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The management of late life insomnia nursing essay

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The management of late life insomnia nursing essay


According to Yang, Lee and Yeh (2011), Insomnia is defined as subjective complaints of difficulty initiating or maintaining sleep or non-restorative sleep, it is one of the most common health-related problems that can affect several aspects of life quality. There have been very few recovery advances in the last decade, drugs like benzodiazepines continue to be overused are proving to be no more effective and have their own risk of negative effects. Older people themselves often request drugs. Both health professionals and the community will require a significant shift in knowledge and attitudes to progress towards improved the management of insomnia.

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Insomnia is a subjective experience of a lack of refreshing sleep and is defined as complaints about the quality, quantity or timing of sleep. From the researches I did, there are an estimated one third of adults in the population display insomnia symptoms, 9%-15% report sleep difficulties with daytime consequences, and about 6% show diagnosable insomnia. Elderly populations could even increase the prevalence; it is because elderly individuals have been proven to have a progressive decrease in total sleep time, sleep efficiency, percentage of slow wave sleep, and percentage of rapid-eye-movement sleep, as well as increased sleep fragmentation and awakening after sleep onset (Yang et al, 2011). In addition, according to Yang et al (2011), another study reported that the prevalence of insomnia in elderly populations of range from 20% to more than 50%. ” A study with in-person interviews of more than 9000 participants aged 65 years and older recruited from three communities in the United States found that 23%–34% of participants had symptoms of insomnia, and 7%–15% rarely or never felt rested after waking up in the morning. Another study of more than 6000 elderly participants reported more than 50% with at least one sleep complaint and 35%–40% with sleep disturbances on a chronic basis. A more recent community based longitudinal study in Korea found that 27% of participants older than 65 years reported difficulty initiating or maintaining sleep at least 3 nights per week. All these with the follow-up 2 years later, 40% of those individuals reported continued sleep difficulty” (p. 10).


Older individuals may be even weak in both psychologically and physically to the impacts of sleep disturbance. Poor sleep quality and insomnia symptoms in older individuals have been related to decreased physical strength, risk of fall, poor cognitive performance, and emotional disturbance (Yang et al, 2011). Besides, Yang et al (2011) stated that ” insomnia also increases the risk of mortality in older adults; a study of sleep evaluation with a follow-up after 4 to 19 years showed that those with sleep latencies longer than 30 minutes or SE less than 80% initially had about twice the risk for mortality. Therefore, late-life insomnia should be well managed by medical professions caring for geriatric patients” (p. 10). Hence, problems such as fatigue, drowsiness, lack of concentration, a decrease of work rate and work performances, muscle seems to be ache for no reason, depression, feeling stressed easily could be the consequences of insomnia.


