Abstract
Background: Insomnia is a sleep disorder frequently observed in older persons. Along with the changes in sleep structure accompanying the ageing process, ageing is also associated with cognitive impairment. In view of the findings showing that sleep during the night is critical in the consolidation of previously acquired memory traces, we hypothesized that intensive new learning experience provided by systematic cognitive training will act as a catalyst to change sleep architecture and by doing so will improve sleep quality among older adults with insomnia. Furthermore, we posited that if that learning specifically targets cognitive function, older people with insomnia will also exhibit improved cognitive performance. Thus, the present study examined the impact of cognitive training on sleep quality and cognitive performance among older adults with insomnia. Fifty-one older adults with insomnia (22M/29F; mean age: 72.13 ± 5.1) were randomized into two groups: a cognitive training group ( n = 34) and an active control group ( n = 17). The participants in the cognitive training group completed an eight-week, home- based, personalized, computerized cognitive training program, while the participants in the active control group completed an eight-week, home-based program involving computerized tasks that do not engage high-level cognitive functioning. Before and after training, all participants’ sleep was monitored for one week by an actigraph and their cognitive performance was evaluated. Mixed models for repeated measures analysis showed between-group improvements for the cognitive training group on both sleep quality (sleep onset latency and sleep efficiency: F1,51 = 5.49, P < 0.05 ; F1,51 = 6.86, P < 0.05 , respectively) and cognitive performance (avoiding distractions, working memory, visual memory, general memory and naming: F1,36 = 5.18, P < 0.05 ; F1,35 = 13.92, P < 0.001; F1,35 = 14.03, P < 0.001 , F1,35 = 15.65, P < 0.001; F1,35 = 9.65, P < 0.01 respectively). Moreover, hierarchical linear regressions analysis indicated correlation between the improvement in cognitive function and those in sleep quality. Cognitive training may be beneficial in the initiation and maintenance of sleep among older adult insomniacs. Cognitive training may be used as a novel non-pharmacological alternative to improve the sleep quality of older adults suffering from insomnia. The present study constitutes pioneering work in this field among older adults with insomnia. The authors thank Paula S. Herer for assisting in the statistical analysis.
Highlights
Insomnia in Older Adults Insomnia is a sleep disorder frequently observed in older persons
Hierarchical linear regressions analysis in the cognitive training group indicated that improved visual scanning is associated with earlier advent of sleep, while improved naming is associated with the reduction in wake after sleep onset and with the reduction in number of awakenings
The results indicate that in the active control group cognitive decline observed in working memory is associated with an increase in the time required to fall asleep
Summary
Adherence and Personal Information 144 applicants, older adults living independently in the community and with a complaint of insomnia, were recruited from several senior citizens local day centres. The between-groups comparisons (columns 13) revealed that, when compared to the active control group, after controlling for age, the cognitive training group showed significant improvements on five cognitive measures: avoiding distractions, naming; general memory, visual memory and working memory. To answer this question we correlated the five sleep mean-differences (post-intervention mean minus baseline mean) with the 16 cognitive meandifferences twice, once for each group These correlations, presented, show that for subjects in the cognitive training group the mean differences in sleep efficiency, wake after sleep onset and number of awakenings were significantly correlated with naming ability. Results, presented, show that in the cognitive training group the improvement in visual scanning is associated with the reduction in sleep onset latency; the improvement in naming is associated with the reduction in wake after sleep onset and with the reduction in number of awakenings, while the improvement in avoiding distracters is related to an increase in total sleep time. In figures 2, 3, 4, 5, 6 we present the regression lines plotted for these results
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