Managing Challenges of Insomnia in Elderly Patients - Episode 5
Peter L. Salgo, MD: What about the consequences for the elderly with poor sleep? Let’s not focus on the diagnosis of insomnia but on the effects. What, if you’re an older person, is the effect of poor sleep on your life? What do you start with?
Sanford H. Auerbach, MD: Well, it’s a couple different things. 1) An elderly population is not sleeping well at night, they’re getting up in the middle of the night in the dark walking around, and they’re at risk for falls. At a very simple level, they’re at higher risk. During the day, it decreases their whole productivity. Maybe they’re not working quite at the level of what they used to do, but if they don’t sleep well at night and they’re dozing at various times during the day, it’s going to impact their quality of life and their ability to integrate into society. They’re more sensitive. Like everything else, elderly people are much more sensitive to the effects of all sorts of stressors. So, if they’re behind on their sleep, it will have a greater risk of developing impairments for cognition and memory, for instance.
Peter L. Salgo, MD: Does it affect their lifespan? Does lack of sleep shorten your life, or do we know?
Karl Doghramji, MD: There were data from a long-term study, it was a 20-year long study in the elderly, showing that those who slept less than 5 hours had a higher mortality than people who slept longer. But we don’t know whether they complain of insomnia or not. That’s the problem.
Sanford H. Auerbach, MD: People who have very short sleep and very long sleep are the ones who get in trouble.
Peter L. Salgo, MD: We don’t know what’s cause and effect, right?
Karl Doghramji, MD: We don’t know. But I also want to point out it’s beginning to emerge that not sleeping well may have consequences along the lines of other disorders as well. For example, sleeplessness increases the risk of future depressive episodes. In the case of a bipolar patient, it’s the risk for the emergence of a manic condition. So it can aggravate other underlying medical conditions. We know that not sleeping well enhances the risk of hypertension and metabolic disturbances. So these physiologic disturbances seem to emerge when you don’t sleep too well.
Peter L. Salgo, MD: I’m going to throw you 1 curve ball before we move on because I promised my kids I would. Why do people sleep?
Karl Doghramji, MD: Well.
Peter L. Salgo, MD: That’s an 8-year-old’s question I couldn’t answer: “Daddy, why do we sleep?”
Karl Doghramji, MD: I think you’re asking why do we need to sleep. We know that sleep is important for you to accomplish certain things, right, brain metabolism, getting rid of certain poisons from the brain, being able to function. But the real question is why do you need to be in this quasi-unresponsive state to accomplish those?
Peter L. Salgo, MD: Right.
Karl Doghramji, MD: Right, and that’s the real question. The answer is we don’t know.
Peter L. Salgo, MD: My kids actually said, “Sleep is dangerous, daddy. If you’re a caveman and you’re unconscious and an animal comes into your cave, you’re at risk.”
Sanford H. Auerbach, MD: Well, no, but it’s the opposite. If you’re a caveman, and it’s night and you’re not well equipped to go around in the night like some of the other animals, you don’t want to be out there wandering around. You want to be in your cave asleep, out of trouble, safe.
Peter L. Salgo, MD: Your bucket is half full. Your bucket is half empty, and my kids have no answer. Thank you so much.