Sleep disturbances in the elderly residing in assisted living: findings from the Maryland Assisted Living Study.
Rao V, Spiro JR, Samus QM, Rosenblatt A, Steele C, et al.;
Commented by , 22 Nov 2005
Background
Up to 50% of over 65s have a sleep disturbance, mainly insomnia and daytime sleepiness; this prevalence rises to 70% in institutions. Insomnia has adverse effects on health and quality of life in older people. This study sought to quantify the problem in assisted living (AL) settings.
Objective
To estimate the prevalence and type of sleep disturbance in AL settings, and examine its effects on cognitive and physical functioning.
Methods
Participants were consenting volunteers from a stratified random sample of people living in 22 AL settings in Maryland; part of the wider Maryland Assisted Living Study.
Comprehensive assessment of 198 residents was completed by physicians and researchers, comprising the Structured Clinical Interview for DSM-IV (for non-demented people), the Neuropsychiatric Inventory, the Psychogeriatric Dependency Rating Scale, and the Sleep Questionnaire.
Sleep problems were differentiated into:
-
Any Sleep Disturbance
-
Insomnia
-
Daytime Sleepiness
T-tests, chi-square, linear regression and one-way ANOVA were used to examine any relationship between sleep disturbance, psychological morbidity, activities of daily living and demographics.
Results
Approximately 80% of the sample were white females, 70% were widowed, only 6/198 were cohabiting with a spouse or partner. 69% had "any sleep disturbance", 42% had significant insomnia, and 35% daytime sleepiness. Interestingly, insomnia and daytime sleepiness were not closely correlated.
Use of hypnotics, sedating antidepressants and depression were associated with insomnia; depression and poor physical health with daytime sleepiness. Participants with daytime sleepiness in isolation performed worst on all measures of cognitive functioning and physical functioning.
Dr Seymour's comments
The prevalence of sleep disturbance in AL settings was similar to that reported in nursing homes. The main finding of this study was that insomnia and daytime sleepiness were not correlated as strongly as one would expect.
Although there are several possible explanations for this, it would seem likely that those with marked daytime sleepiness are a subgroup with poor physical health and cognitive decline. This replicates previous research linking daytime sleepiness to poor social function, cognitive impairment and even increased mortality.
It is an important finding that insomnia by itself does not necessarily predict these poor outcomes, unless accompanied by marked daytime sleepiness.
The authors suggest structured activities to overcome daytime sleepiness, though this needs to be accompanied by medical attention to improve depression and physical health where possible.
Insomnia in older people is a common condition that does not inspire enthusiasm when it presents to the medical profession. Enquiring into daytime sleepiness should now form part of the routine assessment.