According to surveys, Singapore is among the most sleep-deprived nations in the world. Almost half of Singaporeans across age groups are not satisfied with their sleep. Among those, 50% downplay the importance of quality shut-eye and only 40% are aware of the causes of their insomnia. In other words, many of us want to improve our sleep quality but do not quite know how.
Another worrying trend is that insomnia remains under-diagnosed and under-treated in Singapore, despite its known prevalence. A study revealed that only 10% of those who reported difficulty sleeping sought medical advice and treatment, which means that for the remaining 90%, the nightly show ‘Sleepless in Singapore’ is likely to go on for a while.
Chronic insomnia has been linked to impaired functioning of the body, poorer coordination, concentration and memory, higher risk for a number of diseases such as hypertension, diabetes, heart diseases, and a general compromised immune system. In this article, we discuss how insomnia affects your body and health; and what underlying conditions insomnia may indicate. Keep reading to learn more about how to diagnose, assess, treat, and care for those struggling to sleep.
How Insomnia Affects The Body
Insomnia is the most common type of sleeping disorder, characterised by difficulty in falling asleep and/or maintaining sleep throughout the night. It may also include waking up after only a few hours of rest and being unable to fall asleep again.
Sleep allows the body to regulate its hormones, repair damaged cells or tissues, strengthen the immune system, and thereby sustain good health and body functions. Additionally, restful sleep benefits us greatly by restoring balanced energy levels and hormonal regulation to improve our mood. Since insomnia causes sleep deprivation, the body is unable to perform its maintenance functions which brings about symptoms like:
- Poor concentration
- Impairment in performance of daily tasks, such as driving or remembering things
- Mood swings
The health consequences of insomnia are well documented, yet frequently overlooked. Sleep deprivation is linked to weakened immunity, reduced strength, and increased pain sensitivity, according to multiple studies. This type of restlessness also depletes one’s energy levels over time and induces emotional distress among individuals. Physically, sleep loss caused by chronic insomnia may result in long-term damages to the body, increasing the risk of developing a number of chronic conditions, including:
- High blood pressure
- Cardiovascular diseases such as heart attack & stroke
- Anxiety and depression
Types of Insomnia
Since insomnia affects individuals differently, medical professionals usually categorize this sleeping disorder into three main types: transient, acute, and chronic. Observing the length of time that a patient has had sleeping problems typically determines their type of insomnia and its corresponding treatment/s.
This type of insomnia isn’t usually a cause for concern since it only lasts 1-3 nights. Transient insomnia may result from particular events such as jet lag or situations that induce some brief feelings of anxiety or stress in patients. However, in most cases, sleeping patterns normalise on their own with little to no intervention.
Similar to transient insomnia, acute insomnia is characterised as short-term but may last around 1-2 months. This is usually caused by more physically or emotionally taxing external stressors like adjusting to a new environment, taking a new medication, or receiving disconcerting news which contributes to poor sleep quality.
Chronic insomnia is the most severe type since it can affect sleep for more than 3 months. As noted above, this is highly problematic because long-term sleep deprivation is linked to a higher risk of suffering from a heart attack, stroke, diabetes, and depression. Elderlies with existing medical conditions are particularly vulnerable to poorer health outcomes. If you or your loved one has been struggling with sleep to the extent that daytime activities are affected for 3 months or longer, it is crucial to visit a doctor and seek treatment for insomnia immediately.
Causes Of Insomnia
The general cause of insomnia is a state termed ‘hyperarousal’ by sleep scientists. Under hyperarousal, the mind and the body are overactive and as a result, unable to switch off and rest during sleep time. Hyperarousal and thereby insomnia is usually caused by an interplay of several triggers and factors, rather than a single one. Below is a breakdown of common triggers and causes of hyperarousal and insomnia:
During stressful moments, the body produces an elevated amount of cortisol, a hormone that is vital for the body to ‘fight’ the stress. However, regular exposure to stress and constantly high cortisol levels in the bloodstream can cause hyperarousal, which leads to insomnia. This has been confirmed by multiple studies. On the flip side, insomnia affects performance of daily activities at work and at home, resulting in more stress.
