I. Characteristics of sleep in the elderly.
1, biological clock ahead of time, and because there is often nothing to do at night, easy to sleep early and wake up early.
2, sleep latency period is extended, young adults usually only need 5-15 minutes to fall asleep after going to bed, while the elderly need an average of 15-30 minutes to fall asleep.
3, shallow sleep, one is easy to wake up, aware of what is happening around; two is the increase in the number of spontaneous waking during sleep, young adults can wake up once or twice during sleep, while older people can wake up more than 5 times, this part may also be related to the elderly night urination more. NREM sleep stage 3, 4 shortened or lack of deep sleep, reduce the quality of sleep and sleep efficiency.
4.Because of shallow sleep at night, low sleep efficiency and early awakening, elderly people tend to doze off or lie in bed to make up for more sleep during the day, showing polyphasic sleep.
5, the elderly need less sleep, that is, they do not need to sleep as much as when they were young. However, some scholars believe that the total sleep time of the elderly is not reduced if multiple naps during the day are added.
Second, the clinical characteristics of insomnia in the elderly.
1, often mistaken for physiological age-related sleep changes (reduced sleep at night, shallow sleep, early awakening, easy to wake up, etc.) as serious insomnia, which leads to worry, tension and anxiety, and this anxiety often leads to or aggravates really insomnia.
2, the elderly population has a high rate of insomnia, all 4 types of insomnia: difficulty falling asleep, shallow sleep, early awakening, and lack of wake up after having slept sense. Studies in the United States show that only 12% of older people over 65 years of age have not suffered from sleep problems.
3, aging of the brain and the reduction of neurotransmitters such as 5-hydroxytryptamine and dopamine, resulting in reduced and uncoordinated brain function, which affects sleep. Resulting in not sleeping when you should sleep, should not sleep when you want to sleep; shallow sleep, sleep is not deep; or part of the brain sleep, part of the brain has not slept, manifested as sleep walking disorder, before or after sleep hallucinations, for example: fast sleep or fast wake up when you see a ghost or bad guys coming toward the bed, lift the mosquito net, but they just can not move to shout, very fearful. Endocrine changes during menopause is also the cause or cause of insomnia in some older people.
4, often due to poor sleep habits lead to or aggravate insomnia, including going to bed too early at night, doing other things in bed, excessive worry about insomnia, too high expectations of sleep quality and quantity; morning sleep back to sleep, dozing more during the day, lying in bed more or make up for sleep more. This is also partly related to the elderly are too idle, once people do not work, life is easy to be irregular, see report: the elderly sleep poorly, or because they will not sleep.
5.Insomnia is caused by psychosocial factors related to old age, such as personality change (becoming sensitive, suspicious, petty, stubborn, etc.), loss of economic, social and physical functions, retirement, illness, widowhood, living alone, loneliness, fear of death, interpersonal relationship problems, etc.
6. The prevalence of both depression and anxiety in the elderly is higher than that in young adults, and insomnia caused by depression and anxiety is also more frequent. Insomnia caused by anxiety is the most common insomnia in the elderly.
7. There are also more physical illnesses in the elderly, and physical illnesses and corresponding medications lead to insomnia. Physical diseases, anxiety and depression, somatic symptoms of anxiety and depression, and insomnia, all four of which often exist at the same time and aggravate each other, causing patients to be very hard and uncomfortable. However, if treatment is timely and reasonable, leading to a virtuous cycle, it can be twice as effective.
Anxiety and insomnia can raise blood pressure. Clinically, some hypertensive patients with anxiety and insomnia get better, even their blood pressure returns to normal and they no longer need antihypertensive drugs. Therefore, if treating anxiety insomnia in hypertensive patients, it is recommended to monitor blood pressure at the same time to prevent discomfort such as dizziness due to low blood pressure during treatment. When treating insomnia, it is important to be aware of the effects of medications for insomnia on other diseases, and to be careful about drug interactions.
Older people are more sensitive to side effects of drugs, such as the use of tranquilizers, and are prone to wakefulness and unresponsiveness, plus the muscle relaxation effect of drugs, patients are prone to fall. Therefore, after taking sleeping pills, elderly people should sit in bed for a while and get out of bed slowly after they are fully awake. The elderly are prone to slow lung disease, chronic pulmonary insufficiency and sleep apnea, this time cautiously use or prohibit a variety of Valium drugs.
8, serious impact on sleep “restless legs syndrome”, manifested as sitting or lying in bed when the deep calf itchy, sore and soft discomfort, soreness, soreness and numbness, pins and needles, insects crawling and other unbearable discomfort, the need to move or pinch to get better, resulting in sleep or re-sleep difficulties, this uncomfortable symptoms can also develop to other parts of the body This uncomfortable symptom can also develop to other parts of the body. It is also known as “Restless Legs Syndrome (RLS)” and has a high prevalence in the elderly population, but is rarely seen in clinical practice and is mostly underdiagnosed. Use antidepressants with caution in such cases, especially those that increase the obvious effects of 5-HT, not to mention Dexedrine and antipsychotics (such as olanzapine, quetiapine, risperidone, fenadine, etc.).
9, “sunset syndrome” is another easily ignored physiological disorder affecting sleep in the elderly, especially mild “sunset syndrome” is not easy to identify. The symptoms are irritability, abnormal behavior, hallucinations, hallucinations, delusions of victimization and unconsciousness, etc., when the sun is going down. It is more common in older people with physical illness, nutritional imbalance, brain atrophy, cerebrovascular disease or major changes. It is prudent to use various kinds of tranquilizers at this time, which can aggravate the elderly’s consciousness disorder, thus aggravating insomnia.
10, most of the elderly insomnia patients who come to our department have already received medication before coming, but usually the treatment is not standardized and systematic, and some of them have developed drug tolerance or dependence, which makes the treatment more difficult instead.
The treatment of insomnia is, first, the treatment of depression, anxiety, restless legs syndrome and other diseases that cause insomnia, second, the symptomatic treatment of insomnia symptoms, and third, the active self-adjustment of patients under the guidance of doctors, and in this regard, it is recommended to read the literature on “sleep restriction therapy”.