Zoloft insomnia melatonin12/29/2023 Women who are caregivers are found to have increased prevalence of sleep complaints. 22 – 24 Caregiving may be responsible for ruminations and anxiety while trying to sleep. 20, 21 Reduced mobility, retirement, and reduced social interaction are sources of sleep disturbances. 11, 17 – 20 The increased prevalence of chronic conditions in later life may explain most insomnia symptoms in the older population 1% to 7% of insomnia in later life occurs independently of chronic conditions. demonstrated that 93% have one or more comorbid conditions and other factors, most commonly depression, chronic pain, cancer, chronic obstructive pulmonary disease, cardiovascular diseases, medication use, and factors associated with aging (retirement, inactivity, or caregiving). 16 In a study of 6,800 elderly patients (older than 65 years), Foley et al. This replaces earlier categories of primary and secondary forms of insomnia in favor of a broad category for insomnia disorder when insomnia is comorbid with medical or psychiatric conditions. Insomnia in the ICSD-3 is defined as a complaint of trouble initiating or maintaining sleep that is associated with daytime consequences and is not attributable to environmental circumstances or inadequate opportunity to sleep. 15 An important change with respect to diagnostic classifications was defined in the DSM-5 and the third edition of the International Classification of Sleep Disorders (ICSD-3). Hyperarousal is manifested as an elevated whole-body metabolic rate during sleep and wakefulness, elevated cortisol and adrenocorticotropic hormone during the early sleep period, and reduced parasympathetic tone in heart rate variability. The pathophysiology of insomnia disorder induces a state of hyperarousal during sleep and wakefulness. The term “nonrestorative sleep” is no longer an accepted diagnostic symptom for the DSM-5 however, it still remains in the ICD-10 criteria. 14 The fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) emphasizes that a sleep disturbance causes clinically significant distress or functional impairment, and occurs at least 3 nights a week for at least 3 months despite adequate opportunity to sleep, whereas the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) requires at least 1 month of symptoms not explained by another sleep-wake disorder, illicit substance use, or coexisting medical and psychiatric disorders. This is usually associated with one or more of the following: (1) difficulty initiating sleep, (2) difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings, and (3) early-morning awakening with inability to return to sleep. Insomnia is broadly defined as dissatisfaction with sleep either qualitatively or quantitatively. 12 Approximately 50% of the patients with symptoms of insomnia will have a remission during the follow-up period, with higher remission rates among older males relative to females. 10 A study of 6,800 older adults (age 65 years or older) observed an incidence rate for insomnia symptoms of 5% per year, 11 with a yearly incidence of 7.97% at 1-year follow-up. Sleep maintenance symptoms are most prevalent among individuals with insomnia (50% to 70%), followed by difficulty in initiating sleep (35% to 60%) and nonrestorative sleep (20% to 25%). 9 Insomnia is often classified by the predominant symptom of either difficulty in sleep onset or sleep maintenance. 6 The overall prevalence of insomnia symptoms ranges from 30% to 48% in the elderly, 5, 7, 8 whereas the prevalence of insomnia disorder ranges from 12% to 20%. 5 Prevalence of insomnia is higher in older individuals than in the younger population. 2 – 4 As many as 50% of older adults complain about difficulty initiating or maintaining sleep. 1 One of the most common sleep disturbances in the older population is insomnia. The population of older adults continues to expand rapidly from the current 205 million persons aged 60 years or older, to a projected 2 billion by 2050.
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