Sleep Disorders and Health Conditions: Focus on Insomnia - Episode 1

Overview of Sleep Disorders

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Dr Nathaniel F. Watson, MD, provides insight on the prevalence of various sleep disorders, including insomnia, and patient populations at high-risk for developing these disorders.

C. Michael Gibson, MD: Hello, and welcome to this Neurology Live®Peer Exchange titled “Sleep Disorders and Health Conditions: Focus on Insomnia.” I’m Dr Mike Gibson. I’m a cardiologist and a professor of medicine at Harvard Medical School in Boston, Massachusetts. I’ll be moderating today’s discussion. I’m joined by 2 panelists. Our first panelist is Nate Watson. Nate is the director of the Sleep Medicine Center at Harborview at the University of Washington in Seattle, Washington. Welcome, Nate.

Nathaniel F. Watson, MD: It’s good to be here.

C. Michael Gibson, MD: We’re also joined by Dr Ashgan Elshinawy. She’s a pulmonologist at Pulmonary & Sleep Disorders of New Jersey. Welcome, Ashgan.

Ashgan A. Elshinawy, DO: Thank you so much for having me.

C. Michael Gibson, MD: We’re going to talk about the co-occurrence of sleep disorders and other health conditions, the lack of awareness in the patients, prescribers, and physicians. What do we need to do to treat these patients? We’ll discuss the landscape of insomnia, and we’ll focus a lot on the use of dual orexin receptor antagonists. Nate, can you give us an overview of sleep disorders? How common are they? Let’s start in the general population.

Nathaniel F. Watson, MD: Sleep disorders are some of the most common disorders. First, we want to talk about the most common cause of sleepiness, which is sleep deprivation. According to the CDC [Centers for Disease Control and Prevention], sleep deprivation affects about a third of individuals in the United States who aren’t getting adequate sleep to support optimal health and alertness—7 or more hours is the general recommendation. That problem is pervasive throughout our society, but when we move to more specific sleep disorders, insomnia is of course 1 of them. Chronic insomnia affects 10% of the population, but 30% of the population is going to have some issue with insomnia or intermittent insomnia at times in their lives. Almost everybody has experienced some challenges with that at some point: obstructive sleep apnea, or difficulty breathing at night, results in sleep disturbance. This can cause high blood pressure and is associated with other cardiovascular diseases. Depending on the gender and age groups you’re looking at, roughly 10% of the population suffers from that.

Then you have sleep-related movement disorders, like restless leg syndrome, with prevalence estimates from 5% to 20%. A huge percentage of people have sleep disorders and need care for these issues. Unfortunately, in the United States we have a shortage of sleep medicine physicians to address all the sleep disease burden out there. The field is working on increasing our workforce to address access issues, but sleep disorders are pervasive.

C. Michael Gibson, MD: Are there any higher-risk groups? Talk to us about older adults.

Nathaniel F. Watson, MD: Age is a risk factor for everything, but insomnia can become more problematic as we get older. When we think about insomnia medications, we always want to consider safety-related issues, particularly when we’re prescribing them to older individuals. Age increases the risk of sleep apnea, and this is something we have to keep in mind when we’re taking care of our patients and considering what may be the root cause for their sleep disturbance.

Transcript Edited for Clarity