Novel Approaches for Early Detection of Chronic Insomnia Among Older Primary Care Patients

TL;DR

This study finds that chronic insomnia is common among older adults but often undiagnosed, and suggests integrating sleep screening into primary care to improve early detection.

Contribution

The study introduces a novel method for early insomnia detection in older adults through electronic health records and validated sleep screeners in primary care settings.

Findings

One-quarter of surveyed older adults screened positive for chronic insomnia, but only 38% had an insomnia diagnosis in their EHR.

Participants reported a range of symptoms, including difficulty falling asleep and daytime functional impairments.

Patients preferred using a patient portal for insomnia screening and receiving age-friendly sleep recommendations.

Abstract

Sleep disturbance is common among older adults, contributing to social, cognitive, and functional impairments when untreated. Given sleep disturbance is not routinely addressed within primary care, novel methods for its early identification are needed. In partnership with five primary care clinics belonging to a multistate healthcare system, older adults at risk for insomnia, defined by presence of prespecified comorbidities, were identified from the electronic health record and sent a validated sleep screener. Screener domains included sleep schedule, nighttime sleep disturbances, daytime consequences of poor sleep, overall sleep quality, and history of talking with a provider about sleep. Respondents meeting clinical criteria for insomnia were contacted for a telephone interview and invited to participate in additional research activities (interview, co-design, or CBTI treatment). Of 3455 surveys distributed, 446 older adults (mean age: 75(7.2) years, 37% Male, 67% White, 42% pre-frail, 23% poor health) returned a completed survey. One-quarter of respondents screened positive for chronic insomnia (N = 117); yet, only 44 (38%) had an EHR-documented insomnia diagnosis. When asked to describe their sleep in subsequent interviews (N = 94), older adults endorsed a range of symptoms including nighttime sleep complaints (N = 39 (40%), difficulty falling or staying asleep) and negative impacts on daytime function (N = 54 (56%)). These findings indicate insomnia is prevalent yet underdiagnosed and variable in its symptom profile. Patients’ preferences for integrating insomnia screening into primary care included completing a screener via the patient portal prior to a scheduled encounter, tips on communicating sleep problems (e.g., nighttime vs. daytime symptoms), and age-friendly sleep recommendations.