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- Page navigation anchor for RE: chronic insomnia for several years (28)RE: chronic insomnia for several years (28)
Please direct me to a doctor(s) that are very qualified in elderly chronic insomnia. In South West Ontario Canada. I have developed health issues due to days of non sleep with no napping for 27 years!! I sincerely need help please.
Regards
Neena Merrill. 905 636 7803
neenamerrill@hotmail.ca
Thank youCompeting Interests: None declared. - Page navigation anchor for RE: Letter to the Editor Regarding– Insomnia in older adults: Approaching a clinical challenge systematicallyRE: Letter to the Editor Regarding– Insomnia in older adults: Approaching a clinical challenge systematically
Dr. Alan Kaplan, MD, CCFP(EM), FCFP
Conflict of interest: Dr. Kaplan was a member of an advisory board for Eisai Canada, the maker of Lemborexant (DayvigoTM).
The article “Insomnia in older adults: Approaching a clinical challenge systematically” by Molnar and colleagues published in CFP’s January issue (1) is an excellent and timely review of the clinical approach to insomnia. This is increasingly important as the prevalence of insomnia continues to grow, especially in the elderly population.
The article briefly discussed numerous pharmacological treatment options for insomnia in the elderly. However, the review failed to include the drug lemborexant, belonging to the class of orexin receptor antagonists. This drug, approved by Health Canada in 20202, can be considered as an option to treat insomnia in the elderly.
As noted by Molnar et al., benzodiazepines and z-drugs can have substantial side effects and harms so they are not recommended for chronic insomnia (1). In October 2020, Health Canada updated the safety labelling requirements for benzodiazepines and z-drugs to include language around the risks of problematic use and substance use, severe withdrawal symptoms, harm when taken with opioids, which may cause drowsiness, respiratory depression, coma and death; and falls and fractures in elderly patients (3).
There is epidemiologic and experimental evidence to establish a strong causal connection between benzodiazepine/z-drug use t...
Show MoreCompeting Interests: Dr. Alan Kaplan, MD, CCFP(EM), FCFP Conflict of interest: Dr. Kaplan was a member of an advisory board for Eisai Canada, the maker of Lemborexant (DayvigoTM). - Page navigation anchor for Exercise benefits in older patients with insomniaExercise benefits in older patients with insomnia
Dear Editor,
Congratulations Dr. Frank Molnar and colleagues for the practical approach on managing insomnia in older patients published in the January 2021 issue of the Canadian Family Physician [1]. The article includes valuable information, but there are two matters which need to be considered.
First, the authors have mentioned that "The prevalence of insomnia increases to up to 40% for people older than 65 years of age." However, a recent report (2019) has shown that up to 75% of older adults suffer from insomnia [2].
Second, with regard to the non-pharmacological interventions for improving insomnia symptoms, there is growing evidence that regular moderate-intensity exercise, whether aerobic or resistance training, not only improves different aspects of sleep in older adults, including total sleep time, sleep onset latency, sleep efficiency, and overall sleep quality, but also reduces medication use for insomnia [3-7]. In turn, all medical and psychiatric conditions associated with disturbed sleep are positively affected by physical activity and exercise [8]. On these grounds, clinicians should not underestimate the bidirectional associations between daily exercise and sleep function improvement. Importantly, they should routinely monitor the levels of physical activity in people with difficulty sleeping.
Acute and chronic exercise may reduce insomnia by affecting various physiological systems and mechanisms, such as the thermor...
Show MoreCompeting Interests: None declared.