Sleep disorders contribute significantly to chronic illnesses.  We are very honored Elli Porter agreed to guest blog about this issue for our readers.

Dave Wilson

Integrating Sleep Health into a Primary Care Wellness Program

One in three adults sleeps less than the recommended seven hours. These “short sleepers” may be at a higher risk for chronic disease. Insufficient sleep has been linked to obesity, cardiovascular disease, and depression. Short sleep is not often treated as a condition in itself, but it can be a factor in the treatment of other conditions.

Sleep deprivation is likely to be a greater concern in the Medicare population than the population at large. More than three-quarters of Medicare enrollees are over 65 years of age. Older adults are also more likely to have sleep issues. A 1995 survey showed that fewer than 20% of survey participants aged 65 or older reported that they experienced no sleep issues.

Challenges of an Older Population

Circadian rhythm disturbances may occur in older populations due to the decreased sensitivity of the eyes due to aging. The eyes of older adults do not perceive as much of light required to align the circadian rhythm as young adults can see. Light therapy and cataract surgery (which lightens the lens) may help restore a disturbed circadian rhythm.

Sleep disorders in an older population may be related to secondary diseases.

Treating Sleep Disorders

Sleep interventions might not be successful if sleep disorders are not ruled out.

Common sleep disorders include sleep apnea. Mild sleep apnea may affect 10% or more of the population. Screening asymptomatic adults for sleep apnea is not recommended. See this article for more information on screening techniques and recommendations.

Insomnia is also a common sleep disorder. The American Academy of Sleep Medicine (AASM) has found that cognitive behavioral therapy is as efficacious as hypnotic medicines for the treatment of insomnia. See more information here.

Sleep Interventions

Interventions have shown promise in improving the sleep of older adults.

These interventions often address an underlying cause, such as chronic stress. Mindfulness and cognitive behavioral therapy may help this population. Further research on managing stress as a way to improve sleep is necessary.

Other interventions may include a prescribed exercise program.

Implementing a Sleep Health Program

Few recommendations exist for implementing a sleep health program in a primary care setting. However, there are sleep diagnostic tools available to providers that may be used during an annual wellness visit.

The Pittsburgh Sleep Quality Index may be used to assess whether patients are poor sleepers or not. The diagnostic sensitivity of the test was nearly 90% in the first study completed. The self-reported questionnaire takes less than 10 minutes to complete. Patients may complete it while waiting as part of the sign-in process.

Sleep health education may also be incorporated into the practice. Basic sleep hygiene tips, such as setting regular sleep and wake times, should be shared with patients. These interventions may be circulated through pamphlets. Additional training on sleep health with staff may also be implemented.


Poor sleep health is common among the Medicare population. Treating existing sleep disorders is one means to improve sleep quality. Educating patients on sleep hygiene and conducting regular patient assessments may also help to address sleep issues.

Amy Highland is a sleep expert at She loves taking naps during thunderstorms and cuddling up with a blanket, book, and cats.

Ellie Porter
Managing Editor |