The Role of Melatonin in the Management of Insomnia in the Elderly

Review Article

Gerontol Geriatr Res. 2023; 9(3): 1092.

The Role of Melatonin in the Management of Insomnia in the Elderly

Amalia Nur Pratiwi¹*; Hamzah Shatri²; Rudi Putranto²; Vinandia Irvianita²; Edward Faisal²

¹Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo National Central Public Hospital, Indonesia

²Psychosomatic and Palliative Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo National Central Public Hospital, Indonesia

*Corresponding author: Amalia Nur Pratiwi Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia. Email: meilovina9@gmail.com

Received: June 02, 2023 Accepted: August 02, 2023 Published: August 09, 2023

Abstract

Older people have various kinds of comorbidity that can reduce their quality of life, one of which is insomnia. The diagnosis of insomnia is established clinically through history taking and the assessment of sleep quality with PSQI (Pittsburgh Quality Sleep Index) scoring. Insomnia can be a diagnosis of exclusion if there are no signs of other sleep disturbances through polysomnography examination. However, complaints of difficulty falling asleep (Sleep onset latency) and shortened sleep duration that disrupts daily activities during the day can be classified as insomnia. The elderly population has a high prevalence of insomnia, around 60%; therefore, this issue needs to be addressed. Various factors can trigger insomnia in old age, one of which is a decrease in serum melatonin levels. Thus, it is thought that melatonin therapy can improve insomnia symptoms in the elderly and have minimal side effects.

Introduction

Indonesia is a country that has a high elderly population, approximately 27 million people (10%) based on the results of data collection from the Central Statistics Agency for 2020 [1]. This number has increased from 18 million people (7.6%) in 2010. According to the Republic of Indonesia Ministry of Health in 2019, Indonesia is entering a phase with increasing life expectancy followed by an increase in the number of elderly people, referred to as the aging population phase [2]. The increasing number of elderly population is not only happening in Indonesia but also globally. WHO (World Health Organization) data stated that in 2019 there were around 1 billion elderly population over 60 years and the number is expected to increase to 1.4 billion in 2030 and 2.1 billion in 2050 [3].

The large elderly population is a challenge for Indonesia. With old age, the risk of various metabolic diseases such as diabetes, hypertension, cardiovascular disease, and stroke tends to increase [4]. In addition to metabolic diseases in the elderly, there is also a decrease in the amount of hormones in the body, one of which is melatonin. The decrease of melatonin can play a role in sleep disturbances or insomnia in the elderly [5].

Various metabolic diseases also increase the risk of insomnia in the elderly, conversely, the condition of insomnia can also increase the risk of various metabolic diseases. In 2018, the prevalence of insomnia in the elderly is around 10% of the total population of Indonesia, around 28 million people. This figure is quite high. Therefore, the problem of insomnia in the elderly requires special attention from clinicians.