Different treatments are to be used for different types of insomnia. Insomnia can be classified into three categories which are short term insomnia, intermittent insomnia, and chronic insomnia. In addition, chronic insomnia can be divided into two different categories which are primary insomnia and secondary insomnia. There are some treatments have been proven effectively, for example pharmacological, non-pharmacological, cognitive behavioural therapy, and light therapy. Non-pharmacologicalAlleviate night time sleep symptoms and decrease daytime impairments are the goals of insomnia management. Non-pharmacologic interventions should be considered for elderly insomnia patients without severe medical conditions first because elderly individuals may be more prone to the adverse side effects of pharmacotherapy owing to the impact of poly-pharmacy, drug-drug interactions, and diminished metabolism. In addition, the clinical guidelines for the management of chronic insomnia proposed by the American Academy of Sleep Medicine recommend that clinicians should initially conduct behavioural and psychological therapies before pharmacotherapy or non-pharmacotherapy when possible. Even with comorbid conditions, behavioural and psychological therapy is recommended after optimizing treatment for underlying comorbid conditions, followed by pharmacological treatment. However, pharmacological treatment might be the primary treatment modality for geriatric patients with more severe comorbidities, since their sleep disturbances may demand too much support by the caregivers (Yang et al, 2011). Cognitive behaviour therapyIn the other hand, the most effective treatment for insomnia is cognitive behaviour therapy. By managing insomnia in elderly populations, behavioural treatment involves teaching sleep hygiene techniques in combination with other treatments to resist poor sleep habits and cognitive therapy to withstand maladaptive or dysfunctional beliefs. Sleep hygiene refers activities that help promoted high quality sleep. Yang et al (2011) claimed that ” The objectives of sleep hygiene education are to improve basic knowledge about sleep and modify counterproductive sleep practices” (p. 12). Light therapyLight is the most potent and advantage environmental cue that can shift circadian phase, light therapy is one of the common treatment for sleep problems associated with circadian phase misalignment. According to Yang et al (2011), ” exposure to bright light has been shown to shift the phase of circadian rhythms. The magnitude and direction of the phase shift depend on the intensity and timing of light exposure. As a general rule, exposure to bright light right after body temperature minimum (early morning) results in circadian system phase delay, whereas exposure before body temperature minimum (in the late evening) results in circadian system phase advance” (p. 15). Stimulus controlFurthermore, the two most effective behavioural treatments within cognitive behavioural treatment for insomnia are stimulus control and sleep restriction. The aims of stimulus control is to ” break the associations between the sleep environment and wakefulness by directing patients to get out of bed if unable to fall asleep and to rebuild associations between the bedroom and sleep by having them return to bed only when feeling ready to sleep” (Yang et al, 2011). The following instructions are specific for patients to follow in stimulus control therapy: (1) go to sleep only when feeling sleepy; (2) do not use the bed or bedroom for activities other than sleep or sexual activity; (3) if you do not fall asleep within approximately 20 minutes, go into another room and do something relaxing; (4) go back to bed only when feeling sleepy again; (5) repeat the procedure of getting out of bed if you still cannot fall asleep rapidly; (6) get up at the same time each morning regardless of how much you have slept; and (7) avoid napping during the daytime. Relaxation trainingThere are many relaxation techniques developed to reduce tension and arousal has been utilized to facilitate sleep onset and improve sleep continuation. A variety of techniques for facilitating sleep results in positive improvement, for example ” progressive muscle relaxation that reduces muscle tension by sequential tensing and relaxing of the main muscle groups, autogenic training that produces somatic relaxation by inducing sensations of warmth and heaviness in the body, guided imagery that aims to channel mental processes into a vivid story line, and biofeedback that assists the mastering of relaxation through the recording and feedback of physiological activities” (Yang et al, 2011, p. 13). Relaxation training usually goes on with a demonstration of the procedure during the session followed by between-session practice of the techniques once or twice each day at home. By mastering the techniques may take few weeks of times. It is crucial to motivate patients to continue practicing these techniques and helping them deal with obstacles they encounter.


Insomnia remains a problem for many older people. There is a need for further research to improve the overall management of insomnia in older people, but most research in recent times is directed solely at the effects of new pharmacological drugs. guanwei

Sleep disorders in the elderly


Sleep is important for health and quality of life, but older people frequently find sleep elusive. It is a fact that humans need sleeps to survive. Sleeping is exactly as natural for humans as breathing. Poor sleep interacts with psychiatric conditions and many which are more common in older age, which increasing their morbidity. Hence, there are high expectation that there have been major developments in the understanding and management of insomnia in older people. While some progress has been made, there is still a long way before older people with insomnia have a good understanding of sleep disorders, are well assessed and correctly managed.



Studies have shown that there are 40-50% of adults over the age of 60 report disturbed sleep. The types of insomnia which exist include ” sleep onset insomnia (difficulty initiating sleep), sleep maintenance insomnia (difficulty maintaining sleep throughout the night), early morning insomnia (early morning awakenings with difficulty returning to sleep), and psychophysiologic insomnia (behaviourally conditioned sleep difficulty resulting from maladaptive cognitions and/or behaviours), while the most common among older adults being maintenance and early morning insomnia” (Roepke & Israel, 2010, p. 305).

