Insomnia in Middle-aged Adults - Causes, Diagnosis, and Treatment

Introduction

Insomnia is trouble falling or staying asleep. It occurs at least three times a week and lasts for a month. This condition can greatly impact the quality of life.

It may be annoying when one finds it difficult to catch up on sleep. However, good sleep quality at night adds fuel to the next day. Insomnia is a common sleep disorder that keeps people awake. About one-third of adults have insomnia at some point in their life. In around ten percent, insomnia is so severe that it is considered a sleep disorder. Apart from leading to a disturbing day, inadequate sleep can also cause various conditions like diabetes, high blood pressure, obesity, risk of depression, metabolic and heart-related complaints, and problems in focus, attention, and memory. In addition, lack of quality sleep can also make one look older than their age.

What Is Insomnia in Middle-Aged Adults?

Insomnia is common in adults over 60 years of age. The circadian rhythm, or the sleep-wake cycle, is affected in the elderly for several reasons. Certain health conditions and medications taken for the conditions can lead to insomnia. Also, sleep disorders like restless leg syndrome and sleep apnea may impact sleep. Daytime sleepiness and cognitive problems are directly linked to a lack of sleep at night.

The time spent sleeping also reduces with age. People sleep for less time and are awakened after an initial sleep period. Sleep latency, the time taken to fall asleep, also increases with age. Studies suggest that an average person loses 27 minutes of sleep per night every decade.

What Are the Causes of Insomnia in Middle-Aged Adults?

The various causes of insomnia include:

• Poor Sleeping Habits: Irregular sleep timings, overwatching television just before bedtime, and consuming alcohol before sleep can cause insomnia.

• Medical Conditions: Health complaints like pain, arthritis, frequent urination, diabetes, obesity, heartburn, or Alzheimer's disease can affect sleep.

• Menopause: During menopause and postmenopause, women experience symptoms like hot flashes and night sweats. This makes it difficult for them to fall asleep.

• Medications: Certain medications can impact sleep quality as a side effect.

• Physical Inactivity: A sedentary lifestyle can make one feel too sleepy or less sleepy at all times.

• Stress: Stress or significant life events can affect sleep quality.

• Lack of Social Activities: Work, day-to-day, or social activities can help maintain an active lifestyle. A lack of a proper schedule can show an impact.

How to Recognize Insomnia in Middle-Aged Adults?

Insomnia diagnosis in middle-aged adults must meet specific criteria. According to the International Classification of Sleep Disorders (ICSD), a person can be diagnosed with insomnia only if they have the following symptoms despite having a comfortable sleep area:

• Difficulty in falling asleep.

• Regular episodes of waking up earlier than required.

• Not wanting to sleep at a reasonable time every day.

• Difficulty in falling asleep without intervention.

• Reduced daytime activity and irritability.

For a doctor to diagnose insomnia in a middle-aged adult, they must have sleep problems at least three times a week or for three months. Insomnia is diagnosed as primary and secondary. Primary is when sleep problems occur independently, and secondary is when they occur due to an underlying medical condition or medicines. The symptoms remain the same, whether the condition is primary or secondary. However, in cases of secondary insomnia, the underlying condition must be treated before treating insomnia.

How Is Insomnia Treated in Middle-Aged Adults?

The goal of treatment is improvement in sleep quality. The doctor proposes ideas and techniques to create a sleep-friendly environment. The factors include:

1. The optimal room for sleeping should be quiet and dark.

2. The temperature must be maintained below 24 degrees Celsius.

3. The bed has to be used only for sleeping.

4. An air conditioner is recommended during hotter climates.

5. A balanced diet must be followed.

6. Stimulants like tobacco and coffee must be avoided.

Nonpharmacological treatments that help manage insomnia symptoms in middle-aged adults are:

• Managing Sleep-Related Stimuli:The idea of this technique are the following:

• The patient should go to bed only when they feel tired and sleepy.

• They should only stay in bed for 20 minutes if they fall asleep.

• Instead, they should leave the room and go to bed only when they feel sleepy again.

• They should avoid naps during the daytime.

• They should plan to wake up around the same time every day.

• Sleep Restrictions: Sleep restrictions are based on the concept that patients must maintain a diary regarding daily sleep and wake-up timings. Based on this information, the doctor may ask the patients to decrease the time in bed until their sleep efficiency improves and they can spend at least 90 % of the time in their bed sleeping.

• Cognitive Behavioral Therapy: This therapy identifies patients' negative attitudes towards sleep and creates a more positive mindset.

• Light Therapy: In middle-aged patients with insomnia, exposure to bright light in the evenings can make them sleep late and stay in bed for longer.

• Pharmacological Treatment: Some patients may not respond well to nonpharmacological treatment. In such cases, doctors may consider prescribing medications for insomnia patients. These include Benzodiazepines and Nonbenzodiazepines. However, these medicines can cause side effects like hypnotic effects, tolerance, dependence, and withdrawal risk.

The other medicines with a low risk of side effects include Ramelteon and Suvorexant. These medicines cause drowsiness by interacting with the natural hormones in the body. For example, Ramelteon is a melatonin receptor agonist which causes drowsiness after sunset, whereas Suvorexant blocks oxerins, the nerve stimulant that creates feelings of alertness and euphoria.

What Are the Tips to Improve Sleep in People With Insomnia?

A middle-aged person with insomnia can find the below tips helpful.

• Avoiding bright lights and using low-wattage bulbs to produce melatonin naturally in the body, which helps in getting sleep.

• Avoid using backlit devices like phones or tablets at least one hour before bedtime.

• Making the bedroom a quiet, dark, and comfortable place.

• Use ear plugs, or sleep masks to limit sound and light.

• A clock that keeps ticking and can create sleep anxiety must not be kept in the room.

• Trying to sleep and wake up simultaneously every day, even on weekends.

• Developing gentle bedtime habits like bathing, meditating, and listening to soft music.

• Reducing the intake of stimulating foods like coffee, tea, and chocolate later in the day.

• Cutting down on sugary foods at night. Instead, go for a glass of warm milk or a cup of yogurt.

• Cutting down water and fluid intake one hour before bedtime to reduce the trips to the bathroom at night.

Conclusion

Insomnia is difficulty falling asleep. It is common in older adults due to their health conditions or medications. However, due to the current lifestyle and increased stress, the condition has also become common in middle-aged adults. Though not severe, it can significantly impact a person's quality of life. Identifying insomnia and adapting measures can help manage the condition and improve sleep quality.