Insomnia and the Elderly

The following is a literature review of the article “Understanding and Resolving Insomnia in the Elderly” by Phyllis Zee, MD and Harrison G. Bloom MD. The article originally appeared in Geriatrics, volume 61 issue 5, in May 2006.

Insomnia has always been regarded as a condition that coincides with age. There are several contributing factors to increased insomnia with increased age. Of surveyed adults aged 50 and older, only 32% responded that they experienced good sleep 7 days a week. In another survey, roughly 66% of older adults reported having some difficulty sleeping or experiencing a sleep-related problem.

Sleep Stages and Aging
Sleep naturally occurs in 4 stages:

• Stage 1 – REM sleep with rolling eye motion and dreaming
• Stage 2 – Reduced sensory activity and postural control
• Stage 3 – Deep sleep and ceased rolling eye motion
• Stage 4 – Deepest sleep with the slowest brain waves

An understanding of these 4 stages reveals a difference in the sleep of younger and older adults. Elderly adults spend less time experiencing the later sleep stages, causing them to feel less refreshed and more tired throughout the day. The elderly also spend more time experiencing stage 1 sleep, leaving them with longer periods of dreaming and heightened brain wave activity.

Factors That Cause Insomnia
TInsomnia is common in older adults because of a number of contributing factors including comorbidities, depression, medication, and lifestyle.

• Comorbidities – Heart disease, hypertension, psychiatric conditions, incontinence, sleep apnea, and COPD can contribute to insomnia.
• Depression and Anxiety – These factors, and specifically worrying, can cause an older person to have difficulty falling asleep or remaining asleep.
• Medication – Antihistamines, antidepressants, and antihypertensive drugs, among many others, can cause daytime sleepiness and nighttime insomnia.
• Lifestyle – Stressful changes such as moving or the death of a loved one or pet can cause unrest and insomnia.

Consequences of Insomnia
Insomnia and the exhaustion that can result can reduce the quality of life for elderly patients. Insomnia results in functional impairment due to exhaustion. Data also shows that elderly patients with insomnia have trouble coping, completing tasks, maintaining relationships, and controlling mood. Accidents increase as a result of decreased ability to function. In addition, psychomotor and cognitive impairment can be a result of insomnia.

Treatment of Insomnia
Insomnia can be treated with behavioral management, pharmacologic management, or a mix of the two. Behavioral management includes helping patients find ways to eliminate common causes of insomnia such as stimulating activity or food and drink before bed. Cognitive behavioral therapy and the promotion of good sleeping habits and rituals also help in some instances. Pharmacologic management includes consultation with a physician to choose the best medication for each patient’s specific needs. Physicians should be aware of other medications that the patient may be taking to account for drug interaction and side effects.