Insomnia in older adults¹

Insomnia is a sleep disorder where people have dissatisfaction with the quantity and quality of their sleep. They complain of one or more of the following: difficulty falling asleep, difficulty staying asleep (characterised by frequent awakenings or difficulty returning to sleep after awakening), waking up too early in the morning with the inability to return to sleep, sleep that is non-restorative and significant daytime symptoms (e.g. difficulty concentrating and mood disturbances).¹

Insomnia is common in older adults, affecting more than 50 % of this segment of the population.²

Over the course of the night, your total sleep is made up of 4 – 6 sleep cycles. Each sleep cycle consists of 4 stages: Stages 1 – 3 making up non-rapid eye movement (NREM) sleep and stage 4 (rapid eye movement or REM sleep). Deep (or slow-wave) sleep, which is critical to restorative sleep, occurs during stage 3. REM sleep is thought to be essential to cognitive functions like memory, learning and creativity.³

The breakdown of your sleep into various cycles and stages is referred to as sleep architecture.³

The timing of sleep-wake cycles is controlled (regulated) by two systems that interact with each other: the sleep-wake homeostatic drive and the internal circadian clock. The interaction between these two systems keeps young adults alert during the day and enables them to sleep without interruption at night.⁴

As you age your internal clock becomes less efficient affecting your sleep architecture. You may find that you have difficulty falling asleep, the duration of your sleep is shorter (less than 6 – 7,5 hours), you spend less time in slow-wave (deep) and REM sleep, you have difficulty staying asleep (you wake up more often during the night leading to fragmented and unrefreshing sleep) and you spend more time awake in bed after retiring for the night.^1,2,4,5

Older adults find it more difficult to stay awake during the day. You may find that you nap more often and for longer during the day, especially if you have woken up too early in the morning.^1,2

As you age, you may experience changes to your internal clock, your routines, behaviours, medications, and overall health, all of which can increase your risk of developing a sleep problem like insomnia.⁶

Researchers have found that insomnia may increase the risk of or co-exist with one or more of the following conditions^1,6,7:

• Depression (older adults with insomnia have a 23 % increase in risk of development of depression symptoms)
• Anxiety
• Increased risk of suicide
• Heart attack or stroke
• High blood pressure (hypertension)
• Diabetes (middle-aged and older adults who sleep for 5 hours or less are 2,5 times more likely to have diabetes compared to those who sleep for 7 – 8 hours per night)
• Increased risks of certain cancers such as prostate cancer
• Increased risks of cognitive decline/impairment with long-term insomnia e.g dementia, Alzheimer’s disease

Insomnia is also associated with higher healthcare costs.¹

To make a diagnosis of insomnia, your doctor will ask about your history of sleep problems and relevant medical conditions. He/she will also evaluate the nature, frequency (how often), evolution and duration of your insomnia symptoms. To refine the diagnosis of insomnia, doctors may also use diagnostic tools like a sleep diary (additional sleep history) and the Insomnia Severity Index (to assess the severity and impact of your insomnia symptoms).¹ Fillable versions of a Daily Sleep Diary and the Insomnia Severity Index⁸

Treatment of insomnia usually focuses on improving sleep length and quality. Your doctor may recommend medication, cognitive behavioural training, and other lifestyle changes to help you improve your sleep quality.⁶

• Stick to strict bedtimes and waking times – even on the weekends or when you are travelling.
• Establish a routine that will help you wind down each night e.g. reading or listening to calming music.
• Avoid napping close to bedtime.
• Maintain a balanced, comfortable temperature and low light levels in your bedroom.
• Avoid using electronic devices like cell phones, televisions, or computers in your bedroom as they can emit a blue light that makes it harder to fall asleep.
• Exercise during the day but avoid working out within 3 hours of your bedtime.
• Avoid caffeine in the late afternoon or evening.
• Don’t use alcohol as a sleep aid – it can actually cause sleep problems.

Disclaimer
In preparing this article, every effort has been made to provide an objective overview. The content contained in this article contains medical or health sciences information as per cited articles for public information. The content of this article has been initiated and is brought to you by Sanofi South Africa.