What Are the Benefits of Physiotherapy for the Elderly?

The annual prevalence of insomnia in the elderly reaches 5%, and low income, low education, and widowed factors can increase the incidence of insomnia. According to statistics, the incidence of insomnia among people over 65 years of age is 20% to 50%, and women are higher than men. With the increase of age, the central nervous system will undergo degenerative changes, and the elderly will experience symptoms such as sleep rhythm disorders and nocturnal fragmented sleep. There is evidence that insomnia can reduce the elderly's assessment of their own health, increase the risk of depression, and cause cognitive decline. Therefore, the etiology and treatment of elderly patients with insomnia need further attention and understanding. Elderly patients with insomnia are often accompanied by physical diseases and mental and psychological problems. The etiology treatment is the basis. Clinical treatment includes drug treatment, psychological treatment and physical therapy .

Western Medicine Name: Senile insomnia
Affiliated Department: Internal Medicine-Neurology
Disease site: head
The main symptoms: insomnia

Main cause: Degenerative
Multiple groups: Seniors
Contagious: Non-contagious
Whether to enter health insurance: Yes

Elderly insomnia I. Causes and related diseases

The cause of senile insomnia is related to the following factors:

1.Physiological factors

As age increases, pineal gland function gradually decreases, melatonin secretion in the hypothalamus suprachiasmatic nucleus decreases, and intravascular cardiac neuron vasopressin expression decreases, all of which change the sleep structure and regulate the sleep wakefulness cycle Decrease in ability. Degeneration of the structure and function of the central nervous system in the elderly can also lead to decreased sleep regulation. In addition, age-related lens opacity can reduce the ability of the hypothalamic supraoptic nucleus to regulate sleep arousal rhythm.

2.Primary sleep disorders

Primary sleep disorder is a type of sleep disorder caused by non-drugs or other mental illnesses, which is more common in the elderly, including circadian sleep disorders (sleep phase syndrome and sleep phase delay syndrome), sleep apnea syndrome ( Obstructive, central, or mixed), restless leg syndrome, and periodic limb movement disorders. Patients can show symptoms such as insomnia, daytime sleepiness, nocturnal activity, and unpleasant physical sensations.

3. Physical illness

The elderly have a variety of physical diseases. The main physical diseases that cause insomnia are: pain, such as rheumatoid arthritis, lumbar disc herniation, skeletal muscle pain, and other pain conditions; cardiovascular disease, such as heart failure, palpitations, and difficulty breathing at night Nocturnal angina; Pulmonary diseases such as chronic obstructive pulmonary disease and allergic rhinitis (nasal congestion); Digestive system diseases such as gastroesophageal reflux disease, peptic ulcer disease, constipation, diarrhea, and anal itching; Urinary Systemic diseases, such as frequent urination, urinary retention, incomplete bladder emptying, and urinary incontinence; Central nervous system diseases, such as stroke, Parkinson's disease, Alzheimer's disease, and epilepsy; Others include itching, postmenopausal women Hot flashes and other symptoms.

4.Psychological factors

Mental and psychological factors are one of the important factors influencing elderly insomnia. Compared with young people, older people are more fragile and helpless, and older people often feel lonely and lonely. With age, older people are more likely to have negative emotions such as pessimism and sadness. Too much worry about family affairs but inability to make the elderly vulnerable to depression and anxiety. In addition, widowed children, unharmonious family relationships, filial piety of children, and high economic pressures will also make the elderly feel bad, and even have a misogyny. Insomnia is a common symptom of elderly patients with depression, and it is easily associated with physical discomfort. Patients with long-term insomnia are also prone to depression or anxiety disorders. In addition, if physical illness occurs, it will further aggravate the occurrence of bad mood.

5.Behavior and environmental factors

Compared with normal people, insomnia patients have unreasonable beliefs about sleep, night anxiety and non-functional sleep behavior. Patients appear to be exaggerating the consequences of insomnia, worrying that insomnia will cause serious illness, cause substantial physical damage, and attribute bad mood to insomnia. Among the elderly, napping during the day, going to bed early, going to bed after bedtime (reading a book, watching TV), eating too much, lack of exercise and sedentary all can cause insomnia. Sleeping environment is one of the important factors that affect people's sleep quality. Noise, strong light, unsuitable temperature, uncomfortable beds, and lack of sunlight can cause insomnia in the elderly.

