Mistake for Doctors to Neglect Insomnia Treatment in Older Patients

January 3, 2007 - The sleep problems of older people are often not addressed by their primary care physicians, even though treatment of those sleep disorders could improve their physical and mental health and enhance their quality of life, according to a study appearing in the American Journal of Geriatric Psychiatry.

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When patients 60 years and older visited their primary care doctors, physicians did not note sleep problems in the patients' charts. This was significant because independent social workers, who interviewed those same patients after their doctors' visits, learned that 70 percent of them had at least one sleep complaint and 45 percent said they had "difficulty falling asleep, staying asleep, or being able to sleep."

Previous research has linked sleep disorders in the elderly to poorer mental and physical health and quality of life. This new research is from the Feinberg School of Medicine at Northwestern University.

"A doctor may not think it's very important to ask the patient about sleep. We (the researchers) hypothesize that doctors think that sleep problems are a normal part of aging and there's not much they can do about it," said Kathryn Reid, Ph.D., lead author on the study and research assistant professor of neurology at Northwestern's Feinberg School of Medicine.

Patients may also assume sleep problems are inevitable as they grow older and not mention them to their doctors, Reid said.

Some changes in sleep -- such as reduction in slow wave or deep sleep starting at about age 40 -- are natural as we age. But insomnia is not. One recent study showed that among older people with exceptionally good health, only about 1 percent had sleep difficulties.

"Now, a lot of studies show that not getting enough sleep can lower your metabolic function, be associated with cardiovascular problems, cancer and breast cancer in women and increase our mortality. Sleep deprivation also increases your sensitivity to pain. If you have a problem with depression, one of the criteria is a change in sleep," Reid said.

She acknowledges science doesn't know what comes first – the sleep problems that can cause health problems or the health difficulties that disrupt sleep.

But treating the sleep disorders results in improved health and quality of life, Reid noted. Some options include meditation, exercise, and bright light or evening activity to push back circadian rhythm for people who wake up too early.

In the study, 1,503 participants from 11 primary care sites serving mainly elderly patients were interviewed. Researchers reviewed medical charts to determine whether sleep problems were identified by the health care providers.

A total of 68.9 percent of patients reported at least one sleep complaint and 40 percent had two or more. Even when all five sleep questions on the survey were endorsed, a sleep complaint was only reported in the patient chart 19.2 percent of the time. Patients ranged from 62 to 100 years old, the average age being 75.5 years.

Researchers found excessive daytime sleepiness was the best predictor of poor physical and mental health. Simply asking a patient, "Do you feel sleepy during the day?" will clue doctors whether to pursue further questioning about sleep in a patient.

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