At the Medicine Grand Rounds held approximately 1 year ago, Dr Wallace Mendelson discussed the management of insomnia in a 96-year-old woman living in a long-term care facility.1 Mrs G had multiple medical problems but denied depression. Dr Mendelson discussed normal and abnormal sleep patterns in the elderly, the differential diagnosis of insomnia, and behavioral and pharmacologic approaches to therapy. He noted the impact of multiple medications on sleep in the elderly and outlined an approach to sleep hygiene that frequently proves helpful.
MRS G: HER PERCEPTIONS AND UNDERSTANDING
I'm better. I still have trouble falling asleep sometimes. I usually sleep about 3 hours. Then I get up to use the toilet. I need to use it every night about midnight. I go back to sleep, but how long it takes depends on if things are on my mind!
DR T: HER PERCEPTIONS AND UNDERSTANDING
Mrs G reports a