Insomnia is a disorder characterized by poor quality and duration of sleep, associated with difficulty falling and maintaining it, as well as daytime disability. To be diagnosed, it must occur at least three nights per week, persist for more than three months, and not be a consequence of lack of opportunities to sleep (for example, a nighttime work shift). It is estimated that between 10% and 20% of the adult population suffers from this problem and meets the diagnostic criteria. The incidence increases in middle age and old age, as well as during perimenopause and menopause. Additionally, insomnia is associated with an increased risk of cardiovascular disease, depression, and cognitive decline.
Sleeping is a rhythmic and cyclic process that alternates between three stages of Non-REM sleep and one of REM (Rapid Eye Movement) sleep. The architecture of a proper sleep cycle consists of four to five cycles, each lasting approximately 90 minutes, ending with an episode of REM sleep.
During stage 1 of non-REM sleep, sleep is light and awakening is easy. In stage 2, slower brain electrical activity, deep sleep, decreased body temperature, and a lower heart rate are observed. Stage 3, also known as slow wave sleep or delta sleep, is essential for tissue repair and strengthening the immune system. REM sleep, which predominates in the second half of the night, is characterized by dream activity and decreased muscle tone. Memory consolidation occurs at this stage.
Effective sleep time decreases in older adulthood, and the duration of stage 3 non-REM sleep and REM sleep is shorter. These phases are directly related to strengthening the immune system, cognitive ability, memory, and learning. Most of these changes occur on average at age 60 and are associated with increased morbidity. Chronic insomnia is linked to a higher risk of depression, high blood pressure, Alzheimer’s disease, and work disability.
Current medical strategies recommend a multidisciplinary approach to the management of insomnia. Cognitive behavioral therapy is the cornerstone and first line of treatment. As an alternative or adjunct, FDA-approved drugs can be used. However, many medications commonly used to treat insomnia lack regulatory approval based on clinical studies, and there is little evidence supporting their use (e.g., vitamins and magnesium). Self-medication and prescribing without medical supervision are not recommended.
Seventy percent of patients respond favorably to treatment with a reduction in the severity of insomnia. Fifty percent achieve complete remission after six to eight weeks of treatment, and 45% maintain remission for at least 12 weeks.
Insomnia is not a reason for minor consultation. Its lack of medical care is associated with multiple health complications. The need for sleep does not change with age, but changes in the physiology and architecture of sleep can make the process of falling and maintaining sleep difficult. Sleeping well is synonymous with health and longevity.