CLINICAL INVESTIGATION Management of Sleep Disorders in Community-Dwelling Older Women and Men at the Time of Diagnosis Paula Pop, MD,* Susan E. Bronskill, PhD, †‡§ Katrina L. Piggott, MD, ¶ Nathan M. Stall, MD, †‡¶ Rachel D. Savage, PhD, † Jessica D. Visentin, PharmD, † Lisa M. McCarthy, Pharm D, MSc, †∥ ** Vasily Giannakes, MPH, †§ Wei Wu, MSC, † Andrea Gruneir, PhD, †§†† Jodi M. Gatley, MPH, § and Paula A. Rochon, MD, MPH †‡§¶ OBJECTIVES: Sedative and hypnotic medications are associ- ated with harm, and guidelines suggest limiting their use. Only limited evidence has described how older adults are managed following an initial sleep disorder diagnosis. We aimed to describe clinical management patterns of sleep disorders in older women and men at the time of initial diagnosis. DESIGN: Population-based retrospective cohort study using linked administrative databases. SETTING: Ontario, Canada. PARTICIPANTS: Community-dwelling adults aged 66 and older, diagnosed with a new sleep disorder by a primary care provider (n = 30 729; 56% women and 44% men). We compared women and men for each outcome. MEASUREMENTS: The primary outcome was prescription of a medication used for sleep within 30 days of a new sleep disorder diagnosis. Additional analysis included medical investigations such as sleep studies and visits to specialists who manage obstructive sleep disorders within 90 days of diagnosis. RESULTS: Among the 30 729 older adults with a new sleep disorder diagnosis, 5512 (17.9% total; 18.8% of women and 16.9% of men) were prescribed a medication used for sleep. Compared with men, women were somewhat more likely to be prescribed at least one sedative medication (adjusted odds ratio = 1.09; 95% confidence interval = 1.03-1.16). A total of 2573 (8.4%) older adults underwent a sleep study, and 3743 (12.2%) were evaluated by a specialist; both occurred more commonly in men. CONCLUSION: In our cohort, almost 1 in 5 older adults with a new sleep disorder diagnosis were prescribed a medi- cation used for sleep; of these, a higher proportion were women. Comparatively few older adults were further evalu- ated; of these, a higher proportion were men. Our study high- lights the high rates at which medications are prescribed to older adults with a new sleep disorder diagnosis and identifies potential sex differences in the management of such diagno- ses. J Am Geriatr Soc 00:1-8, 2019. Key words: medications used for sleep; sleep disorders; women and men; older adults D ifficulty sleeping is common with advanced age, 1-4 with a self-reported insomnia prevalence of roughly 50% in older adults. 5 Chronic sleep-related issues were linked with an increase in morbidity and associated with psychiatric disorders. 6-8 The American College of Physicians’ clinical practice guideline on the management of chronic insomnia disorder suggests that the initial management of insomnia in older adults should focus on nonpharmacologic interventions. 9 Additional guidelines also support focusing on behavioral modification as the first-line treatment for From the *Department of Medicine, University of Toronto, Toronto, Canada; † Women’s College Research Institute, Women’s College Hospital, Toronto, Canada; ‡ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; § ICES, Toronto, Ontario, Canada; ¶ Department of Medicine, Division of Geriatric Medicine, University of Toronto, Toronto, Canada; ∥ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; **Department of Family and Community Medicine, University of Toronto, Toronto, Canada; and the †† Department of Family Medicine, University of Alberta, Edmonton, Canada. Address correspondence to Paula A. Rochon, Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Ontario, Canada. E-mail: paula.rochon@wchospital.ca Funding sources and previous presentations: This work was supported by ICES, funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Paula A. Rochon holds the Retired Teachers of Ontario (RTO/ERO) Chair in Geriatric Medicine at the University of Toronto. The preliminary results of this study were presented as a poster presentation at the Canadian Geriatrics Society 38th Annual Scientific Meeting in Montreal, QC (April 2018). DOI: 10.1111/jgs.16038 JAGS 00:1-8, 2019 © 2019 The American Geriatrics Society 0002-8614/19/$15.00