The Effect of Magnesium Supplementation on Primary Insomnia in the Elderly
This article examines the effect of magnesium supplementation on primary insomnia in the elderly. Insomnia is defined as dissatisfaction with the amount or quality of sleep, which persists for a long period. Its symptoms include difficulty falling asleep, staying asleep, and waking up too early. This issue is not an inevitable part of aging; however, due to various reasons, its prevalence increases with age. Most elderly individuals who do not have optimal aging conditions suffer from major sleep disorders. In other words, aging itself does not automatically lead to sleep disorders; rather, it often occurs due to other factors related to aging. The most significant sleep-related changes associated with aging include:
- Decreased sleep duration
- Reduced sleep efficiency
- Less deep sleep
The prevalence of insomnia symptoms across all population groups ranges from 10% to 48%. Studies on its prevalence among the elderly indicate that 42% of them experience difficulty in falling asleep or staying asleep. A follow-up of the mentioned study over three years showed that 15% of participants who initially did not report insomnia later developed it, indicating an average annual incidence rate of 5%. Other estimates suggest that over 40% to 50% of adults over 60 years old suffer from insomnia.
Problems Associated with Insomnia
At all ages, individuals suffering from insomnia experience memory impairment, increased response time, short-term memory problems, and decreased efficiency. However, insomnia is particularly problematic in the elderly, as it increases their risk of falls, cognitive impairment, poor physical function, and mortality. Sleep disorders are also linked to reduced quality of life, general health issues, increased healthcare costs, and symptoms of anxiety and depression.
Treatment
Currently, treatment includes both pharmacological and non-pharmacological approaches. There is low to moderate-quality evidence regarding the effectiveness of non-pharmacological treatments for insomnia, and clinically significant results are often lacking. Generally, there is insufficient accurate data on the impact of these methods compared to control groups. Pharmacological treatment for insomnia involves a wide range of medications. However, the American National Institute of Health’s Sleep Disorders Conference has stated that the risks of commonly used sleep disorder medications outweigh their benefits, making them unsuitable for the elderly. This concern is particularly relevant for older adults, as 81% of sleep medications are used by them, often daily and for prolonged periods.
Magnesium
Magnesium is the fourth most abundant cation in the body and the second most prevalent intracellular cation, participating in over 300 vital biochemical reactions. It acts as an essential cofactor for numerous enzymatic reactions, particularly those involved in energy metabolism and neurotransmitter synthesis. Aging is a major risk factor for magnesium deficiency.
Its Effects in the Elderly
During aging, the body’s magnesium status undergoes several changes. With increasing age, total body magnesium decreases due to a reduction in bone mass, which serves as the primary reservoir of magnesium in the body.
Epidemiological studies indicate that despite magnesium’s significant physiological role, dietary magnesium intake is insufficient in various populations. Certain demographic groups, especially the elderly, have low magnesium intake due to:
- Inability to consume magnesium-rich foods
- Preference for processed foods
- Lower consumption of whole grains and leafy green vegetables
However, studies show that the need for magnesium does not change with age. Other age-related changes in magnesium metabolism include:
- Decreased magnesium intake
- Reduced intestinal absorption
- Increased urinary and fecal excretion due to medication use
Among these factors, reduced magnesium intake appears to play a key role in age-related magnesium deficiency.
Its Role in the Body
Although the exact impact of magnesium on neural function and sleep behavior is not fully understood, magnesium plays a role in regulating the conductivity of various ion channels, such as NMDA (N-Methyl-D-Aspartate) receptors and unidirectional potassium channels. It is also essential for the binding of most monoamines to their receptors.
Therefore, this cation plays a crucial role in neurotransmission at both the presynaptic and postsynaptic membrane levels. Several studies have confirmed its role in regulating excitability in the central nervous system. As a natural NMDA antagonist and a GABA agonist, magnesium may play a key role in sleep regulation.
Magnesium Supplementation
Given the points mentioned above, if magnesium supplementation can improve insomnia and prevent complications related to this disorder, such as:
- Reduced daytime efficiency
- Increased healthcare costs
- Chronic stress
- Depression
- Shortened lifespan in the elderly
It may serve as an alternative or complementary treatment to conventional medications, helping to reduce their multiple side effects, including:
- Long-term sedative effects
- Memory impairment
- Increased risk of falls due to daytime drowsiness
- Rebound insomnia
- Respiratory suppression
- Tolerance development requiring higher doses
- Dependence and withdrawal issues
- Drug misuse
- Potentially increased mortality risk
For this reason, the present study was designed to investigate the effect of magnesium supplementation on insomnia in the elderly.
Conclusion
Overall, the results of this study suggest that taking 500 mg of magnesium daily for eight weeks can improve biochemical and questionnaire-based sleep indices, including increased sleep duration, sleep efficiency, and serum levels of renin and melatonin. Additionally, magnesium supplementation can improve insomnia severity scores while reducing serum cortisol levels and sleep onset latency in elderly individuals with insomnia. The observed effects of magnesium supplementation on insomnia, at the administered dose, were free of any side effects, including gastrointestinal irritation symptoms.
Reference:
Abbasi, Behnoud, Kimiagar, Masoud, Sadeghniat, Khosro, Mohammad-Shirazi, Minoo, Hedayati, Mehdi, Rashidkhani, Bahram, Shahidi, Shahriar, Payab, Moloud, & Karimi, Nastaran. (2012). The Effect of Magnesium Supplementation on Primary Insomnia in the Elderly. Scientific Journal of Birjand University of Medical Sciences, 19(3 (Issue 52)), 0-0. SID. https://sid.ir/paper/384571/fa