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Elders and Insomnia
Last edited |
10/27/2008
The aging process is accompanied with various diseases which
deteriorate quality of life. Among others, changes in both subjective and
quantitative sleep patterns have been reported
Recent epidemiological surveys
revealed that between 23 to 33% of individuals over the age of 65 complain about
their sleep (1-6).
Compared to their younger counterparts, elderly:
Other studies
have shown that sleep duration tends to increase with age (11-14).
It has been
hypothesized that a disturbance in the circadian rhythm might be responsible for
the altered sleep patterns observed in some elderly (11, 13, 15-19).
According to this
hypothesis, the total sleep duration remains the same across the entire life
span but its distribution changes during the later years of life: less time is
given to night sleep, which is compensated for by napping in the daytime.
Still however, other
avenues remain to be explored.
The changes
responsible for this phenomenon could simply be caused by factors such as
retirement, decease of the spouse, social isolation, decrease in sensory impulse
due to decrease in audition, vision, smell, etc. (20-23).
Research
This study aimed to explore the relationship the consequences
of inactivity and the dissatisfaction with the social life on sleeping habits
and insomnia symptoms in the general population.
Our hypothesis was based upon the belief
that adjustments in changes occurring in life and not age largely contribute to
the sleep problems often observed amongst the elderly.
Methods The subjects came from three
countries: United Kingdom, Germany and Italy.
The total sample is composed of 13,057 subjects aged between 15 to 100 years.
Elderly subjects (65 years of age or older) represented 18.6% of the sample.
Results
Influence of age on Insomnia
Results of our study confirm
our initial
hypothesis.
Indeed, age alone, after controlling for possible effects of
activity and social satisfaction, is not a significant predictive factor for
insomnia symptom.
These findings indicate that the bidimensional
relationship between age and insomnia symptoms can be entirely explained by
other factors.
In
the last years, the linear relationship between aging process and the increase
in insomnia symptoms prevalence has been discussed.
For
example, in a three-year longitudinal study involving 6,800 elderly, Foley et al
(31) concluded that aging process per se was not responsible of incident
insomnia.
Other factors such as chronic disease, physical disability, depressed mood, poor
perceived health, widowhood and use of sedatives explained the incident
insomnia.
This
observation is in line with our finding: healthy elderly (i.e., without physical
or mental diseases) has a prevalence of insomnia symptoms similar to that
observed in the other age groups.
Influence of
inactivity and dissatisfaction
with the social life
Furthermore, our results suggest that being
active and with a satisfying social life appears to be a protective factor
against insomnia symptoms at any age.
Other studies also have shown the
importance of social engagement in the prevention of cognitive decline in the
elderly individuals. In a 12-year longitudinal study involving 2,812 noninstitutionalized persons 65 years of age or older, Bassuk et al (32)
observed that social disengagement was significantly associated with a higher
probability of cognitive decline at each follow-up period.
Conversely, the
increase of social engagement was associated with a reduction in the likelihood
of cognitive decline.
Daytime activity Daytime activity was also related to better sleep in
elderly by other researchers (12, 33).
For example, Habte-Gabr et al (12) found
in their elderly sample that social activities (club membership, having a close
friend being active in religion involvement) were related to a better sleep
quality.
Furthermore, regularity in life-style has been hypothesized to be an
adaptive mechanism in age-related changes in the circadian system's sensitivity
and therefore, helps to maintain a good health and well-being (34).
Diminished adaptation However, if
poor sleep can be the consequence of declining physical and mental health,
declining sleep quality can also be the antecedent to diminished adaptation in
the last years of life.
For example, Hoch
et al (35) found superior sleep quality in a group of very old nuns who had
remained engaged in their vocations and who restricted time in bed, as compared
with an age-match group of healthy elderly women who were retired, had no
religious affiliation and who spent 30-45 minutes longer in bed nightly.
Life adjustments Life
adjustments such as retirement, departure of children from family home, decease
of the spouse, etc., can have a great influence on the sleep-wake pattern
(20-23).
Such
major changes often bring a perturbation in the traditional temporal markers.
For
example, some retirees might neglect the need for keeping a fixed wake up or
bedtime schedule. Therefore, these elderly individuals have little or no life
constraints that condition their sleep-wake patterns.
These observations support our finding that continuing engagement in life,
coupled with curtailing time in bed, is associated with preservation of better
sleep quality.
Naps
Researchers have also hypothesized that
aging may have an influence on biological rhythms as manifested by reduced and
fragmented sleep with an apparition of naps to compensate the lack of night
sleep among the elderly.
Our results show that napping is very different from
insomnia symptoms and is not influenced by the activity status nor social life
satisfaction.
Physical diseases or chronic illnesses
Sleep can also be modified by other factors such as physical diseases or chronic
illnesses which are known to be significant contributors for poor sleep and
insomnia symptoms.
This relationship between sleep and health, however, could
also be bidirectional.
Dew et al (36) observed that inefficient sleep predicted future declines in
subjective sleep quality, fewer social activities at follow-up, and higher
depressive symptom levels and higher chronic medical burden at one year
follow-up.
In
our study, we found that physical illnesses and mental disorders are
important risk factors for insomnia symptoms and, to a lesser extent, for
napping:
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Mental disorders are more frequent among young individuals (less than 45 years
of age)
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Physical illnesses are more common in elderly: about one third of elderly
reported a physical illness compared with less than 10% in youngsters (15-24
years of age).
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About 20% of subjects before 55 had a mental disorder while this is less than
10% in the elderly.
Mental Disorders The
association between mental disorders and insomnia symptoms has been widely
demonstrated in younger populations but has lead to mixed results in geriatric
care.
However the role of psychological issues on sleep quality in elderly should not
be obscured to the favor of other factors such as physical health status.
Major life changes experienced with growing old (e.g. retirement or bereavement)
also have an impact on insomnia symptoms.
In conclusion, these results illustrate the
complexity of insomnia symptoms.
Age per se,
in healthy individuals, is not a contributing factor for insomnia in the
elderly.
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