The Assessment and Management of Insomnia Among Older Adults

Abstract

As many as 50% of older adults have concerns regarding the initiation or maintenance of sleep. The underdiagnosis or misdiagnosis of sleep disorders can cause significant complications in the elderly, and this symposium aims to provide the geriatric specialist with the knowledge and tools to evaluate and treat common sleep concerns. The session will open with a brief introduction overviewing the epidemiology and significance of insomnia. Dr. Srinivasan will open with a review of the physiologic stages of the sleep cycle. She will also discuss age-related changes in sleep architecture that clinicians should be aware of when conceptualizing sleep in elderly patients.In section 2, Dr. Johnson will review the evaluation of insomnia in older adults, with a focus on differential diagnosis of sleep disorders. Insomnia will be sub-divided into initial, middle, and terminal insomnia and include brief overviews of obstructive sleep apnea, parasomnias including REM sleep behavior disorder, restless legs syndrome, and factors impacting the circadian cycle. Screening tools and scales to assist in the evaluation of sleep disorders will also be discussed.Section 3 will be an overview of non-pharmacological interventions from Dr. Srinivasan. She will review the evidence for Cognitive Behavioral Therapy for Insomnia (CBT-I) and also discuss the core components of CBT-I. While sleep hygiene and behavioral therapies are usually considered first line treatment, pharmacotherapy may be beneficial as adjunctive treatment in patients with persistent insomnia who are unable to pursue cognitive behavioral therapies. According to the medical literature, both treatment modalities have been found to yield similar short-term outcomes, while CBT-I has been shown to yield better long-term outcomes. In the 4th section of the session, Dr. Dix will provide an overview of different classes of pharmacological interventions for insomnia, discussing a variety of treatments and their mechanism of action, dosing, efficacy, risks, and benefits. Prior to allowing time for questions from the audience, Dr. Tampi will briefly discuss the practical application of available evidence in managing insomnia among older adults.