Senile insomnia 2. Differential diagnosis

Clinical symptoms of insomnia in the elderly: The patients are often characterized by insufficient sleep time, insufficient sleep depth, sleep failure to eliminate fatigue, and recovery of physical strength and energy, which can be manifested as difficulty falling asleep, or falling asleep, or falling asleep. Wake up, or ca nt sleep after waking up, or even stay up all night,

If the symptoms of insomnia in the elderly are met and insomnia occurs at least three times a week and lasts for more than one month. You can judge insomnia.

Senile insomnia III. Principles of treatment

1 Senile insomnia 1, medication

(1) Benzodiazepines and non-benzodiazepines

Benzodiazepines can reduce REM sleep time, reduce sleep latency, and reduce nighttime awakening. The absorption of benzodiazepines has nothing to do with age, but it is related to body fat, so it should be used with caution in obese patients, and it should not be used for a long time. Although insomniacs receive benzodiazepines

The treatment of tritium drugs is particularly effective initially, but long-term use can easily lead to drug resistance.

Non-benzodiazepines include Zolpidem, Zaleplon, Zopiclone, and Indiplon. Zolpidem can be used in patients with difficulty falling asleep. The elderly are better tolerated and do not change the structure of sleep. Zolpidem has fewer adverse reactions, mainly dizziness, drowsiness, and nausea. Zaleplon's pharmacological mechanism is similar to zolpidem, with a half-life of only 1 hour. The elderly are safe to use, easily tolerated, and have no drug withdrawal response. Picolone is a cyclopyrrolidone drug that acts on GABA and is metabolized by the liver. This drug also has anticonvulsant, muscle relaxant and anxiolytic effects. Zopiclone has a small effect on daytime behavior and a very small effect on cognitive memory. Indiplon is a pyrazoline acridine drug and a GABA-A receptor coordinator.

(2) Antidepressants

Sedative antidepressants can be used in the treatment of insomnia patients with depression. Such drugs include trazodone, amitriptyline, doxepin, and mirtazapine.

(3) Prescription drugs

Antipsychotics are commonly used in elderly refractory insomnia, behavioral disorders, and depression. Antipsychotic weight gain caused by antipsychotic drugs can increase the risk of sleep apnea syndrome and reduce sleep quality, so it should be used with caution for patients with insomnia.

(4) Over-the-counter medicine and Chinese medicine

Over-the-counter medicine and traditional Chinese medicine also have certain effects on insomnia. Alcohol can promote sleep, reduce sleep latency and rapid eye movement sleep time, but long-term use or abuse can cause sleep disorders.

2 Senile insomnia 2. Psychotherapy

For insomnia caused by psychological or behavioral factors, psychological intervention may achieve satisfactory results. The American College of Physicians (ACP) recommends that all adult patients should use insomnia cognitive behavioral therapy (CBT-I) as the preferred treatment for chronic insomnia. Through in-depth communication, find out the maintenance factors of patients with insomnia, and then guide the patients to establish good sleep cognition and habits through individual or group-assisted methods, and establish correct sleep beliefs .

3 Senile insomnia 3.Physiotherapy

Transcranial magnetic stimulation (TMS) is a kind of neurostimulation and neuromodulation electrophysiology technology. It regulates the excitability of the cerebral cortex through magnetic fields. The cerebral cortex of patients with insomnia belongs to a state of high excitement. Low frequency stimulation can effectively improve sleep quality. The mechanism may be related to TMS. Stimulating the brain to produce inhibitory neurotransmitters is related to the melatonin synthesis and secretion of the pineal gland. Repeated TMS can improve sleep quality without changing the normal sleep structure, and no obvious adverse reactions occur.

Other studies for the treatment of insomnia include acupuncture, high-level electrostatic therapy, EEG feedback therapy, ultraviolet light quantum oxygen therapy, and low-energy He-Ne laser therapy.