From psychophysiological insomnia to organic sleep disturbances: a continuum in late onset insomnia - with special concerns relating to its treatment.
The population suffering from insomnia in old age onset (LOI) is quite large. LOI might include a larger scale of syndromes ranging from typical psychophysiological insomnia to night delirium. The correlation between the biological, biochemical changes and the quantitative as well as the qualitative alterations of the sleep process through aging has not been fully explored. One can suppose that any cerebral lesion leading to a dysfunction in mental performance can also act on the sleep. The majority of LOI brain metabolic disturbances might therefore have some etiological role. The authors suggest the application of this concept in the clinical evaluation of LOI. The authors constructed a heuristic model for the pathophysiology and treatment of LOI. It is a bipolar axis containing the most typical symptoms of LOI. On the opposite margins psychophysiological insomnia and organic/metabolic insomnia (up to delirious states) are settled. The position on the axis (i.e., its distance from the "edge syndromes") gives information on the probability of its organic nature. Based on their clinical experiences and considering the data of the very few studies, they suppose that with the help of a detailed analysis of the symptoms of LOI and using some additional (electrophysiological and neuroimaging) laboratory methods most patients with LOI can get a strict diagnostic position on the LOI axis. Using the LOI axis not only a detailed evaluation of the symptomatology but also more sophisticated therapeutic interventions become possible. Symptoms on the "metabolic side" can be cured by a single evening application of any drugs improving the function of the brain (like nootropics, neuroprotective agents or even slight stimulants, e.g., caffeine) might show a "paradoxical hypnotic" effect, or in combination with sleeping pills they can cause an additive effect in LOI patients. The efficacy of this treatment can also have a diagnostic value: i.e., it helps to differentiate between the primary (organic) and psychophysiological (exogenous or emotional/psychic) forms of LOI.
Peter
Rajna
R
Semmelweis University, Faculty of Medicine, Department of Psychiatry and Psychotherapy, Balassa u.6., H-1083 Budapest, Hungary. rajna@psych.sote.hu
Peter
Tariska
T
Brigitta
Baran
B
Zsuzsa
Vida
V
Judit
Veres
V
Waldemar
Szelenberger
S
D017668:Age of Onset; D003072:Cognition Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008954:Models, Biological; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*