Insomnia is defined as having trouble falling or staying asleep. Insomnia affects 1 in 3 adults every year in the United States. Fifty percent of people over 65 years have various sleeping disorders. It can be transient, acute or chronic. Acute insomnia is brought on by situations such as stress at work, family pressures or a traumatic event. Chronic insomnia lasts for a month or longer and is the symptom or side effect of some other problem. Individuals with insomnia and short sleep duration are at increased risk for developing a number of health issues, including diabetes and hypertension.
Adults need 7½ to 8 hours of sleep each night. As we age our need for sleep decreases slightly to 6½ to 7 hours at night. Normal aging includes a general trend toward more time in bed but the same or less time asleep. Older people tend to go to sleep earlier in the evening and wake up for the day earlier in the morning. Compared with young adults, the elderly tend to have delayed sleep onset, fragmented sleep, early morning awakening and decreased time in deepest stages of sleep.
Causes of insomnia:
- Changes in sleep patterns because of different work hours or travel
- Acute stress, such as hospitalization or illness of a relative
- Behavior-related problems, such as anxiety or depression
- Medical problems, such as sleep apnea or hyperthyroidism
- Use of alcohol or caffeine
- Medicines, such as those used to treat heart problems and cancer
- Pain, shortness of breath and other discomfort
How is insomnia diagnosed?
The health care provider will take an interview, perform a physical exam and take a blood sample for laboratory tests. A person may be asked to keep a sleep diary. The provider may order a sleep study that involves sleeping overnight in a sleep center.
How is it treated?
Avoid daily use of sleep medications as they can become addictive. Cognitive behavioral therapy encourages good sleep habits and uses several methods to relieve sleep anxiety. Techniques such as relaxation exercises sleep, restriction therapy and reconditioning may be useful.
Chronic insomnia involves treatment of the underlying disorder. For example, if insomnia is caused by depression, the medicine used to treat depression should help insomnia. In some situations, a medication may be prescribed to aid sleep. Ambien (zolpidem), Sonata (zaleplon), Lunesta (eszopiclone) are some of the newer drugs on the market replacing benzodiazepines as sleeping pills. Herbal supplements such as Melatonin, L-tryptophan or Valerian tea are also used to treat insomnia.
What lifestyle changes are recommended?
Good sleep habits include:
- Stick to a schedule of sleeping time and waking time
- Get regular exercise
- Avoid or limit caffeine or alcohol, especially after lunch
- Stop smoking
- Drink less liquids after dinner to avoid going to the toilet at night
- Don’t eat a heavy meal late in the day
- Finds way to relax before the bedtime, such as reading, warm bath, massage
- Avoid or limit naps during the day
- Do not read or watch television in bed
Minimize sleep interruption by closing the bedroom door to avoid noise and keeping the bedroom temperature comfortable
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Dr. Ritabelle Fernandes, MD, MPH, FACP is Clinical Associate Professor at the Geriatric Medicine Department of the John A. Burns School of Medicine, University of Hawai‘i. She is board certified in Geriatric medicine, Hospice and Palliative Medicine, Internal Medicine and Home Care. She is a practicing physician at the Kokua Kalihi Valley and Kalihi-Palama Health Center.
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