crowd welcome to another MedCram lecture in the next set of lectures
we're going to talk about insomnia what causes it what are the different
diseases that can cause it and how to manage it and I would say that even
though I am a sleep specialist some of the recommendations I'm going to be
giving are not for everybody so you need to make sure that you follow
up with your own physician but let's go through insomnia the first thing we got
to do is talk about what happens with normal aging there are different stages
of sleep there is stage one what we term n one there's stage two and there stage
three couple of other stages as well there is REM sleep which I'm sure you've
heard about generally speaking what happens over the period of a night is
someone starts out wake they go down into very transient sleep phase called
stage one and then they go down to stage two and eventually go down into stage
three where they stay until they go into REM sleep which I'll code here as very
dark then they come out of that and they go right back up to the beginning of
stage one and they repeat the same thing again now as this occurs throughout the
night this REM sleep gets longer and longer until actually most of the REM
sleep is towards the end of the night these deep stages of sleep so stage
three are usually longer towards the beginning of sleep so something that we
see here in normal sleep is that stage 3 is concentrated toward the beginning of
the night and REM sleep is concentrated more towards the end of the night both
of these are very restful this is physically restful stage 3 sleep this is
where growth hormone is produced and REM sleep is very mentally restorative so
both of these are very very important and unfortunately as we get
older we see a reduction in both of these types of sleep and an increase in
this very sort of bland end to type of sleep which really is is more of a light
sleep so this is what we see with in normal aging now most of these changes
occur by the age of 40 or 50 years of age and sleep remains pretty constant
from the age of 60 to 90 there is one exception and that sleep efficiency so
what is sleep efficiency sleep efficiency is simply the amount of time
of sleep divided by the amount of time in bed and that steadily decreases from
about 95 percent down to about 80 percent in general as one approaches 80
years of age so what happens when you approach middle age there's a number of
things that occur normally there's increased awakenings so you're waking up
more in the middle of the night there's a Razzles and there's more stage shifts
this is the stage as I was talking about before you also see a decrease in stage
3 and you also see a decrease in REM sleep as I mentioned before you get a
decrease in sleep efficiency and as you reach middle age there is more of what
we call a phase advancement what do I mean by phase advancement with phase
advancement you're going to be getting up earlier
so basically getting up from bed earlier and going to bed earlier
the interesting thing however is that despite all of these things you're a
little bit more resistant to sleep deprivation or to the effects of sleep
deprivation what I mean by this is that let's say as a teenager if you missed
four or five hours of sleep it wouldn't affect you as much as if you were older
and you missed four or five hours of sleep you'd be able to perform a little
better which is kind of paradoxical from what you would think now in terms of
disease in actual disease insomnia goes up as we get older no surprise there if
we look at a study of 18 the 34 year olds now there's about 14% incidence of
insomnia from the age of 35 to 49 the incidence is about 15% so it remains
pretty stable however when we get to 50 to 64 years of age we hit about a 20%
incidence here's the key though from 65 to 79
years of age that jumps up to 25% this is this is a pretty astounding figure
when you realize that a quarter of the population of retirement age has a
problem with insomnia and insomnia is a pretty generic term I mean if we could
use a number of different words to describe it some about 19% of people
wake up too early
another 19% would describe trouble falling asleep
twenty-five percent have daytime napping
29% basically come right out and just say they've got insomnia and then if you
look at both initiating and maintaining sleep we're looking at 43 percent of
older adults so these are people who have a mean age of 74 years of age of
those people these are what they're complaining about and 43 percent have
problems with initiation and maintaining both now this is by no means a geriatric
diagnosis there are many of young people and middle-aged people who have this
problem now in terms of the different causes of insomnia let's say we got rid
of all of the easy causes of insomnia for instance drinking too much caffeine
or some of these things if we were to break it down what would be the
breakdown of insomnia in terms of cause well it turns out the biggest reason for
people to have insomnia so 35 percent of people who have insomnia have some sort
of psychiatric illness and what I mean by that is depression so you've got to
know that in terms of treatment because if you don't treat the depression the
insomnia is not going to get better next on the list about 15 percent have what
we call psycho physiologic
or what we call performance anxiety what do I mean by that have you ever been in
the kitchen or in the living room or the family room felt really tired and then
as soon as you went into the bedroom you just could not fall asleep
this is psychophysiological we're going to explain about that in the upcoming
lectures 12% is alcohol or drug yes these can cause insomnia another 12% is
restless leg syndrome something that we'll talk about as well 10% is
circadian rhythm circadian rhythm disorder and finally the last 9% is kind
of a weird diagnosis it's it's actually where they think they can't sleep but
they actually are sleeping if you test them it's called paradoxical so you can
see here that this is where the bulk of your diagnosis azar this one's going to
be the most interesting so what we're going to do is we've kind of laid the
groundwork of what insomnia is where it comes from let's talk about where the
pathophysiology meets the road in terms of causes diagnosis management and
treatments join us for the next lecture
you