Psychological factors associated with insomnia include anxiety, depression, and grief. 5 These sleep disorders can lead to nighttime awakenings, sleep-onset difficulty, and daytime sleepiness. 6 PLMD, which is characterized by repetitive flexion and extension of the lower leg during sleep, occurs in about 80% of RLS patients. 6 The estimated prevalence of RLS is 5% to 15%. Usually associated with leg discomfort, RLS is relieved with movement prolonged bed rest during hospitalization can worsen it.
RLS is characterized by an urge to move the legs while at rest, especially at night. 4,5 This sleep fragmentation and oxygen desaturation causes snoring or gasping during sleep and can lead to hypertension, cardiac arrhythmias, cognitive decline, and increased mortality. OSA, which occurs in 24% of men and 9% of women in the United States, is characterized by repetitive episodes of breathing pauses (apnea) and hypoventilation (hypopnea) that precipitate brief awakenings. Sleep disorders include obstructive sleep apnea (OSA), restless legs syndrome (RLS), and periodic limb movement disorder (PLMD). Multiple factors can lead to insomnia in hospitalized patients, including sleep disorders, psychological and physical factors, certain medical conditions, medications, environment, clinical activities, and poor sleep hygiene. 1 In a longitudinal observational study of insomnia prevalence in 280 hospitalized elderly patients, 21% reported new-onset insomnia, 38% reported moderate or severe insomnia, and 38% reported sleep disturbances during hospitalization, and severe morbidity, pain, and impaired functional status were significantly associated with insomnia. Interestingly, when the medical records were reviewed, no patient had physician documentation of insomnia symptoms. 2 In one study, 47% of 222 patients reported that they had insomnia and/or excessive daytime somnolence while in the hospital.
1 It is characterized by an increase in sleep latency (trouble falling asleep), a decrease in sleep maintenance (trouble staying asleep), or a decline in sleep quality (less time sleeping compared with time spent in bed). Insomnia is a common complaint in hospitalized patients, especially the elderly.
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