![]() Additionally, 12% of residents continued to have sleep problems despite the use of medication.3Ī recent study published in the journal Sleep found that patients treated for insomnia experienced reductions in inflammation comparable to the benefits reported with vigorous physical activity or weight loss.5 C-reactive protein (CRP), a known marker of inflammation, increases when insomnia is left untreated. basic goals of behavioral methods including reducing the time it takes to go to sleep to below 30 minutes and reducing wake-up periods during the night.Īlthough nonpharmacological interventions have demonstrated efficacy in managing sleep disturbances, a 2012 report on quality in Texas nursing homes indicated that only 12% of residents with sleep problems had nonpharmacological interventions attempted prior to initiating the use of sedative/hypnotic medications.sleep hygiene training and stimulus control: correcting bad sleep habits and. ![]() sleep restriction: severely limiting and then gradually increasing time in bed.relaxation training and biofeedback: encouraging relaxation.cognitive therapy: changing attitudes/beliefs that hinder sleep.Furthermore, most of those who have been taking drugs are able to stop or reduce their use.ĬBT involves combinations of the following therapies1,2: Head-to-head comparison has shown that the long-term benefits of nonpharmacologic interventions are superior to those of medications.ĬBT has benefits that extend well beyond the end of treatment with certain interventions resulting in positive outcomes with continuation and improvement of sleep patterns for at least two years.1 Studies report that the majority of patients who are treated with nondrug methods experience improved sleep. The American Academy of Sleep Medicine recommends pharmacological and nonpharmacological interventions, such as cognitive behavioral therapy (CBT), for the treatment of insomnia however, behavioral therapies should be considered first-line treatments in primary insomnia, especially in older adults who are vulnerable to adverse effects of hypnotic medications. Treating insomnia can significantly improve overall patient health. Adjusting the timing or changing current medications known to contribute to insomnia may also provide benefits.1 Recognizing and treating comorbid conditions such as major depression, medical disorders, or chronic pain are essential as are identifying and modifying inappropriate intake of caffeine, alcohol, and self-medication. Insomnia affects quality of life because of the effects of daytime dysfunction including fatigue, moodiness, irritability or anger, daytime sleepiness, anxiety about sleep, lack of concentration and motivation, poor memory, headaches, and increased accidents.3ĭetermining the underlying cause of insomnia is essential before starting sleep medications. Psychosocial factors such as isolation, loneliness, bereavement, decreased activity, or financial constraints and other late-life stressors, including declining health and relocation to a different living situation, can also contribute to insomnia.4Įnvironmental factors (see sidebar below) should be ruled out as causes of insomnia and are common in long term care facilities.4 movement disorders such as restless leg syndrome.psychiatric conditions, including depression, anxiety, or delirium.chronic medical conditions such as congestive heart failure, arthritis, or pulmonary disorders.Secondary insomnia is often chronic and occurs as a result of other problems including the following:2,3 Primary insomnia is sleeplessness that cannot be attributed to existing medical, psychiatric, or environmental causes. Insomnia may be acute or transient (lasting less than one week), short-term (lasting one to four weeks), or chronic (lasting longer than one month).1 Changes in circadian rhythms also affect sleep in older adults. Sleep architecture changes occurring with increasing age often result in an increased time to fall asleep, an overall decline in REM sleep, and an increase in sleep fragmentation. ![]() Insomnia, the repeated difficulty with sleep initiation, maintenance, duration, and/or quality of sleep that results in daytime impairment, affects nearly one-half of older adults over the age of 60. ![]()
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