The Correlation between Insomnia with Blood Pressure in the Elderly in Banjar Wangaya Kajathe

The Elderly is a term for an individual who has entered the period of late adolescence or old age. The number of elderly in the province of Bali in 2018 reached 572.518 inhabitants. Elderly degeneration in terms of both aspects of the psychological and physiological aspects. One form of setbacks is a sleep disorder (insomnia). Insomnia is a disorder of the quantity and quality of sleep that inhibits its function. The elderly who suffer from insomnia to be an increase in sympathetic activity will increase blood pressure and decreased parasympathetic activity lowers blood pressure, in which blood pressure is infl uenced by the autonomous system that is sympathetic and parasympathetic. This study aims to determine the correlation between insomnia with blood pressure in the elderly in Banjar Wangaya Kaja the work area of Public Health Center III North Denpasar. This research is analytic correlational research aimed to see whether or not the correlation insomnia with blood pressure exists in the elderly by using the cross-sectional approach. The ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY


INTRODUCTION
Increased Denpasar City is in the rank 6 th with the elderly population aged 45-59 years as many as 44.172 people, age over 60 years as many as 49.776 inhabitants and over 70 years as many as 15,800 inhabitants (4).
Regarding the aging process, the body function of the elderly will be decreased, the more problems that arise in the elderly is caused by gradual physiological changes, it will lead to a decrease in the physical, psychological and social, one of the effects of psychological changes often experienced by the elderly is the sleep disorders (insomnia) (5) and (6) (11). Insomnia in the elderly in the province of Bali, where the study was conducted at the Integrated Implementation Unit of Public Health Ubud I showed as much as 57% of the elderly suffer from severe insomnia, 44% had moderate insomnia and 29% had mild insomnia at age 55-74 years (19). The same study conducts in Sanglah Hospital showed as much as 55.8% of the elderly experienced mild insomnia and 23.3% had moderate insomnia (12).
Elderly patients with insomnia tend to increase levels of the hormone cortisol and adrenocorticotropic hormone (adrenocorticotropic hormone, ACTH)(13), Increased levels of cortisol will increase heart and blood vessels in response to the effects of catecholamines, increased catecholamine activity will increase cardiac output and vasoconstriction of blood vessels that lead to increased peripheral resistance.
Both processes will work in synergy to increase blood pressure (14).
Blood pressure normally decreases during normal sleep (about 10-20% is considered normal), this situation occurs because of a decrease in sympathetic activity during sleep, but in sleep disorders (insomnia) there is no decrease in blood pressure during sleep so there will be an increase in blood pressure that causes the risk of hypertension, normally every 5% decrease was supposed to happen and not experienced by someone who is having trouble sleeping (insomnia), then the possibility of 20% would be an increase in blood pressure (15), stages of insomnia in a person can affect blood pressure. Elderly who fall into the category of mild insomnia will have normal blood pressure, otherwise, the elderly who fall into the category of severe and very severe insomnia will lead to low or high blood pressure (16).
If insomnia not treated it will adversely affect the health of the elderly. Physiologically impact causes daytime sleepiness, impaired attention and memory, mood, depression, frequent falls, decreased quality of sleep and an increase in blood pressure (17). The right treatment to overcome sleep disorders (insomnia) in elderly with acts of non-pharmacological such as avoiding and minimize the use of coffee, tea, soda and alcohol, and smoking before bedtime can interfere with sleep elderly, avoid naps, especially after 2:00 pm, go to bed only when sleepy, urination before going to sleep, maintain a comfortable temperature in the bedroom, noise, light, and temperature can disturb sleep (18). This study was supported by research (19), where factors affecting insomnia that is as much as 63.36% is a habit of drinking coffee, 57.1% is a habit of smoking, and 78.6% are not comfortable with the environment.

RESULTS AND DISCUSSION
Characteristics of respondents in this study can be seen in the following table: Based on   The brain changes due to aging result in excitation and inhibition in the nervous system.
Part of the cerebral cortex may act as an inhibitor  Increased levels of cortisol will increase heart and blood vessels in response to the effects of catecholamines, increased catecholamine activity will increase cardiac output and vasoconstriction of blood vessels that lead to increased peripheral resistance. Both processes will work in synergy to increase blood pressure (14).
Based on these results, researchers assume that their insomnia relationship with blood pressure in the elderly because most elderly have severe insomnia. Severe insomnia can affect the system autonomously the sympathetic and parasympathetic. When the elderly suffer from insomnia then be obtained an increase in an increase in sympathetic activity which will increase blood pressure, on another side the decreased parasympathetic activity will lower blood pressure. The elderly still less active to follow the elderly gymnastics held in Banjar Kaja Wangaya because many elderly people spend their time at home to take care of their grandchildren besides, the elderly also unable to drive to join the elderly gymnastics held in Banjar.