Insomnia Among Hospitalized Older Persons
Section snippets
Importance of sleep and consequences of sleep deprivation
When we are ill, the thought of restful sleep is paramount in our minds. The paradox is that it is as if the body is telling the brain to “heal, I need you to fall asleep,” while the brain is yelling at our body, “I know, I know, if I could fall asleep, I would feel better too.” This struggle becomes obvious when one examines the definition of sleep as “a natural occurrence having a psychological and physiological function that activates the restorative repair process of the body” [1]. How
Secondary disorders and sleep disturbances
Although the emphasis of this article is on insomnia, the phrase “sleep disturbance” has also been used to give a broader scope to the problems that can occur and that can be identified. Queries about the quantity and quality of sleep, about the subjective and objective patterns of sleep, should be part of the standard medical evaluation of older patients. When something is amiss, it may represent an opportunity to identify or diagnose a treatable or reversible problem.
In one study, where
Causes of insomnia
The causes of insomnia among hospitalized older persons are numerous and varied. They can be categorized as intrinsic or extrinsic to the patient (Box 1). Most causes in both categories are modifiable and treatable.
The intensive care unit
One of the most studied areas of the hospital related to sleep disturbance is the Intensive Care Unit (ICU). Although everything noted above in this section applies to the ICU environment, some special remarks are needed.
The ICUs are one of the nosiest and busiest locations in hospitals. While several studies have shown that noise levels and patient care activities by nurses and other staff are so high that sleep disturbances seem unavoidable, results of two studies using polysomnography (PSG)
Interventions
Nonpharmacologic interventions are preferable to the use of medication for sleep problems because of the risk associated with the use of sedating drugs in the elderly. These risks among hospitalized older persons include the risk of delirium, falls, hip fractures, dependency, and rebound insomnia [11], [12], [13], [14], [15]. No medication in this category is without some risk for an adverse drug event. Although newer agents continue to come to market, and are possibly safer if they have
Summary
Rates of insomnia and rates of use of sedative-hypnotic drugs among older hospitalized persons are high. Insomnia may represent undiagnosed sleep disorders or underlying medical or psychiatric problems. Evaluation and management of insomnia should target intrinsic (underlying medical illnesses, medications, or withdrawal from medications or alcohol) and extrinsic causes (hospital environment, patient care activities, noise, and medical technology or monitoring). Nonpharmacologic interventions
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