Sleep disorders in the elderly patient

The primary care physician commonly encounters patients who complain of insomnia, defined as persistent difficulty in failing or staying asleep that affects daytime functioning. Causes include circadian rhythm disturbances, primary sleep disorders, psychiatric or medical disorders, medications, and substance abuse. Older patients have shortened total nocturnal sleep, easier arousal, more difficulty failing asleep, and less deep sleep. These physiologic sleep changes can resemble pathologic sleep conditions. A thorough history and physical examination and a selective laboratory examination should be performed. Formal sleep studies are indicated when a primary sleep disorder, such as obstructive sleep apnea, is suspected. Educating the patient about avoiding stimulating or diuretic medications close to bedtime is an important aspect of the treatment. Otherwise, specific therapy is tailored to the underlying etiology. Benzodiazepines should be avoided because of the many adverse effects and the risk of habituation. Benzodiazepine use and sleep disturbances are especially prevalent in older female patients. Therefore, the obstetrician/gynecologist must be very familiar with the work-up, differential diagnosis, and treatment of insomnia in the elderly patient.