Introduction

It is obvious that the world’s populations are aging. Epidemiological studies show that, by 2050, about
22% of the population will be above the age of 60 years old (
https://onlinelibrary.wiley.com/doi/epdf/10.1111/prd.12126). Aging considered one of the most
identified risk factors for chronic illnesses and related comorbidities. The risk of developing insomnia
increases to affect about 50% of the elderly. While the cause of this elevated risk not well defined, it
thought to be due to age related changes in circadian rhythm of sleep, partial decline in functionality of
sleep control centers and presence of preexisting of underling comorbidities. (Insomnia: Definition,
Prevalence, Etiology, and Consequences)

It would be interesting to understand the physiology of sleeping process. In the literature, sleep is
classified in four stages. The first 3 stages of sleep refer to N1, N2 and N3 sleep all are Non-Rapid eye
movement (NREM) sleep, these stages account for 84% of adult sleeping time. Whereas Rapid eye
movement (REM) sleep is the fourth stage of sleep and accounts for only 18% of sleeping time. During
the NREM men experienced many physiological changes starts with N1 stage which is the lightest sleep
stage and accounts for 18% from sleeping time. N2 stage accounts for about 48% of sleeping time, starts
when sleep begins to deepens. Moreover, the deepest stage of sleep (N3) reached when brain waves
slow, body temperature begins to drop, and heart rate slows. During the NREM sleep, the brain activity
will be similar to awake state therefore it called “paradoxical sleep”. This last stage of sleep marks by
increasing heart rate and blood pressure along with muscle atonia. (Insomnia in the Elderly: A Review)
With aging there are multiple physiological changes in these sleeping stage which leads to disturbed
sleep. Mostly because of delayed circadian phase. There is also a natural decrease in total sleep time
through the individual life. Night time sleep rapidly decreases from 10 to 14 hours in pediatric population
to 6.5 to 8.5 in young adults. Followed by slow decrease in the old age to 5 to 7 hours a night. These
natural decease in night time sleep may lead to irrational expectation, producing more stress and anxiety
that may negatively affect or even cause insomnia. ( Insomnia in the Elderly: A Review)
 Most often insomnia described as difficulty falling or staying asleep. For this paper, the criteria of the
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), has been applicated to
define insomnia. The criteria of primary insomnia defined firstly, for at least one month, difficulty
initiating or maintaining sleep, or nonrestorative sleep. Secondly, there is significant impairment in
important areas of functioning. Thirdly, the disturbance does not occur exclusively during the course of
narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or a parasomnia, and
lastly, it has not to occur exclusively during the course of another mental disorder or as a direct effect of
substances use. (Insomnia DSM). (Insomnia: Definition, Prevalence, Etiology, and Consequences)

Al together with the aging process and it associated comorbidities, the responsibility of healthy and
secure aging increases. Research’s show that olde people with untreated insomnia have 23% increased
risk of developing mental illness (insomnia in elderly)( Insomnia in the Elderly: A Review). Besides,
insomnia is also associated with increased costs in the health system and the society. Consequently,
there is increasing need to develop and validate methods to early detect insomnia. Despite that the
diagnosis of insomnia is mainly clinical, objective methods, including polysomnography and wrist
actigraphy, and subjective methods including questionnaire have been developed. However,
polysomnography used mainly to evaluate sleep apnea and parasomnias and is not recommended to
evaluate primary insomnia. While wrist actinography measures the response to treatment. In addition,
there is a limited number of questionnaires have been validated to be used in elderly. In 2016-2017
systematic review have been done by two Catholic university of Leuven students to investigate the
psychometric properties of sleeping questionnaires in elderly. This paper is likewise, aimed to further
investigate, review and update the valid and reliable scale to be used in elderly.

It's not bad but there is something odd in all your sentences. I must think “what does she mean?” in
almost all the phrases. It’s hard for me to rewrite everything. So, take the comments, adjust your text
and then I can read it again and bring adjustments where needed. It would still have errors even with the
adjustments so send back to me when you’re done.