Some Myths About Insomnia and Aging
Well, thanks for having me. I'm excited to be able to be here today and talk to you all about. a subject that is very near and dear to my heart and that I always jump at a chance to talk about because I love to talk about insomnia. And my hope today is to, as the title implies, break some myths and raise some consciousness about what I would call the disorder of insomnia. I think that as a whole, we tend to think about this in a very different way that it needs to be thought about. And I'm hoping to show you that today. So without any further ado, let's get started. What's the definition? What are we talking about here? When I talk about insomnia, I know from talking to people that a lot of people have different ideas about what that looks like. Well, I know it when I see it. Here's what it looks like. Lying wide awake, staring at the clock, doing those sorts of things. Some of you may be familiar with this posture to get more technical. we're talking about a disorder of initiating and or maintaining sleep. And in truth, in most of our classification schemes, our diagnostic schemes, there is no definition for severity of how long is too long to get to sleep after all this time. Interestingly, we haven't put that down on paper, but I can tell you that the sleep community in general all agree that about 30 minutes is too long,
that one should be able to fall asleep faster than that or reinitiate sleep if you wake up in the middle of the night, 30 minutes is a pretty long time. It's a full sitcom. So that's a long time to be laying there. Right. So I have trouble getting to sleep if it takes me more than thirty minutes to fall asleep. Trouble with maintenance, insomnia. That is middle of the night or end of the night. If I'm awake for thirty minutes or more, some combination. So maintenance, insomnia can take a lot of have a lot of different faces. We can have maintenance, insomnia for awake for an hour in the middle of the night or awake for two hours in the middle of night. Maintenance, insomnia. If I wake up earlier than I want to by more than thirty minutes and maintenance, insomnia, if I wake up five times during the night for ten minutes apiece, those look very different. But all of them would be considered maintenance, insomnia. The next piece of the definition, as you see, is the difficulty occurs despite adequate opportunity, which means I have to at least give myself some chance to sleep. Some people are not getting enough sleep in our society. They're burning the candle at both ends. Some of you may have at times or now be doing that, having lots of things to do, work projects, whatever it is, going to bed late, then needing to get up early in the morning for one reason or another. And you're not getting enough time to get enough sleep. And you may be tired as a consequence of that. But that's not insomnia.
We're saying if we give myself the opportunity, but I can't get it and I'm laying there and I can't sleep, that's insomnia. And then the next thing we have to keep in mind is that I think of insomnia disorder as a twenty four hour disorder. It's not just about the nighttime. So we don't fully make the diagnosis of insomnia without taking into account what's happening during the day. And to make the diagnosis, there have to be some sort of daytime consequences. So if I'm having trouble initiating and maintaining sleep, do I then feel one or more of these symptoms? Tired fatigue, low energy problems with concentration, problems with performance of one type or another, mood disturbances like irritability. I usually have to ask the bed partner about that motivation and energy proneness for errors and also physical symptoms like tension headaches, stomach stomach ache, that sort of thing, and even just having concerns or worry about sleep. All of these would be considered symptoms of the sleep loss the night before, and we need to see some of that to make the full diagnosis. If one is having problems initiating and maintaining sleep but feel perfect during the day, then that's not insomnia. Now, that doesn't mean that that person likes laying there in the middle of the night and there may be things to do about that, but that's something different. Any ideas why somebody might be laying awake at night and not feel good during the day? I feel fine during the day, rather. That's right, the truth is that we all have a different what I would call sleep. No, you all have a sleep. No, it has nothing to do with the sleep number bed, but it means the right number of hours to feel rested during the day. And some people need less than others and some people who need less sleep. If they're in bed for lots of hours, they're going to have some signs that they don't sleep, but they'll feel fine the next day. So for the diagnosis of insomnia, I have to feel it. I have to feel like there's a consequence to my not sleeping. Also, want to draw your attention to this idea at the top of fatigue or sleepiness, we tend to use those terms interchangeably. But the truth is in sleep medicine, those things are not the same. Fatigue is this. This is fatigued, tired, run down, worn out, needing stimulants to get myself through the day, bedraggled, anybody recognize this, these these signs and symptoms, this is tired, OK? And this is sleepy sleepiness is a proneness to fall asleep, to be ready to fall asleep. And the interesting thing about this is this. Most people with insomnia don't get very sleepy. You don't see this is a symptom for most people. Some do. But when I do evaluations of people with insomnia, when I ask the question, do you get sleepy and define this, most of them will say, I wish, right. I wish I could feel that sleepy. Certainly they don't feel sleepy at the right times. Some will have some sleepiness during the day at certain times, but for the most part they feel more we would call tired but wired. You can be exhausted in the middle of the night and not feel like you're sleepy. And so I wanted to make that distinction for you because that's often the case. So insomnia, I mean, is this that big of a deal? Insomnia. We have lots of other things to worry about in the world. Is insomnia problem? I'm thinking it must be a problem at this point because Dr. Oz is starting to talk about insomnia. Now, I think that that's a good thing, the truth is sleep medicine is a relatively young science, and so we have only just started really to explore this in the last relative to medicine in the last 20 to 40 years. And that's relatively recent in the history of medicine. So I think it's good that it's starting to get into the mainstream culture and that people are starting to talk about sleep because as I will about to show you, it is a much more significant problem than any of us give it it to do. First of all, let's just talk about numbers, just a show of hands. How many people here have in your life ever had a bad night of sleep? And everybody's laughing. And I could do that in an audience of 200 people and it wouldn't matter because that's universal. That's not the problem I'm talking about here. All of us have had the experience of either difficulty initiating sleep, but the problem comes when it starts to build on itself and become more chronic. So right now, the estimates are that anywhere from about thirty to thirty five percent, that's almost a third of the country at this moment, are having some problem with at least acute bout of insomnia, which means that they're having troubles initiating and maintaining sleep more than three nights for up to three months. That's usually associated with some stressor. Something's happening, right? We're coming up on tax time. The stock market is going down. Whatever the issue might be, that might worry somebody might keep you not sleeping for a little bit of time. But we expect whatever it is, whether it's illness, whether it's psychological, whether it's stress that when that stress remits, when it gets better, when we've dealt with it in some way, that the problem goes away, the insomnia goes away. And for many people, that is the case, maybe for up to 70 percent, but anywhere from 10 to 30 percent still. And even the 10 percent number is a huge number for some that insomnia does not go away. And so when we start to talk about chronic insomnia, what we're talking about is trouble initiating sleep or maintaining sleep for more than three nights a week for more than three months. And something happens once we cross that threshold. I think it's even less I think it's more like a month, because once we get beyond that period, it doesn't tend to go away by itself, regardless of whether the stressor admits or not. For some people, for up to 10 percent, which is a huge number when we're talking about this, it does not go away without there being some intervention. And by the way, and I'm going to show you this, we don't tend to talk about it. So do I see people who have had insomnia for four months? I wish, but I don't get them that quickly. Most of the patients I see have had their insomnia for five years, 10 years, 20 years, 30 years and 40 years. Once you cross that threshold, it doesn't tend to go away. And what does it do? It affects everything. Now, if we had all day and believe me, I've talked about insomnia all day. I could show you slide after slide that essentially shows you what I'm summarizing here, which is essentially this anything you want to measure, the worse the insomnia gets, the worse the problem gets. So insomnia has impact.
Credit
https://www.youtube.com/watch?v=nU6FXWwLS-w
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