Mental health conditions
Sleep studies in Singapore found that close to 40% of those suffering from insomnia disorder had psychiatric disorders, such as depression, anxiety, ADHD or bipolar disorder. Similar to the relationship between stress and insomnia, mental disorders can cause insomnia and can in turn be exacerbated by insomnia. Treatment of insomnia in these cases calls for treating the underlying mental conditions.
Other underlying medical conditions
Loss of sleep is commonly reported among patients suffering from heart diseases, cancer, Alzheimer’s disease, dementia, and hyperthyroidism (overactive thyroid). In addition, conditions that cause chronic pain such as arthritis or heartburn can rob the patients of restful sleeping time. Diseases that affect breathing quality such as sleep apnea, asthma, COPD (Chronic Obstructive Pulmonary Disease) have also been found to cause awakening during the night and other sleep interruptions.
Usage of certain medications
Several medications are known to cause sleeplessness, such as drugs for high blood pressure, anti-asthma, and anti-depression. In other cases, drugs cause drowsiness during the day, interfering with regular sleep at night.
In Singapore, a number of lifestyle factors that can make it hard for you to get your quality slumbers
- Late-night work hours: Singapore as a global business hub means late night calls and emails are commonplace for many office workers. For others, night shift jobs and jet lags can prevent the body from getting the quality rest time that it needs.
- Modern lifestyle: Living with an abundance of stimulation and entertainment might do more harm than good to our sleep quality. Watching TV, movies, playing video games or using mobile phones till late at night can keep the brain stimulated past bedtime and cause sleeping problems.
- Poor diet choices & habits: Consumption of caffeine, alcohol and nicotine in the evening has been found to worsen sleep quality. Eating heavy and/or spicy food late at night can also cause sleep disturbance.
- Irregular sleep routine: With an increasingly demanding lifestyle, maintaining a fixed bedtime and wakeup time seems almost like a luxury. Many people resort to sleeping in during the weekends to make up for the lost sleep during the working week. However, research shows that the impact of frequent loss of sleep cannot be undone by oversleeping during the weekends. In fact, it can further confuse the body clock, worsening overall shut-eye quality.
Additional Causes of Insomnia Among Elderlies
All the causes of insomnia above apply to elderlies. In addition, a number of age-specific risk factors make our seniors more vulnerable to insomnia.
Firstly, as individuals age, they tend to experience more frequent sleep disturbances and lower quality of sleep. Generally, this is due to the body spending fewer hours in deep sleep and producing less melatonin – the hormone responsible for eliciting sleepiness. Elderly patients also tend to have greater sensitivity to environmental factors like noise, stress, or light exposure which affects their ability to sleep properly at night.
Secondly, elderlies are more prone to an underlying health issue that manifests with insomnia as a symptom. They are also more likely to use medications that cause the side effect of sleeplessness, such as those for high blood pressure or depression. Aside from the above listed medical conditions that can cause insomnia, other issues such as an overactive bladder, digestion problems, napping habits or lack of physical activity during the day can also prevent a senior from getting quality sleep at night.
A study on the well-being of elderly Singaporeans shows that those above the age of 60 who have sleep problems are significantly more likely to suffer from chronic diseases compared to those without sleep difficulty. Therefore, when a senior struggles with sleep, it is important to consult a doctor to determine whether insomnia is the primary problem or a symptom of another disease that should be treated.
Diagnosing & Assessing The Severity Of Insomnia
To diagnose insomnia and assess the type and severity of insomnia, the doctor usually asks patients to keep track of sleeping patterns by using a sleep diary. It is important to find out what keeps them up, how long they’ve been struggling with sleeping, and how many hours of sleep they typically get every night. Recently, wearable medical grade devices can also be used to track sleep patterns accurately and conveniently, replacing the need to conduct sleep analysis in a sleep clinics for many individuals. An example is the Rooti ECG patch which monitors the patient’s ECG and movements to determine sleep patterns.
Another helpful strategy is to examine the patient’s routines and lifestyle habits to determine possible contributors to insomnia. Factors like a sedentary lifestyle, inadequate sunlight exposure, excessive usage of electronic devices at night, a lack of social interactions, or prolonged daytime naps or medication usage in seniors may be the cause of a patient’s sleeping problems.
