More than 1/3 of the elderly suffer from insomnia. What can we do?

Myth: "Old people often wake up at night and can't fall asleep because they don't need to sleep long because they are old?"

Elderly people sleep less, so it is normal for them to have restless sleep at night. There is no need to make a fuss about it, and therefore many people do not care about it.

Rumor analysis: This statement is not rigorous.

Although the sleep time of the elderly has decreased due to various reasons, they still need to pay attention to the quality of sleep, because long-term poor sleep quality may be a manifestation of other problems, and if ignored, it may lead to deterioration of health.

As we age, our sleep patterns do differ from those of our youth, but this does not mean that we can ignore the decline in sleep quality. Good sleep is still an important foundation for a healthy life. If sleep quality is not guaranteed for a long time, we need to intervene and find the cause in time, because this may not only be a sleep problem, but also a manifestation of psychological or mental health problems.

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Recently, I read an article. The author's mother is 73 years old and has needed to rely on drugs to fall asleep since 4 years ago. Later, I took my mother to a mental health hospital in the county. After a series of assessments, she was diagnosed with anxiety and depression. The author often took her mother to the follow-up visit and found that at 9 o'clock every morning, the door of the sleep disorder department was full of middle-aged and elderly people with tired expressions. This touched the author's heart. After consulting the literature, I found that for a long time, we may not really realize that so many elderly people's sleep problems are actually closely related to mental health problems.

More than 1/3 of the elderly suffer from insomnia

A meta-analysis of more than 110,000 Chinese people showed that the prevalence of insomnia in the Chinese population is 15%. However, the proportion is much higher among the elderly.

A study on the mental health of the elderly in rural areas of four cities in Anhui Province included 871 elderly people, and the prevalence of sleep disorders among them was as high as 45.7%. Another study on 3,176 community elderly people in four cities in Hebei Province showed that the prevalence of insomnia was also as high as 37.75%. In these studies, at least one-third of the elderly had sleep problems, and this situation was more serious among the rural elderly population.

Sleep disorders are often just a superficial phenomenon. Most sleep problems come from physical diseases and mental disorders. However, it is worth noting that when middle-aged and elderly people feel unwell, they will actively or passively choose to seek medical treatment, thereby getting a certain degree of relief or complete recovery. If their insomnia is only caused by physical diseases, these problems will disappear.

However, the mental health problems hidden behind insomnia have not received due attention. For example, in the aforementioned study on elderly people in rural Anhui, it was found that their overall prevalence of depressive symptoms was as high as 34%, and the prevalence of combined insomnia and depressive symptoms reached 20.3%.

At the same time, due to prejudice and stigma against mental health problems, few people will face up to their own mental health problems, let alone seek psychiatric diagnosis and treatment. Studies have shown that only about 1/5 (21.1%) of the elderly are willing to take medication to improve sleep, and the rate of visits to the hospital for depression is only about 3%, while the rate of visits to the hospital for depression in the overall population of my country is about 25.4%, which is eight times that of the elderly.

Therefore, the sleep and mental health problems of the elderly may be far more serious than we imagined, and due to the lack of professional knowledge and prejudice against these issues, they are often more reluctant to seek help from professionals, causing these problems to accompany and trouble their daily lives.

What's wrong with elderly people suffering from insomnia?

Frequent insomnia can lead to emotional problems, fatigue and a series of physical health problems, but relying solely on medication to improve sleep will often only lead to drug dependence and will not really "eliminate" insomnia, because insomnia is usually a somatic symptom of poor mental state and is difficult to solve with just sleeping pills. For the elderly, the following are common psychological factors that cause insomnia.

1. Depression

Depression is very common among the elderly. The prevalence of this phenomenon is related to multiple factors, the most significant of which is the accumulation of negative life events, such as unresolved emotional knots in past life experiences. With the loss of social roles after retirement, these emotional knots will once again bite back. Middle-aged and elderly people also often face many chronic diseases. Physical discomfort will bring painful emotions. When these emotions are not dealt with in time, it is easy for the elderly to feel helpless and lose control, thus suffering from depression.

2. Anxiety

Many elderly people also suffer from anxiety. Studies show that about 11.24% of people over 60 in my country suffer from anxiety. Although many elderly people can take care of themselves, they lack the company and emotional support of their children, especially those with a narrow circle of interpersonal relationships, which leads to frequent anxiety. For the elderly, anxiety about death has become an important source of psychological pressure, leading to strong anxiety.

3. Decreased cognitive function

Studies have shown that about 15.4% of the elderly in China have mild cognitive impairment. The decline in cognitive function affects a person's memory, language and executive function, and is also an early sign of Alzheimer's disease. This may lead to a decline in the elderly's ability to live in daily life, causing a strong sense of frustration and uncertainty about the future.

