I can work till 3 in the morning and I’m great in the morning.” Are there people like that? There are people who say, “I get by, I don’t need sleep. Salgo, MD: That’s another thing I want to bring up to the panel. You don’t need as much sleep as everybody else.
So somebody who says, “I get 6 hours of sleep at night, I don’t think it’s enough, but, gee, I’m top notch during the day. It really hinges on the second part of that definition, which it has to have an impact on daytime function.
It’s not an issue of not being able to fall asleep, stay asleep. Auerbach, MD: That’s the biggest point about this is that it’s not just having difficulties with sleep at night. Salgo, MD: And what are the consequences? And of course, it has to cause some consequences for it to be insomnia disorder. Karl Doghramji, MD: If you have the problem more than 3 nights per week and if it lasts at least a few weeks or longer, then it’s defined as insomnia disorder. None of this matters as long as you feel good. It’s less than 3 hours sleep, 5 hours sleep, 8 hours sleep, you wake a lot. Salgo, MD: I would bet out in our audience, most folks are looking for a far more definitive answer than that. Salgo, MD: But wait, you said it’s subjective. Peter, the most widely accepted nosologic understanding of insomnia is in DSM-5, which says that insomnia disorder is basically a subjective dissatisfaction with sleep where people have difficulty with sleep quality or quantity, either not falling asleep quickly enough or not staying asleep, and that there’s some consequence associated with it, some disturbance. Karl Doghramji, MD: I’ll take that, Peter. What are we talking about? What is insomnia here? Who wants to jump in? Why don’t we start with the obvious question. I want to thank all of you so much for being here. Participating today on our distinguished panel are:ĭr Sanford Auerbach, director of the Sleep Disorders Center and Sleep Medicine Fellowship Training Program, and associate professor of neurology, psychiatry, and behavioral neurosciences at Boston University School of Medicine in Boston, Massachusetts ĭr Nicole Brandt, executive director of drug therapy and aging, and professor of pharmacy practice and science at the Peter Lamy Center on Drug Therapy and Aging at University of Maryland School of Pharmacy in Baltimore, Maryland ĭr Karl Doghramji, medical director of Jefferson Sleep Disorders Center and program director of Fellowship in Sleep Medicine at Thomas Jefferson University in Philadelphia, Pennsylvania Īnd Dr Gary Johnson, medical director at a large national insurer who works from his home in Northern Michigan. I’m a professor of medicine and anesthesiology at Columbia University Vagelos College of Physicians and Surgeons and associate director of surgical intensive care at NewYork-Presbyterian Hospital in New York, New York. Our panel of experts is going to discuss some safe and effective treatment options for elderly patients who experience insomnia.
However, inconsistent sleep can cause agitation and depression in elderly patients, especially with neurologic comorbidities. These medications can cause confusion and memory problems, which could increase the risks for falls and fractures. Salgo, MD: Hello and thank you for joining this AJMC® Peer Exchange titled “Managing Challenges of Insomnia in the Elderly.”Įlderly patients are likely to be more sensitive to the adverse effects of medications.
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