Insomnia

What does an ideal night's sleep look like for most people?

Ideal sleep is characterized by falling asleep within 20 minutes of going to bed, and limiting wakeful time during the night to 30 minutes or less.

For adults under 65, seven-to-nine hours is a typical night of sleep; seven-to-eight hours is sufficient for adults 65 and older.

Stages of sleep consist of non-rapid eye-movement (NREM) and rapid eye-movement (REM), which occur in 90-minute cycles throughout the night. REM sleep is an activated state with increased breathing and heart rate, although the muscles are paralyzed.  It is associated with dreaming. NREM sleep is a slower state for most body processes, including heart rate and breathing. It is thought to be a time for the body to repair itself. The length of each sleep stage shifts throughout the night, as well as with aging.

When does “difficulty sleeping” become problematic/pathologic?

Insomnia can manifest in a couple of ways: Sleep onset insomnia occurs when someone has difficulty falling asleep. Sleep maintenance insomnia involves struggling with staying asleep through the night or experiencing early waking prior to sufficient sleep.

These kinds of difficulties become problematic when they result in impairment of daytime functioning. The diagnosis is based on the subjective experience of the patient.  

How does insomnia change with age?

Although the definition of insomnia doesn’t change with age, the risk increases. Causes for that change likely include greater frequency of medical conditions, lifestyle shifts, and alterations in circadian rhythm, all of which can contribute to sleep difficulty.