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