[Reprint] Sleeping Well is More Important Than Sleeping Longer: Discussing Insomnia in the Elderly
By Chen Baohuan, Attending Physician, Department of Psychiatry, Taipei Medical University Hospital
Insomnia is a common complaint among the elderly, whether in a hospital clinic or ward. Research indicates that this is not without reason. The aging process itself alters the sleep structure of the elderly, including an increase in light sleep and a decrease in deep sleep and non-rapid eye movement (NREM) sleep. This leads to difficulty falling asleep, frequent sleep interruptions, and difficulty falling back asleep after waking up early. In addition, the elderly are more prone to physical illnesses and medication side effects, and mental disorders such as dementia and depression can also increase the chances of insomnia. Therefore, it seems that getting a good night's sleep is not easy for the elderly, which explains why there are so many complaints about insomnia.
When encountering elderly patients or their families with insomnia in the clinic, the first treatment that often comes to mind is taking sleeping pills. However, few people realize that improper use of sleeping pills not only fails to help with sleep but can also increase the risk of falls, decreased attention, and memory loss, thus worsening the original insomnia and overall physical and mental health. Therefore, before prescribing sleeping pills, doctors will always establish correct sleep and medication concepts, reducing the use of sleeping pills after sleep improves. Additionally, it is necessary to treat any other psychosomatic illnesses that coexist with insomnia. So, leave the medication prescribing to the doctor, but please note whether you have already adopted the following sleep and medication habits:
(1) Maintain a regular sleep-wake cycle, waking up at the same time every day:
Like other living beings, humans have an internal biological clock that regulates various physiological functions, allowing the body to synchronize with the solar clock, working at sunrise and resting at sunset. Therefore, maintaining a regular sleep-wake cycle and biological clock helps stabilize sleep, with waking up at the same time every day being the most effective.
(2) Reduce time spent in bed during the day and encourage outdoor or bright outdoor activities:
Spending time outdoors or in bright places during the day can help synchronize your biological clock with the solar clock, stabilizing your sleep cycle. In addition, reducing time spent in bed and engaging in moderate activity during the day can tire the body and also help you sleep better at night.
(3) Restrict fluid intake after dinner to reduce nighttime urination that disrupts sleep:
Sleep interruptions due to nighttime urination are not uncommon among the elderly. This can be addressed by limiting the intake of soup, water, or fruit at dinner to reduce sleep disruptions caused by nighttime urination.
(4) Taking sleeping pills only before bedtime:
Sleeping pills are most effective when taken before bedtime. Taking them too early and waiting for them to take effect can actually reduce their effectiveness and prevent them from working properly.
(5) Sleeping well is worse than sleeping long:
When suffering from insomnia, one often thinks: "I need to sleep longer to make up for lost sleep." However, research indicates that increasing time spent in bed only reduces sleep efficiency, leading to feeling tired and lethargic the next day. This is especially true for older adults, whose actual sleep time is often limited. Therefore, it's better to sleep well than to sleep for a long time. The closer your actual total sleep time is to your total time spent in bed, the better your sleep efficiency will be.
Have you followed all the above precautions? If you still have any questions, please don't hesitate to discuss them with a professional physician.