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Old age should not simply be assumed for the reason of insomnia. There are several sign of insomnia such as having trouble falling asleep, wake up too early in the morning, and frequently wake up many times during the night which find it difficult returning to sleep. Table 1 show that there are different way which causes of insomnia, for example physical illness, psychiatric and cognitive disorders, medications, sleep disorders, environment factors, and behavioural factors. However, according to the research of Roepke and Israel (2010), insomnia is most probably co-morbid with medical or psychiatric illnesses, medication use, circadian rhythm changes, and other sleep disorders. ” Although 28 per cent of older adults reported chronic insomnia, only 7 per cent of the cases were in isolation of common co-morbid conditions” (p. 306). They concluded that the conditions that often accompany ageing result in poor sleep, not simply because ageing alone cause sleep disruption.


In addition, with the concerns stemming from its high prevalence, insomnia should not be overlook by clinicians because of its consequences. While the possibilities of negative effects from drugs used to treat insomnia have been known for some time, the consequences of insomnia have only recently been recognised. As far as I know, long term insomnia can affect health if the problem is not properly addressed. It will influence performance at work, as well as thinking abilities. Besides, insomnia which lack of quality sleep will result in body no longer has the ability to resistance disease. Moreover, lack of sleeping time may leads to weight gain. People from all age stages with long term sleep difficulty show sign of poorer attention, slower response times, problems with short-term memory, and decreased performance levels. Furthermore, insomnia is more trouble in older adults as it puts them at greater risk for falls, cognitive impairment, poor physical and mortality, even after controlling for medication use. Sleep difficulty could also links to decreased quality of life and increased symptoms of anxiety and depression (Roepke & Israel, 2010).


PharmacologicalAccording to Roepke and Israel (2010), ” Pharmacological intervention is the most common treatment for insomnia. Several different medications are used to treat insomnia such as sedative-hypnotics, antihistamines, antidepressants, antipsychotics, and anticonvulsants” (p. 306). However, these treatments are not recommended to elder adults because there is no systematic evidence proves that antihistamine, antidepressant, antipsychotic, and anticonvulsant treatment is effective for insomnia, while it concluded that the risks outweigh the benefits. There is a table where list the sleep hygiene tips. First, do not spend too much time in bed, because sleeping during day could lead to being unable to sleep at night. Second, maintain consistent sleep and wake times, establish a sleep routine because some people will sleep better if there is a sleep routine, wake up and go to bed about the same time in every morning and night. Third, get out of bed if unable to sleep, it will be better to get up and do something relaxing until you get tired and go to bed again, for example reading. Fourth, exercise regularly, as we know exercise will definitely good for health. People will get tired by doing exercise, which result in there is no longer excessive adrenaline to contribute insomnia. Fifth, increase overall light exposure; do join communications and outdoors activities because it burns energy when participated. Sixth, avoid caffeine, tobacco, and alcohol after lunch. Last, do not eat right before getting to bed, it can cause indigestion which could prevent humans from getting quality sleep (Roepke & Israel, 2010). Sleep restrictionIn the other hand, Roepke & Israel, (2010) claimed that sleep restriction therapy limiting the amount of time the patient is allowed to stay in bed by increasing sleep efficiency. Basically, patients are told that they can stay in bed for 15min longer than the time of actual sleep they report each night, which results in daytime sleepiness that allows for an increased sleep drive the following night. As sleep improves each week, the amount of time allowed in bed will gradually increase.



The symptoms in the elderly population of insomnia have got higher prevalent. It is important to detect, assess and manage insomnia. Insomnia in the elderly population may be complicated by normal age-related sleep changes as well as the higher prevalence of comorbid conditions. These factors should be considered in the evaluation and treatment of late-life insomnia. Both non-pharmacological and pharmacological treatments have been demonstrated to result in effective treatment outcomes. Non-pharmacological approaches can improve and often resolve insomnia, but when pharmacotherapy is required, a short-acting benzodiazepine is the preferred option. Proper treatment of insomnia in this age group is effective and can improve the overall quality of life of the patients.

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