Sleep Difficulty: Epidemiology excessive sleepiness 3% continuous - - PowerPoint PPT Presentation

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 1

Sleep Difficulty: Epidemiology

transient insomnia 18% no sleep difficulty 64% continuous

• r severe

insomnia 15% excessive sleepiness 3%

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 2

Gallup Poll

• Occasional insomnia: 27%
• Regular, chronic sleep problem: 9%
• Insomniacs:

– Wake up feeling drowsy or tired: 72% – Wake in middle of night: 67% – Difficulty returning to sleep: 57% – Initial difficulty falling asleep: 56% – Self-medicate (alcohol or OTC drugs): 40%

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 3

Patients seen at Sleep Disorders Centers for Evaluation

insomnia 31% hyper- somnia 51%

• ther

18%

Cooperative study

• f 3900 patients

evaluated in 11 centres

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 4

Insomnia Diagnoses

Psychiatric 36% Psycho- physiologic 15% Other insomnias 19% Restless legs syndrome 12% Drug and alcohol dependency 12% Sleep apnea syndrome 6%

psychosis 5% Major affective disorders 50% Personality disorder 45%

Psychiatric insomnias breakdown

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 5

Hypersomnia Diagnoses

Sleep apnea syndrome 43% Narcolepsy 25% Idiopathic hyper- somnolence 9% Psychiatric 4% Other hyper- somnias 19%

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 6

EEG Stages of Normal Sleep

• Note decrease in stage

3 and 4, and increase in awakenings, with aging

• REM sleep occurs

every 90 minutes, and increases through the night

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 7

Excessive REM sleep causes depression:

• Medications which

increase REM sleep

• Total or partial sleep

deprivation

• Sleep prolongation
• Sleeping late
• Selective REM sleep

deprivation

• Medications which

decrease REM sleep

• Sleep abnormalities in

affective disorder

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 8

Depression vs Arising Time

5.7 9.6 2 4 6 8 10 12 Beck Depression Inventory up before 7 am (n=29) up at 7 or later (n=95) p = .032

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 9

Fatigue vs Arising Time

3.8 4.8 4.9 5.8 5.5 6.4 7.1 8.1

chronic fatigue all fatigue up before 7 am (n=29) from 7 up to 8 (n=35) from 8 up to 9 (n=37) 9 am or later (n=24)

p=0.0094 p=0.013

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 10

Attitudes about Sleep

• Attitudes about sleep

and sleep behaviours:

• q1. If I don’t get

enough sleep during the night, I should make up for it by sleeping late or taking a long nap. (agree strongly = 0; disagree strongly = 6)

• q2. Sometimes it’s

necessary to miss work

• r school because of

lack of sleep or really poor sleep.

2.9 3.0 2.6 1.5 5.0 4.2 4.5 3.5 up before 7 am (n=29) from 7 up to 8 (n=35) from 8 up to 9 (n=37) 9 am or later (n=24)

• q1. Sleep late
• q2. Miss work

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 11

The Scientific Literature

• “Six hours sleep for a man,

Seven for a woman, And eight for a fool.”

—18th century proverb

• “Early to bed, early to rise,

Makes a man healthy, wealthy, and wise.”

—Ben Franklin

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 12

Age-related Sleep Changes

• Shorter sleep
• Lower sleep efficiency
• Less slow wave sleep
• More awakenings
• More time in bed

15 mar 1998 Insomnia in the Elderly - H. Olders, MD 13

Insomnia is:

• Distressing
• Unhealthy
• Dangerous
• Costly