Sleep Disturbances In Older Adults Research Articles

Effect of combined Tai Chi and repetitive transcranial magnetic stimulation for sleep disturbance in older adults: A randomized controlled trial

Effect of combined Tai Chi and repetitive transcranial magnetic stimulation for sleep disturbance in older adults: A randomized controlled trial

Integration of tai chi and repetitive transcranial magnetic stimulation for sleep disturbances in older adults: A pilot randomized controlled trial

BackgroundThe arousal state has been demonstrated to be involved in the fundamental pathophysiological mechanism of sleep disturbances. Tai chi (TC) and repetitive transcranial magnetic stimulation (rTMS) have been documented to alleviate sleep disturbances by interfering with different arousal components. It is reasonable to assume that combining TC and rTMS could induce synergistic and longer-lasting benefits for sleep disturbances. MethodsThirty-eight older community-dwelling people were randomly assigned to one of three groups: TC plus rTMS (n = 12), TC alone (n = 13), and treat-as-usual (TAU) (n = 13). The interventions were conducted three times per week for 4 weeks for the two intervention groups. The primary outcome was the insomnia severity, while the secondary outcomes were the actigraphy-assessed sleep patterns, use of hypnotic medications, mood states, and quality of life. The mediator outcomes included self-reported somatic arousal and cognitive arousal as well as electroencephalogram (EEG)-assessed cortical arousal. The assessments were conducted at baseline (T0), post-intervention (T1), and 3-month follow-up (T2). ResultsSignificant improvements in the insomnia severity were observed in the TC plus rTMS group compared with the TAU group at T1 (Cohen's d = 1.62, p = 0.003) and T2 (Cohen's d = 1.97, p < 0.001). In contrast, significant improvements in the TC alone group were found only at T2 (Cohen's d = 1.03, p = 0.010) when compared with the TAU group. Significant interaction effects were noted on the actigraphy-assessed sleep efficiency (p = 0.015) and total sleep time (p = 0.004), depression (p = 0.003) and stress scores (p = 0.002), and mental function in relation to quality of life (p = 0.042). However, none of the mediators elucidated how combining TC and rTMS could improve the insomnia severity. ConclusionThe research findings are expected to guide further clinical practice in the management of sleep disturbances among older adults using various interventions. Future studies are needed to unravel the underlying mechanism and optimize the protocol to maximize the therapeutic benefits.

The association between loneliness, social isolation, and sleep disturbances in older adults: A follow-up study from the Swedish good aging in Skåne project.

The aim of this follow-up study was to investigate whether loneliness and social isolation in a sample of older adults, mean age of 67.4 years at baseline examination, were associated with sleep disturbances at re-examination at a mean age of 76.4 years. The study sample consisted of 2897 participants. Data on loneliness, social isolation, and sleep disturbances were collected through questionnaires and medical examinations. Logistic regression models were constructed to identify associations between levels of loneliness and social isolation at baseline and sleep disturbances at follow-up. Sociodemographic and health-related confounding factors were controlled for in the models. Sleep disturbances were reported by 25.6% (95% CI: 24.0%-27.2%) at baseline and 23.7% (95% CI: 22.1%-25.3%) at re-examination. Odds ratios for sleep disturbances at re-examination in relation to not being lonely or socially isolated were as follows: single occasions of loneliness (OR: 1.37, 95% CI: 1.05-1.78), recurring periods/constant loneliness (OR: 1.92, 95% CI: 1.01-1.99), less severe social isolation (OR: 1.18, 95% CI: 0.78-1.79), and severe social isolation (OR: 1.88, 95% CI: 1.01-3.49). Sleep disturbances are common among older adults and are associated with loneliness and social isolation. Healthcare professionals should be aware of the potential effects of loneliness and social isolation when investigating sleep disturbances in older adults.

How do light therapy, physical activities, social activities, and multimodal interventions compare with usual care for sleep disturbances in older adults with dementia?

How do light therapy, physical activities, social activities, and multimodal interventions compare with usual care for sleep disturbances in older adults with dementia?

Tailored Music Listening in Persons With Dementia: A Feasibility Randomized Clinical Trial.

