Karl Doghramji, MD: Elderly Insomnia Drivers


As patients age, they become more susceptible to the cyclical factors that can drive insomnia severity.

The driving risk factors of insomnia are mostly manageable, but the ability to prevent them diminish with age.

In an interview with MD Magazine®, Karl Doghramji, MD, professor at Thomas Jefferson University, explained the multitude of factors which can drive insomnia in the elderly—everything from too many, to too little disruptions in the morning.

Doghramji will also be moderating a discussion on sleep disorders at the 1st annual International Congress on the Future of Neurology. The Congress, to be held on September 27-28, 2019 in New York City, will feature a rigorous agenda of presentations, question and answer sessions, and lightning rounds highlighting topics across the breadth of neurology.

Included in the agenda is Doghramji’s session, titled “Beyond Counting Sheep: Effective Therapies for Sleep Disorders. Attendees can learn firsthand from experts in the field, as they discuss new insomnia therapeutic approaches, optimal narcolepsy management, and therapeutic abuse risks.

For more information on the Congress and to register, click here. Receive 25% off registration fees with code Neuro19SI.

MD Mag: What are the causes of insomnia in the elderly?

Doghramji: So, we know that the prevalence of insomnia increases as we age, and there are a number of reasons for that. One of the major and most important reasons is that sleep seems to naturally fragment as we age.

So, as we age, we wake up more, we sleep less during the course of the night, and the elderly become more sleep during the course of the day and nap more. In addition, they seem to have a shortened amount of slow wave sleep, or some of the deeper stages of sleep, and increase their rate of shallow sleep.

There seems to be a natural deterioration of the sleep-wake cycle as we age. The question has always been, are these changes a result of the natural process of aging, or are these caused by psychiatric or other conditions—which also might increase in prevalence as we age.

The data seem to suggest that not all of these changes are due to comorbid conditions, that there seems to be a natural degradation in sleep as we age. We simply cannot sleep as much as we age.

Some of the other factors which contribute to insomnia as we age include external influences: noise in the setting of nursing homes, for example, strongly contribute to waking at night. The bells that are going off, the workers who are coming into the room and disturbing patients as they give them medications, and so on.

The other extraneous factors that seem problematic are room temperature being too hot or too cold, or being exposed to light at the wrong time of day—light exposure in the late afternoon seems to be associated with insomnia. And too little light in the morning when they wake up can make them sleep longer into the day and fragment sleep cycles even more.

Also, a lack of exercise. It's been shown elderly people who lie around too much tend to nap more, which steals from sleep the following night. Some of these behavioral factors are important in contributing to insomnia.

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