On 22 Mar, 2025, Seniors Today hosted their weekly Health Live Webinar with a Senior Pulmonologist, Dr Ravi Dosi who spoke on and answered questions about Sleeping Soundly in your Senior Years: Understanding Age Related Sleep Changes
Dr Ravi Dosi has been in the field of chest medicine since 2005. He was an Assistant Professor Department Of Respiratory Diseases, Sri Aurobindo Medical College & Post Graduate Institute, Indore from Dec 2015 till Aug 2018. He has also been a Professor & HOD Department Of Respiratory Diseases, SriAurobindo Medical College & Post Graduate Institute, Indore. He has been in charge, SAIMS COVID Hospital 15th March 2020 to 2022 with more than 50000 IPD. During the First wave, Post COVID OPD JAN 2021 TO SEPT 2022 he saw more than more than 10000 OPD. He has also been a Consultant pulmonologist at CHL Apollo, CHL & care CHL hospitals for more than ten years. He has also been the Director, Senior pulmonologist at Dosi Chest Clinic, operational since 2010. His areas of interest include Tuberculosis, interventional pulmonology, sleep medicine, COPD, Asthma. He has performed IPD consultation, chronic respiratory management, flexible & rigid bronchoscopy, pediatric bronchoscopy, semi rigid & rigid thoracoscopy, indwelling pleural catheter, immunotherapy, pleurodesis, pleural tapping, icd placement, pig tail placement, pleurodesis. Dr Ravi Dosi did his MBBS from MGM Medical College, Indore (1997 to 2002) followed by a Diploma in Tuberculosis & Chest Diseases – Manorama Raje TB Hospital & Maharaja Yeshwant Rao Hospital, Indore (2005 – 2007). He pursued his D N B [Respiratory Diseases] – Mediciti Super specialty Hospital, Hyderabad (2007 – 2010). He went on to get Registered as a polysomnographic Technician\, RPSGT, 2022 BRT, USA. Diploma in Pediatric Sleep Medicine, University of Colorado, USA& Shakshuka, Bangalore. Post – Doctoral Diploma in Interventional Pulmonology, EBUS by Amrita Institute Of Medical Sciences, Kochi,2019. Post graduate diploma in clinical research according to ICH GCP Guidelines[PGDCR], Clinical research Education & Management Academy, Hyderabad, 2010. Fundamental Critical Care Support Course [ Instructor] ISCCM Jaipur, 2010. Advanced Cardiac Life Support Course ISCCM Jaipur. He’s pursued fellowships from Fellowship of United Academy of Pulmonary Academy ,2022 by United Academy of Pulmonary Medicine Udaipur 2022, Fellowship in Allergy, Asthma & Immunotherapy, Bangalore 2017, Fellowship in Sleep Medicine from Safdar Ganj Hospital, New Delhi 2018, Fellowship in Interventional Pulmonology &EBUS , Amrita Institute, Kochi, 2019.
One very important aspect of Respiratory Medicine is sleep medicine.
Snoring is a sleep related issue but it is not entirely a sleep related issue. Snoring in every case is not a disease.
There can be different types of snoring.
Sleep is highly personal to every individual.
We should try to sleep at a fixed time and place. We should try to sleep in the most comfortable environment possible.
Insomnia can be both a disease and also a normal part of the process of ageing.
Insomnia is a sleep disorder. It is the most prevalent sleep disorder in the world. As high as 50- 55% of the world population, at some point in their life suffer from insomnia.
Sleep disturbances are very common in adults, i.e. anybody over the age of 18 years, suffers from sleep related disorders/ disturbances.
As we age, our natural sleep hours tend to go down which makes us prone to more sleep disturbances.
As we grow, we have more things that we consume and are addicted to, such as caffeine, tobacco, alcohol. Our sleep time is constantly changing.
Sleep disturbances are very common in India. The most common of these is insomnia.
Insomnia is when a person finds it difficult to go to sleep, and/ or maintaining sleep and/ or waking up in the morning refreshed.
Elderly people are more likely to have other diseases in addition to insomnia which can make the person overlook insomnia and attribute his inconsistent sleep to the disease.
It is important to identify insomnia since it has an affect on our daily functioning and the quality of our life.
In order to have a good tomorrow, you need to sleep well today.
Insomnia can be caused due to the following factors:
- Genetic factor
- Stress related
- Environmental factors which can include psychological stressors
- Psychological factors
- Behavioural factors
A combination of these factors can cause insomnia.
These factors come and go throughout our lives and keep changing on a daily basis. Some of us know how to deal with them effectively, while others don’t.
2 important systems in the human body are the homeostatic system and the circadian system.
The basic interplay between these 2 systems helps achieving a good sleep and maintaining our daily routine. The homeostatic system helps you sleep, whereas the circadian system tries to keep you awake.
Melatonin is the hormone that is responsible for the circadian system.
The suprachaismatic nucleus in the brain receives the stimulus from the eyes in the morning and that is how we get up in the morning; as the stimulus tends to go away, we tend to sleep at night.
Our sleep is divided into 2 cycles:
- Non REM
- REM
Ageing decreases the overall quantity of sleep, sleep efficiency, time and quality of sleep, etc.
Ageing causes a change in the sleep architecture.
In order to diagnose somebody with a sleep disorder, the problem needs to persist for a little while. Since the disorder can either be acute or chronic.
Loss of sleep due to a stressor or changes in life cannot be called insomnia, it is rather an acute stress response and is called acute insomnia.
However, if the problem continues for over 3 months, that is when we call it chronic insomnia and this needs to be addressed.
Symptoms of insomnia also include:
- Easy irritability
- Decrease efficiency during the day
- Inability to perform to the best of your mental capabilities
- Weakness during the day
The elderly often complain of sleep maintenance issues or early awakening. They tend to go to bed early and wake up early.
This is due to the readjustment in their sleep cycle.
With this chronic insomnia and sleep fragmentation, they develop cognitive and functional impairments. It is shown by several studies that shorter duration of sleep and reduced sleep efficiency affects their life quality and is associated with cardiovascular defects and depression.
Assessment of a patient with insomnia is done using simple pattern recognitions, assessment of your mental, psychological and psychiatric issues, assessment of duration and quality of sleep.
You are screened for medical conditions.
Non pharmacological approaches are tried first. One of the most important of these is having a good sleep hygiene.
Sleep hygiene includes:
- Regular physical activity
- Eating properly
- Having a comfortable sleep in a good environment
- Avoiding stimulus such as caffeine, alcohol and nicotine
Behavioural therapy is also given for patients suffering from insomnia wherein we try to control the way you spend time on your bed, you’re only allowed to go to your bed to sleep, no device is allowed on the bed.
The last measure is taking pharmacological treatment which includes taking hypnotics.
Inanity to sleep is not the only sleep disorder. There are others too wherein the patient talks or walks in his sleep, excessive sleeping, etc.
To diagnose any of these sleep disorders a polysomnography which is a sleep pattern test on the basis of which a diagnosis is made and treated accordi
