Sleep disturbances of older persons: physicians' attitudes

To determine their attitudes about sleep problems in older persons, 45 experienced geriatricians were surveyed. Disturbed sleep was a common and clinically important problem in their elderly patients, but most practitioners acknowledged no formal training in this area. Although historical information was nearly the exclusive diagnostic tool, a defined, comprehensive sleep history was not obtained routinely by nearly half of these clinicians. Most often, physicians attributed sleep complaints to conditions secondarily disrupting sleep and to the effects of medications. They rarely diagnosed primary sleep disorders and seldom obtained polysomnography to evaluate their patients. The hazards of pharmacologic therapy were widely recognized, but few clinicians employed predefined nonpharmacologic sleep hygiene programs in their practices. There is a critical need for improved education of clinicians about sleep problems of the elderly and for development of skills essential to their diagnosis and management.