Insomnia in The Elderly: A Threatening Condition But Manageable

Insomnia in the elderly: a threatening condition but manageable
Sleep is one of the important aspects of life, and it allocates onethird of

everybody's life span. Insomnia is one of the most important sleep problems among
older adults. It is a chronic or acute sleep disorder characterized by a subjective
complaint of difficulty initiating, and/or maintaining sleep, poor-quality sleep, or
inadequate sleep duration (Kamel, Gammack, 2006; Buysse, 2011; Passos, 2011).
Insomnia is a condition that is underrecognized, underdiagnosed, and undertreated
in the general population (J Clin Psychiatry. 2001). Despite being a common
complaint among elderly people (aged 65 years and older), sleep disorders are
rarely systematically diagnosed and treated, even by geriatric specialists (J
Gerontol. 1982).
In 1982, the National Institute on Aging conducted a multicenter, epidemiologic

study to assess the prevalence of sleep complaints among more than 9000 non-
institutionalized elderly persons aged 65 years and older. Over half (57%) of these
elderly people reported some form of chronic disruption of sleep, while only 12%
reported no sleep complaints (Sleep. 1995 Jul). Among all participants (N = 9282;
mean age = 74 years), the prevalence of chronic sleep complaints included
difficulty in initiating or maintaining sleep (43%), nocturnal waking (30%),
insomnia (29%), daytime napping (25%), trouble falling asleep (19%), waking too
early (19%), and waking not rested (13%)(Sleep. 1995 Jul). A 3-year follow-up
study reported an annual incidence rate of approximately 5%, with roughly 15% of
elderly insomniacs resolving their symptoms each year. Chronic insomnia is also
more common in this population. A 1991 National Sleep Foundation poll of a
representative sample of 1000 Americans aged 18 years or older, who were divided
by age into 6 groups (18–24, 25–34, 35–44, 45–54, 55–64, and ≥ 65), found that
9% of the sample reported chronic insomnia, while 20% in the group ≥ 65 years
reported chronic insomnia, the highest among all age groups (Sleep. 1999).
Most treatment guidelines recommend that nonpharmacologic approaches to

insomnia control, including sleep hygiene and behavioral methods, be used as
supportive therapies.Behavioral therapy techniques, such as cognitive-behavioral
therapy, may be used either alone or in combination with pharmacotherapy and
may aid in long-term management of insomnia following medication
discontinuation (JAMA. 1999). Stimulus control, progressive muscle relaxation,
and paradoxical intention meet American Academy of Sleep Medicine criteria for
empirically supported psychological treatments for insomnia; sleep restriction,
biofeedback, and multifaceted cognitive-behavioral therapy were the treatments
considered most likely to be efficacious (Sleep. 1999).There are very few data
regarding behavioral therapy in primary care. The effectiveness and extent of use
of this treatment in the primary care setting has yet to be determined.
In the Philippines, there are two major laws were enacted to address senior citizen
concerns, namely, RA 7876 and RA 9994. RA 7876 mandates the establishment of
the Office of the Senior Citizens Affairs (OSCA) in all local Government Units
(LGUs), while RA 9994 provides for a 20% discount on basic food and medicine
purchases (Carandang, Asis, Shibanuma, Kiriya, Murayama, and Jimba). These
laws were submitted and approved by the senate to help Filipino senior citizens to
at least help the elderlies. However, these laws do not totally help the holistic being
of the elderlies. Especially the mental being of the senior citizen. To be able to help
the elderly with insomnia, the government should organize a program or to
mandate light activities wherein, senior citizen and their families are involved. In
addition, elderly social and support groups are also appreciated where in senior
citizen can actually voice out their feelings wholeheartedly.
References:
Kamel NS & Gammack JK (2006) Insomnia in the elderly: cause, approach, and
treatment. Am J Med 19(6):463-469.
https://doi.org/10.1016/j.amjmed.2005.10.051.
Roth T. Introduction: new developments for treating sleep disorders. J Clin

Psychiatry. 2001 62suppl 10. 3–4.
Webb WB. Sleep in older persons: sleep structures of 50- to 60-year-old men and
women. J Gerontol. 1982;37:581–586.
Foley DJ, Monjan AA, and Brown SL. et al. Sleep complaints among elderly
persons: an epidemiologic study of three communities. Sleep. 1995 18:425–432.
Morin CM, Colecchi C, and Stone J. et al. Behavioral and pharmacological

therapies for late-life insomnia: a randomized controlled trial. JAMA.
1999 281:991–999.
Edinger JD, Wohlgemuth WK, and Radtke RA. et al. Cognitive behavioral therapy
for treatment of chronic primary insomnia: a randomized controlled trial. JAMA.
2001 285:1856–1864.

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Insomnia in the elderly: a threatening condition but manageable

Sleep is one of the important aspects of life, and it allocates onethird of

In 1982, the National Institute on Aging conducted a multicenter, epidemiologic

Most treatment guidelines recommend that nonpharmacologic approaches to

Roth T. Introduction: new developments for treating sleep disorders. J Clin

Morin CM, Colecchi C, and Stone J. et al. Behavioral and pharmacological

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