Sleep Disorders in the Elderly

As a former health care administrator of two well-respected, community-based, continuing care settings for the elderly [Iowa Jewish Senior Life Center, Des Moines, Iowa, and the Robison Jewish Health Center, Portland, Ore], I thought that I was aware of the nature of sleep disorders in this population. I was wrong. It was not until recently, when I developed a sleep disorder myself, that I began to reflect on the impact that such disorders could have on residents of my former facilities, as well as on the nearly 17,000 nursing facilities nationwide caring for an estimated 1,600,000 residents under care.

 The November 2005 article “Treating Older Adults” is available online at

If you asked nursing staff members in such a setting about sleep disorders, they would probably be able to speak about the importance of sleep and the many problems that can arise from a lack thereof. Yet, when queried as to how many of their residents have a diagnosed sleep disorder, they would be challenged to identify even one patient.

Why is it that so few long-term care patients are identified with sleep disorders? Is there a disconnection between knowledge and action on the part of long-term care staff? Are patients being underdiagnosed or misdiagnosed? Is there a need for further sleep disorder education within our nation’s long-term care facilities? Do these facilities have appropriate policies and procedures to identify, authorize, refer, and treat sleep disorders? Are facilities taking advantage of pulmonary and polysomnographic consultation and is such readily available to them? And finally, can a preliminary sleep study be conducted in-house and be still eligible for private insurance or Medicare reimbursement?

The operative word here is in-house. Most community sleep laboratories are ill-equipped to deal with the complex nursing problems of elderly continuing-care patients. The nursing facilities where these patients reside are more logical places to conduct such studies for this frail population.

A typical nursing facility already has equipment for monitoring pulse oximetry and blood pressure, creating electrocardiograms (ECGs), performing emergency resuscitation, and more. Therefore, any additional equipment needed for monitoring of respiration, snoring, and limb movement would be simple to acquire and master. Add to this a consultant pulmonologist and a polysomnographic technologist and you have created a one- or two-bed sleep study center in-house.

There is an unmet need to address the sleep disorder problems of our nation’s elderly who reside in the thousands of long-term care facilities through our country. Only through a concerted effort can real change be effected. I believe that the long-term care industry, if sensitized to the need, will step up to the challenge and implement the policies and procedures necessary to screen for these disorders along with the adoption of challenging sleep educational offerings appropriate to their settings.

Carl S. Rogat
Notes4Review Inc
Beaverton, Ore

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