Taking Charge of Your Health

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

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