Sleep Complaints in Community-Dwelling Older Persons
May 15, 1998 3 minutes read
Sleep Complaints in Community-Dwelling Older Persons
ABSTRACT & COMMENTARY
Synopsis: Sleep disturbances were found in a majority of Italian persons aged 65 and older, including night awakening and insomnia, in proportions larger than a similar American study. Strong associations for sleep complaints were found with female gender, regular use of sleep medications, and depressive symptomatology.
Source: Maggi S, et al. J Am Geriatr Soc 1998;46:161-168.
This study from northeast italy selected a random sample of 2398 non-institutionalized older persons in both rural and urban areas, using a series of questions from an earlier United States sleep study1 that allowed a cross-national comparison. The Italian elderly had more sleep complaints than Americans, with insomnia in 54% of Italian women and 36% of men. American insomnia complaints ranged from 25% to 36% in women and 19% to 26% in men. The authors suggest that cultural differences in coping style and psychological and behavioral factors may be responsible for the variation, supported also by a higher number of Italian elderly self-reporting disability in activities of daily living than the American group.
Like previous studies on sleep complaints in the elderly, there was no increase in problems seen with advancing age. Significant associations for insomnia were found with self-reported depressive symptomatology and other medical conditions (especially arthritis, COPD, varicose veins, and previous myocardial infarction). Persons with insomnia complaints were six times more likely to be using sleep medications regularly.
Close to 60% of both women and men in this study complained of night awakening, with physical factors most often identified as the cause, especially the need to use the toilet (58% of women, 73% of men). Difficulty falling asleep was attributed to psychological factors by half of both the women and men, such as thoughts and memories, inability to relax, and anxiety. Complaints of awakening without feeling rested occurred in 32% of women and 20% of men.
COMMENT BY MARY ELINA FERRIS, MD
The Italian authors of this study suggest that "differences in self-perceived health status and attitude toward complaining ". . . may account for the higher number of Italian elderly with sleep complaints compared to Americans. I'm glad I didn't say that! With a broad sweep, they've characterized their elderly rather stereotypically. Could it not also be possible that these elderly have limited opportunities to deal with stress and grieving associated with aging and illness? The authors also acknowledge that they were not able to link any severity of actual health condition with sleep disturbance, which may have demonstrated more organic causes of the sleep disturbances.
Before we dismiss these widespread sleep complaints as "too much whining," it's prudent to consider the known changes in sleep patterns that occur with aging. The ability to sleep seems reduced, with sleepiness occurring earlier in the evening. However, the need to sleep is not changed, so that an early bedtime means an early rising; if elderly stay up late, they will still wake up early and feel less rested. There is also less deep sleep and less REM sleep, so there are more awakenings at night.
The increased number of elderly women with sleep complaints compared to men was present in both the American and Italian studies; there is a minefield ahead in speculating on the cause of that difference. However, it is notable that women were twice as likely as men to have prescriptions for sedative-hypnotic medications, which might say something about how physicians deal with their complaints. The large number of psychological complaints associated with sleep disturbances for both women and men also indicates unmet needs.
No matter what the cross-national and gender differences were, both countries showed a large number of persons age 65 and over with complaints of disturbed sleep, including night awakening. We should be alert to the hazards of nighttime falls when prescribing therapies for the elderly and remember to include questions in our examinations about this highly prevalent problem.
Reference
1. Foley DJ, et al. Sleep complaints among elderly persons: An epidemiologic study of three communities. Sleep 1995;18:425-432.
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