Insomnia in the Elderly and How to Manage It

Causes and consequences of insomnia in older adults

According to Hedges & Gotelli (2019), insomnia is a prevalent type of sleep disorder frequently characterized by persistent difficulty to remain or fall asleep despite one having the opportunity to do so.  Besides, insomnia people may experience excessive daytime sleepiness or even feel tired when they wake up.  They often experience sleep onset as well as sleep maintenance issues.  Sleep-onset insomnia results in difficulty falling asleep, while sleep maintenance insomnia makes one strain to stay asleep.  Studies have shown that people aged 60 and above are more prone to insomnia. This has been attributed to various factors, including older people being at higher risk of psychiatric and medical conditions, leading to insomnia symptoms and other sleep disorders like restless legs syndrome.  Thus, this essay aims to look at insomnia in older adults and how to manage it.

Patel, Steinberg, & Patel (2018) state that insomnia is caused by three factors: perpetuating factors, precipitating factors, and predisposing factors.  Perpetuating factors, in this case, consist of cognitive or behavioral changes caused by acute insomnia. On the other hand, Predisposing factors entail social, psychological, biological, and demographic characteristics, while precipitating factors include medical conditions or stressful life happenings that might disrupt sleep. What is more, in their findings, they have stated that older people are more tolerant of sleep deprivation compared to young people.  This is because of the increased prevalence of chronic conditions and cognitive impairment in older people.   Besides, insomnia has been regarded as an independent risk factor for sick leave, work disability, and reduced work performance.   The economically driven analysis points out that insomnia is attributed to high indirect and direct costs for society and the healthcare system. Adults with insomnia may become mentally and physically tired, irritable, and anxious.  As bedtime approaches, they become more tense and worried about their work, personal problems, health, and even death.

However, if untreated, insomnia can result in numerous psychological and medical consequences; thus, early treatment is vital in this case.  Treatment can be divided into pharmacological and nonpharmacological options.  Hedges & Gotelli (2019) have pointed out that treating or managing insomnia in elderly should start with nonpharmacologic options.   These interventions surround cognitive-behavioral therapy (CBT) and behavioral approaches geared towards insomniac elders, which occur during the primary care office setting.  Such interventions include education on how to use a sleep diary, ways to avoid or minimize too much sleep during daytime and sleep hygiene during the night in order to help sleep onset.  These interventions are considered more effective when managing insomnia for extended periods, even to those with cognitive impairment.

Pharmacological and non-pharmacological treatments for insomnia in elderly

On the other hand, pharmacologic management should be considered if the condition perseveres after behavioral and nonpharmacological options have been used.  They are primarily classified as melatonin receptor agonists, nonbenzodiazepine sedatives, benzodiazepine sedatives, orexin receptor antagonists, and antidepressants.  The American Academy of physicians has provided guideline that explains the implementation of pharmacologic interventions based on their effectiveness since most of them, if not all, are of low-quality. In regard to this, a therapist ought to first come up with an open dialogue with the patient concerning the benefits and probable harms of using pharmacological options.  Prolonged use of drugs in treating insomnia can result in residual daytime sedation, rebound insomnia, cognitive impairment, dependence, tolerance, and increased risk of falls, mostly in institutionalized older adults.

To sum up, insomnia has been considered to be prevalent in older people. Although late life does not change sleep patterns, it is pretty common for aging people to develop health issues that can cause sleep disturbances. Fortunately, studies have proved that it is possible to treat insomnia effectively even though it often takes little effort and time. Using a patient's history as well as physical examination and together with insomnia scales, therapists or clinicians can evaluate, treat, and effectively manage insomnia in the rapidly aging population. Cognitive-behavioral therapies have been considered to provide very effective longer-duration treatment. They are also recommended to be used as first-line treatment options compared to sedatives mode of treatment.  Researchers have pointed out that the use of sedatives should be the last resort. This is because most medications subject people to becoming sleepy and can alter how the brain functions in both the long-term and short-term.

References

Patel, D., Steinberg, J., & Patel, P. (2018). Insomnia in the elderly: a review. Journal of Clinical Sleep Medicine, 14(6), 1017-1024.

Hedges, C., & Gotelli, J. (2019). Managing insomnia in older adults. The Nurse Practitioner, 44(9), 16-24