongation of the hypnotic effect

  26. Prescriptions for sleep disturbances Benzodiazepines hangover effects prolongation of the hypnotic effect amnesia, delirium

  27. Prescriptions for sleep disturbances Benzodiazepines hangover effects prolongation of the hypnotic effect Contraindications sleep apnea syndrome amnesia, delirium

  28. Prescriptions for sleep disturbances Benzodiazepines hangover effects prolongation of the hypnotic effect Contraindications sleep apnea syndrome amnesia, delirium Insufficient efficacy periodic limb movement (PLM)-assocoated arousals

  29. Prescriptions for PLM Saletu M, et al (2001) Eur Neuropsychopharmacol 11: 153-61 Milter MM, et al. (1986) Sleep 9: 385-92 Boghen D, et al (1986) Can J Neurol Sci 13: 245-7 GABA L-dopa Hening W, et al. (1999) Sleep 22: 970-99 Brodeur C, et al. (1988) Neurolgy 38: 1845-8 Pramipexole Jama L, et al. (2009) Sleep Med 10: 630-6 Manconi M, et al. (2007) Sleep Med 8: 491-7 Clonazepam Dopaminergic agents dopamine

  30. Sleep Disturbances in the Elderly The effect of Herbal prescription TJ-54 on sleep disturbances

  31. Yokukansan (YKS) Theherbal prescription Yokukansan, TJ-54 Yi-Gan San Pulvis deressionis efficientiae

  32. Introduction Yokukansan (YKS) The herbal prescription

  33. Introduction Yokukansan (YKS) The herbal prescription • YKS was originally developed as a remedy for restlessness and agitation in children.

  34. Introduction Yokukansan (YKS) The herbal prescription • YKS was originally developed as a remedy for restlessness and agitation in children. • In Japan, YKS has been approved for neurosis, insomnia, and night time crying in children.

  35. Introduction Yokukansan (YKS) The herbal prescription • YKS was originally developed as a remedy for restlessness and agitation in children. • In Japan, YKS has been approved for neurosis, insomnia, and night time crying in children. • Recently YKS is prescribed for psychiatric symptoms in dementia.

  36. TheIngredients of YKS 7 herbs Uncarie UncisCum Ramulus Glycyrrhizae Radix Cnidii Rhizoma Bupleuri Radix AngelicaeRadix Atractylodis Lanceae Rhizoma Hoelen

  37. Yokukansan (YKS) Extract Granules for Ethical Use

  38. The effect of YKS on sleep disturbancesin patients with Dementia Polysomnography Shinno H, et al (2008) Prog Neuropsychopharmacol Biol Psychiatry 32: 881-885. YKS administration (7.5 g/day) mean age: 81±7 years old Alzheimer’s disease: 4 cases Dementia with Lewy bodies: 4 cases YKS treatment days (week)

  39. The effect of YKS on sleep disturbances Shinno H, et al (2008) Prog Neuropsychopharmacol Biol Psychiatry 32: 881-885. time (min)

  40. Significant increase in Total Sleep Time and WASO The effect of YKS on sleep disturbances Shinno H, et al (2008) Prog Neuropsychopharmacol Biol Psychiatry 32: 881-885. time (min) WASO; wake time after sleep onset

  41. Significant increase in Stage II Sleep The effect of YKS on sleep disturbances Shinno H, et al (2008) Prog Neuropsychopharmacol Biol Psychiatry 32: 881-885. time (min)

  42. Number of awakenings at night No. of arousals After YKS treatment, number of awakenings significantly decreased. * *P<0.0５ Shinno H, et al. (2008) Prog Neuro-Psychopharm Biol Psychiat

  43. The effect of YKS on PLM during sleep PLMs index (No. / hour) Shinno H, et al (2008) Prog Neuropsychopharmacol Biol Psychiatry 32: 881-885. PLMs index =No. of PLMs / sleep time (hour)

  44. The effect of YKS on sleep disturbances PLMs index (No. / hour) Shinno H, et al (2008) Prog Neuropsychopharmacol Biol Psychiatry 32: 881-885. ** **p<0.01 YKS reduced PLMs.

  45. developed by Buysse et al. (1989) Pittsburgh Sleep Quality Index (PSQI) PSQI score * YKS treatment improved subjective sleep quality. baseline YKS-treated *P<0.05 Shinno H, et al. (2008) Prog Neuro-Psychopharm Biol Psychiat

  46. Effect of YKS on Insomnia in the (non-demented) Elderly

  47. Effect of YKS on Insomnia in the (non-demented) Elderly Subjects: 10 patients with neurotic disorders 4 males and 6 females mean age 73.3±4.4 years old Methods: Polysomnography was carried out at adaptation night, baseline after treated with YKS for 4 weeks Sleep architectures and PLMs index were compared. -1d Adaptation night YKS 5g/d (evening and bedtime) For 4 weeks After treatment baseline

  48. Effect of YKS on Insomnia in the (non-demented) Elderly Time (min)

  49. Effect of YKS on Insomnia in the (non-demented) Elderly Time (min) Improved Daytime sleepiness NOT affected Apnea-Index

  50. Effect of YKS on Insomnia in the (non-demented) Elderly ** **p<0.01

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