Original article Insomnia in the elderlydA hospital-based study from North India Indrajeet Singh Gambhir, MBBS, MD a, * , Sankha Shubhra Chakrabarti, MBBS a , Amit Raj Sharma, MBBS, MD b , Dharam Prakash Saran, MBBS a a Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India b Post Graduate Institute of Medical Education and Research (Formerly in Institute of Medical Sciences, Banaras Hindu University), Chandigarh, India article info Article history: Received 18 February 2014 Received in revised form 23 April 2014 Accepted 27 May 2014 Available online 5 August 2014 Keywords: Geriatrics Sleep Sleep initiation and maintenance disorders abstract Background/Purpose: Insomnia affects the elderly population significantly. The Indian elderly population is growing rapidly and the epidemiology of insomnia needs to be studied in detail in this group. Methods: An observational study was carried out using a standard questionnaire on 304 male and 200 female Indian elderly patients presenting to the geriatric clinic of the Sir Sunderlal Hospital of the Institute of Medical Sciences, Banaras Hindu University, to study the prevalence and nature of insomnia in this population. The mean age of the study group was 66.47 (±6.855) years. The distribution of insomnia in the various groups (based on sex, occupation, residence, habit-forming substance use, depression) was compared using the Chi-square test with SPSS version 16.0. Results: Insomnia was present in 32% of the study population. A statistically significant association was found between increasing age and insomnia (p ¼ 0.035) but no significant sex differences were appreciable (p ¼ 0.173). Early insomnia was found to be the most common pattern of insomnia identified (39% of total affected). Most of the cases were of chronic insomnia (89.45%) and associated with some comorbidity (100%). Cardiovascular diseases were the most common comorbidity (27.3% of patients with insomnia). Further, positive and statistically significant correlation was found between insomnia and the place of living (p ¼ 0.034), habit-forming substance use (p ¼ 0.045) and depression (p < 0.001). Conclusion: The nature and attributes of insomnia in the Indian elderly are identified by this study. The scope for cause-finding studies is highlighted and points regarding adequate intervention are suggested. Copyright © 2014, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Elsevier Taiwan LLC. 1. Introduction Insomnia is the complaint of inadequate sleep. The International Classification of Sleep Disorders, Second Edition (ICSD-2; 2005) defines insomnia as a complaint of difficulty initiating sleep, diffi- culty maintaining sleep, or waking up too early, or sleep that is chronically nonrestorative or poor in quality. 1 Insomnia is classified according to the nature of sleep disruption into sleep onset, sleep maintenance, sleep offset insomnia, and nonrestorative sleep and on the basis of the duration of the complaint into transient, short- term, and long-term/chronic insomnia. Insomnia lasting for >3 weeks is said to be chronic. 2 Many patients with chronic insomnia have no clear or single identifiable underlying cause for their dif- ficulties with sleep. These cases come under the umbrella of pri- mary insomnia. 3 Complaints about sleep disturbances increase steadily with age. It has been estimated that sleep disturbances affect >50% of community-dwelling individuals aged >65 years as well as an estimated two-thirds of institutionalized elderly persons. In institutionalized elderly, sleep becomes even more disturbed and fragmented than in community-dwelling older adults. 4 The consequences of poor sleep quality may include cognitive impair- ment, daytime sleepiness, and reduced quality of life. 5 In addition to affecting the quality of life in the aged, problems with sleep have been associated with increased risk of nursing home placement and an increased mortality. 6 The annual incidence of insomnia in those aged 65 years or older is approximately 5%. There are many po- tential causes of disturbed or unrestful sleep in the elderly, including emotional stress, physiologic changes of aging including circadian rhythm disorders, psychosomatic disorders, adverse ef- fects of medications, and serious underlying medical conditions. 7,8 Hence, a large section of the elderly population suffers from potentially reversible causes of insomnia. Foley et al 9 estimate that only 7% of the incident cases of insomnia in the elderly occur in the absence of one of these risk factors. Frequent association is found * Corresponding author. Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, Uttar Pradesh, India. E-mail address: gambhir_bhu@yahoo.com (I.S. Gambhir). Contents lists available at ScienceDirect Journal of Clinical Gerontology & Geriatrics journal homepage: www.e-jcgg.com http://dx.doi.org/10.1016/j.jcgg.2014.05.005 2210-8335/Copyright © 2014, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Elsevier Taiwan LLC. Journal of Clinical Gerontology & Geriatrics 5 (2014) 117e121 Open access under CC BY-NC-ND license. Open access under CC BY-NC-ND license.