Insomnia and Sleeping Difficulties in the Hospitalized Elderly Patient

Author: Nneamaka Enwemnwa, MD and Kathleen Murphy, PhD, MS

Overview

Insomnia is a sleep disorder in which a patient suffers from an inability to initiate or maintain restful sleep.

Insomnia is associated with poor quality or quantity of sleep despite adequate opportunity to sleep.

Most cases of insomnia in the elderly are due to secondary causes such as medical conditions, medications, anxiety, depression, behavioral and environmental factors.

Primary Sleep disorders which represent approximately 5-20 percent of the cases include diagnoses such as Circadian rhythm disorders, sleep apnea, restless leg syndrome, and nocturnal myoclonus (Martin, Alam and Alessi, 2007).

 

Key Points

Subjective insomnia assessment includes questions regarding depth and quality of sleep as perceived by the patient.

Objective insomnia assessment includes determination of sleep latency, duration and number of arousals and night time awakenings.

Poor sleep can result in cognitive dysfunction, falls, depression, decreased quality of life and increased mortality.

 

Intervention

Treatment may be non-pharmacological and pharmacological.

If insomnia is a new complaint, thorough assessment of potential secondary causes is important. Non-pharmacologic intervention may be very effective at this stage.

Examples of non-pharmacologic sleep hygiene interventions include: Pharmacological Therapy management includes:

 

References

Flaherty, J. (2008). Insomnia Among Hospitalized Older Patients. Clinics in Geriatrics Medicine:24:51-67.

Kamel, N.S., & Gammack, J.K. (2006). Insomnia in the elderly: Cause, Approach and Treatment. The American Journal of Medicine 119, 463-469.

Martin, J.L., Alam, T., & Alessi, C.A. (2007). Sleep Disorders. In R. J. Ham, P.D. Sloan, G.A. Warshaw, M.A Bernard & E. Flaherty (Eds). Primary Care Geriatrics: A Case-Based Approach (5th Ed). New York: Mosby Elsevier: pp. 391-400.

Subramanian, S. & Surani, S. (2007). Sleep disorders in the elderly. Geriatrics, 62(12):10-32.