4. Loneliness

Loneliness may be the most common mental health problem among the elderly. Studies have shown that among the elderly in rural Anhui Province, my country, 78.1% of them have moderate to severe loneliness. Many events can lead to increased loneliness in the elderly, such as poor family relationships or alienation, shrinking social circles, the death of relatives and friends, and decreased physical function. Divorce or widowhood are the most important factors leading to loneliness.

What can we do about insomnia in the elderly?

To alleviate insomnia and mental health problems in the elderly, if the situation is not serious, it is not necessary to rely on medication. A more effective way is to help them make changes in their daily lives.

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Build healthy habits

· Regular work and rest time: It is recommended to get up and go to bed at a fixed time every day. A regular work and rest time can help adjust the biological clock and reduce difficulty falling asleep. If you need to take a nap during the day, control it within 20-30 minutes, which can quickly restore energy without affecting your sleep at night.

Optimize the sleeping environment: Make sure the bedroom is quiet and dark, for example, use light-blocking curtains and noise-proof glass to reduce external disturbances. At the same time, choose comfortable mattresses and pillows for the elderly to support the body's full relaxation at night.

Reduce the intake of stimulants: Many elderly people may have the habit of drinking tea. Try to avoid drinking tea or other caffeinated beverages in the afternoon or evening. It is recommended to have a moderate dinner and not eat too much or too greasy food to reduce the digestive burden at night.

Moderate daytime exercise: Doing moderate physical activity every day, such as walking, jogging or Tai Chi, can effectively shorten the time it takes to fall asleep and prolong the duration of deep sleep. However, you need to avoid strenuous exercise at night to avoid stimulating the nervous system and affecting your sleep.

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Build positive social connections and emotional support

Regular and long-term social activities: Encourage the elderly to expand their social circles and stay connected with the outside world by actively participating in community activities, interest groups, volunteer services, etc. Regular social interactions can not only enhance mental health, but also provide emotional support and alleviate loneliness.

· Provide emotional support: We often see that the elderly like to ask about each other's well-being. In fact, this is a way to provide emotional support to each other. By sharing daily trivia with each other, negative emotions can be well relieved. However, this cannot replace the mutual communication and companionship in close relationships. Due to cultural habits and growth environment, the elderly are often reluctant to take the initiative to speak out when facing life troubles or psychological pressures. Therefore, the companionship and care of family members, especially children, is particularly important. Guiding the elderly to actively express their emotions can effectively relieve psychological burdens and prevent psychological problems.

Pet companionship: If conditions permit, keeping a pet is also an effective way to relieve loneliness and improve happiness. Pet companionship can reduce anxiety in the elderly, increase the fun of daily life, and help them fall asleep more easily.

Finally, if it is found that the elderly have more serious insomnia and mental health problems, it is recommended to seek help from the hospital psychiatry department or professional psychotherapist. After a period of psychotherapy, it can effectively help the elderly release emotions and deal with negative thoughts, thereby improving sleep quality and alleviating psychological problems.

Looking in the mirror of rumors

"Age" can easily be considered the "cause" of many physical abnormalities, but this may mask the real problem. For the health of the elderly, the elderly and their relatives may wish to learn more about some common symptoms that need attention, so that hidden dangers can be discovered earlier and intervention can be made earlier to achieve a higher quality of life in old age.

References

[1] Yang, JJ, Cai, H., Xia, L., Nie, W., Zhang, Y., Wang, S., ... & Xiang, YT (2021). The prevalence of depressive and insomnia symptoms, and their association with quality of life among older adults in rural areas in China. Frontiers in psychiatry, 12, 727939.

[2] Wang, YM, Chen, HG, Song, M., Xu, SJ, Yu, LL, Wang, L., ... & Lu, L. (2016). Prevalence of insomnia and its risk factors in older individuals: a community-based study in four cities of Hebei Province, China. Sleep medicine, 19, 116-122.

[3] Li, W., & Reavley, N. (2020). Recognition and beliefs about treatment for mental disorders in China: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 55, 129-149.

[4] Liu, Y., Xu, Y., Yang, X., Miao, G., Wu, Y., & Yang, S. (2023). The prevalence of anxiety and its key influencing factors among the elderly in China. Frontiers in Psychiatry, 14, 1038049.

[5] Deng, Y., Zhao, S., Cheng, G., Yang, J., Li, B., Xu, K., ... & Rong, S. (2021). The prevalence of mild cognitive impairment among Chinese people: a meta-analysis. Neuroepidemiology, 55(2), 79-91.

[6] Zuo, S., Lin, L., Chen, S., Wang, Z., Tian, ​​L., Li, H., & Xu, Y. (2023). Influencing factors of loneliness among older adults in China: A systematic review and meta-analysis. Psychogeriatrics, 23(1), 164-176.

[7] Wang, G., Zhang, X., Wang, K., Li, Y., Shen, Q., Ge,

Author: Chen Yufeng, Master of Developmental and Educational Psychology

Review | Yang Xiaoyang, Associate Professor, School of Psychology, Sichuan Normal University