Epidemiology

Insomnia is common in the elderly. The prevalence of insomnia is 40-50% of people above the age of 60 and more common among women.

Definition of insomnia

Insomnia is a subjective report of insufficient or non-restorative sleep despite adequate opportunity to sleep.

Sleep problems among elderly may be due to changes in hormonal level and circadian (sleep) cycle. Currently, there is no gold standard on how much sleep is normal for the older adult.  It is based on the person’s perceptions and the impact on functional status.

Adequate sleep is shown by feeling energetic in the morning after waking up from sleep.

Physiology of sleep changes with ageing. Children require more sleeping hours compared to adults. Insomnia is not about how many hours spent on sleep, but how the sleep is able to rest the mind and body.

Classification of Insomnia

• Acute Insomnia- Lasting for few days

Acute insomnia happens when there is short term environmental and/or mood changes such as travelling, hospital admission or excitement. Usually, the symptoms will go away in few days and should not cause any serious sleep problem.

• Short Term Insomnia- Few days to 3 weeks

Short term insomnia happens when there is an occurrence of major life changing events such as death of a love one, termination from work or divorce. The symptoms may be prolonged but should not be lasting longer than 3 weeks. 

• Long term insomnia-  Months to years

Long term insomnia occurs if short term insomnia is not handled properly. This condition is also known as chronic insomnia.

Chronic insomnia may last from few months up to years. It may be made worse by anxiety, medications, drug/alcohol abuse and other concomitant health problems.  

It is critical to identify the cause of chronic insomnia for the proper management of severe sleep disorder.

Sign and symptom of insomnia

• Take longer time to initiate sleep (time from going to bed to the time that sleep starts)
• Increased time spent in lighter sleep
• Experience frequent early morning awakening
• Feeling lethargy and daytime sleepiness causing frequent daytime naps

The impact of sleep impairment

• Physically and mentally fatigued, anxious and irritable
• Increase risk of accidents
• Decrease memory, concentration and impaired performance of daily activities
• Increase risk of fall
• Increase risk of mortality

Prevention and treatment of Insomnia

Non-pharmacological Approach

Patient education on age-related changes in sleep and good sleep hygiene may be adequate treatment for many older adults. If the initial history and physical examination findings do not reveal a serious underlying cause, a trial of improve sleep hygiene is the best initial approach.

The common recommendations for good sleep hygiene include the following:

• Maintain a regular sleeping time and wake up time
• Decrease or eliminate daytime naps
• Exercise daily but not immediately before bedtime
• Use the bed only for sleeping or sex
• Do not read or watch television in bed
• Avoid heavy meals at bedtime
• Maintain a routine  before bedtime (eg, washing up, brushing teeth)
• Control the nighttime environment with a comfortable temperature, quietness, and darkness.
• Wear comfortable, loose-fitting clothes to bed
• Get adequate exposure to bright light during the day

Pharmacological Approach

Please consult your doctor if sleep problem persist. The doctor will asses and perform physical examination to identity the cause of insomnia. Sleeping pills usage should be guided and used only when medically necessary. Wrong usage may perpetuate sleeping problems and cause dependency to sleeping pills.

References

1. Epidemiology of Insomnia in Malaysian Adults: A Community-Based Survey in 4 Urban Areas Asia Pac J Public Health July 2008 20: 224-233