When all lifestyle factors have been ruled out, or lifestyle changes do not improve sleep quality, doctors will look for underlying medical causes. A blood test could be ordered to check for overactive thyroid problems. An ECG test could be useful to determine if a patient has any early signs of heart problems. In other cases, a general health screening could be recommended for a thorough check of all possible causes.
Treatments For Insomnia
While insomnia is often difficult to deal with, it can be treated and even cured once the causes can be identified. If an underlying condition causes insomnia, treatment involves treating the primary causes. If insomnia is the result of medication usage, sleep will get better once you stop using the medication, or switch to an alternative option without the side effect.
Without medical underlying causes, the insomnia case is known as primary insomnia. Treatment for this type of insomnia often involves adjustments in routine or lifestyle to improve sleep routine. To help you or your elderly loved one who is struggling with insomnia, you may consider the following treatment options:
- Cognitive-behavioural therapy – This treatment is recommended for individuals who find it difficult to fall asleep due to excessive worrying. Cognitive-behavioural therapy helps patients identify the cause of their repetitive, negative thinking patterns for greater relaxation and improved sleep-onset.
- Light therapy – This involves adjusting the patient’s circadian rhythm by increasing their sun exposure or having them sit in front of a bright, artificial light every morning. Typically, this is recommended for patients with difficulty falling asleep or staying asleep for longer periods.
- Melatonin supplements – For elderly patients who naturally produce less melatonin, this dietary supplement may assist in inducing sleepiness by restoring melatonin levels within normal ranges.
- Mindfulness meditation – Growing research suggests that meditation may help treat insomnia by reducing stress and negative thoughts that typically keep patients awake. Additionally, it promotes psychological well-being and increases relaxation among individuals suffering from insomnia.
- Physical exercise – Studies show that engaging in aerobic exercise or activities that encourage movement is effective in improving mood and overall sleep quality, especially among ageing individuals.
- Prescribed medication – Generally, medication for insomnia is prescribed after a series of alternative treatments have failed to improve sleeping conditions. This is often seen as a last resort since it may produce dependence on the medication among patients.
How Ninkatec Can Help You and Your Elderly Loved One With Insomnia
As one of Singapore’s leading home care and elderly care providers, Ninkatec offers a range of cost-effective medical services to improve the health and well-being for you and your elderly loved ones at the convenience and comfort of your homes.
Our patient-centric approach enables thorough examination of each individual’s condition to determine the cause of insomnia, without you or your senior loved one having to step out of home. We use wearable medical grade devices to conduct sleep monitoring like RootiRx, a small patch attached to your chest that you can comfortably wear 24/7. Such devices help our patients monitor sleep patterns, and detect risk factors for heart diseases.
Reach out to Ninkatec Care Team today for a private and personal consultation about the sleep quality for yourself or your elderly loved ones. Alternatively, you can contact our Partner GP Clinics listed below for an in-clinic consultation of your insomnia and heart health condition at a clinic location most convenient for you:
- Mayfair Medical – Dr Jipson Quah
- A Life Clinic Pte Ltd – Dr Choo Kay Wee
- Hwang & Liang Family Clinic & Surgery – Dr Lim Shee Lai
- Charazoi Medical Clinic – Dr Choo Dee Pheng
Despite being the most common sleep disorder, insomnia remains largely undiagnosed and untreated across all ages in Singapore. We hope the article highlights the physiological and psychological toll insomnia can take on our health and well-being, and the importance of getting enough quality shut-eye time, especially among elderlies. Although getting 7-9 hours of sleep every night remains essential across all ages, the risks of insomnia are more significant among aging individuals and the effects of sleep deprivation are often more damaging to their health.
More than a daily nuisance, insomnia may manifest as a symptom of a more serious underlying health issue. Therefore, it is crucial to consult doctors and address insomnia through treatment. Medical professionals will be able to help screening for and treating underlying conditions early on, leading to deeper and longer hours of sleep which promotes cognitive functioning, daytime alertness, lowers overall medical risks and generally boosts our well-being.
Individuals of all ages are recommended to take notice of sleep quality and seek professional help immediately if insomnia lasts for more than 3 months and affects daily functioning.