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 is thought to be due to a variety of factors, including older adults being at higher risk for psychiatric and medical illnesses, leading to symptoms of insomnia and other sleep disorders such as restless leg syndrome. Therefore, this paper aims to review insomnia and its management in older adults.
Patel, Steinberg, and Patel (2018) state that insomnia is caused by three factors: persistent factors, precipitating factors, and predisposing factors. The perpetuating factor in this case is the cognitive or behavioral changes caused by acute insomnia. Predisposing factors, on the other hand, include social, psychological, biological, and demographic characteristics, while triggers include medical conditions and stressful life events that can interfere with sleep. Furthermore, the results showed that older adults were more tolerant of sleep deprivation than younger adults. This is due to the increase in chronic diseases and cognitive impairment among the elderly. Furthermore, insomnia is considered to be an independent risk factor for sick leave, incapacity to work, and poor work performance. Economically oriented analyzes show that insomnia results from high indirect and direct costs to society and the health care system. Adults with insomnia can feel mentally and physically tired, irritable, and anxious. As bedtime approaches, you become more nervous and start worrying about work, personal problems, health, and even death.
However, if insomnia is left untreated, it can have a variety of psychological and medical consequences. Therefore, early treatment is important in this case. Treatment is divided into drug therapy and non-drug therapy. Hedges & Gotelli (2019) pointed out that the treatment or management of insomnia in older adults should start with non-pharmacological options. These interventions target older adults with insomnia and include cognitive behavioral therapy (CBT) and behavioral approaches used in primary care practices. These interventions include training in the use of sleep diaries, ways to avoid or minimize excessive daytime sleep, and nighttime sleep hygiene to support sleep onset. These interventions are thought to be more effective in treating insomnia over the long term, even in people with cognitive impairment.
On the other hand, if symptoms persist even after using behavioral and non-pharmacological options, drug treatment should be considered. They are mainly classified into melatonin receptor agonists, nonbenzodiazepine sedatives, benzodiazepine sedatives, orexin receptor antagonists, and antidepressants. The American Physical Society has published a guide that describes the implementation of pharmacological interventions based on their effectiveness, as most, if not all, pharmacological interventions are of poor quality. In this context, therapists should first have an open dialogue with patients about the benefits and potential harms of using pharmacological options.
Long-term use of drugs to treat insomnia can cause residual daytime sedation, rebound insomnia, cognitive impairment, dependence, tolerance, and increased risk of falls, especially in institutionalized older adults. There is a gender. In summary, insomnia is common in older people. Although sleep patterns do not change as we age, older adults often experience health issues that can lead to sleep problems. Fortunately, research shows that it is possible to effectively treat insomnia, often with little effort and time. Therapists and clinicians can use patient history and physical examination and the Insomnia Scale to assess, treat, and effectively manage insomnia in a rapidly aging population. Cognitive behavioral therapy is considered a highly effective long-term treatment. It is also recommended for use as an initial treatment option compared to sedative treatments. Researchers caution that the use of sedatives should be a last resort. This is because most drugs can make people sleepy and change brain function in both the long and short term.
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
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