Introduction: This study examined the feasibility, acceptability, and preliminary efficacy of tailored music listening intervention on sleep disturbances in older adults with dementia and their caregivers. Methods: We randomly assigned 33 older adults with dementia (mean age 71.7 [SD: 7.1], 72.7% female, 81.8% African American/Black) and their caregivers (mean age 58.4 [SD: 16.7], 72.7% female, 84.8% African American/Black) to a wait-list control or intervention group (NCT04157244). Results: The music intervention was feasible as evidenced by high study measure completion and retention rates (>90%). Recruitment was stopped prematurely due to the COVID-19 pandemic. We found mixed acceptability results from the survey and qualitative interviews with the participants. Both groups improved on objective sleep outcomes of sleep latency and wake sleep after onset. We found a small effect size for sleep duration post-intervention. Discussion: The findings provide preliminary evidence for the feasibility of a tailored music intervention and identified ways to improve its acceptability.

Sleep, Sensory Processing, &amp; Emotional States Among Older Adults

Abstract Date Presented 04/22/2023 The high prevalence of sleep disturbances in older adults warrants further research exploring their negative impacts on occupational engagement. Sensory loss and sensory impairment are common occurrences during normal aging and may result in difficulties in engaging in occupations such as sleep (Correia et al., 2016). This study examined the relationship between emotional states, including depression, anxiety, and stress, and sleep in older adults. Primary Author and Speaker: Megan C. Chang Additional Authors and Speakers: Madeline Bennet, Bailey Coe, Angela Santana, Katherine Schultz, Erin Serrano

Brain-derived neurotrophic factor (BDNF) variants and promoter I methylation are associated with prolonged nocturnal awakenings in older adults.

Brain-derived neurotrophic factor (BDNF) is important for sleep physiology. This study investigates whether BDNF variants and promoter I methylation may be implicated in sleep disturbances in older adults. Genotyping was performed for seven BDNF single nucleotide polymorphisms (SNPs) in 355 community-dwelling older adults (aged ≥65 years) and BDNF exon 1 promoter methylation was measured in blood samples at baseline (n=153). Self-reported daytime sleepiness and insomnia, ambulatory polysomnography measures of sleep continuity and architecture, and psychotropic drug intake were assayed during follow-up. Logistic regression adjusted for age, sex, comorbidities, body mass index, and psychotropic drug intake. Associations were found specifically between wake time after sleep onset (WASO) and four SNPs in the participants not taking psychotropic drugs, whereas in those taking drugs, the associations were either not significant (rs6265 and rs7103411) or in the reverse direction (rs11030101 and rs28722151). Higher BDNF methylation levels were found at most CpG units in those with long WASO and this varied according to psychotropic drug use. The reference group with short WASO not taking drugs showed the lowest methylation levels and the group with long WASO taking treatment, the highest levels. Some SNPs also modified the associations, the participants carrying the low-risk genotype having the lower methylation levels. This genetic and epigenetic study demonstrated blood BDNF promoter methylation to be a potential biomarker of prolonged nocturnal awakenings in older people. Our results suggest the modifying effect of psychotropic drugs and BDNF genetic variants in the associations between methylation and WASO.

Sleep Disturbances in Older Adults Receiving Dialysis

Sleep Disturbances in Older Adults Receiving Dialysis

Older Adults with Dementia: Association of Prayer with Neuropsychiatric Symptoms, Cognitive Function, and Sleep Disturbances.

Protective factors that slow dementia progression and improve quality of life are needed. Neuropsychiatric symptoms (NPS), cognitive decline, and sleep disturbances are commonly found in dementia, indicate progression, and increase caregiver distress. The purpose of this study was to examine the association of private prayer with NPS, cognitive function, and sleep disturbances in older adults with dementia. We analyzed data from the Health and Retirement Study in 2000, 2006, and 2008 and Aging, Demographics, and Memory Sub study in 2001-2003, 2006-2007, and 2008-2009 among 40 older adults (age 70-100 years, mean age = 84.67, 29 females and 11 males, 73.9% non-Hispanic White, and 19.2% Non-Hispanic Black, and 3% Hispanic, cognitive function = 1.169 indicating mild cognitive impairment) using correlational analysis. The results indicated that increased frequency of private prayer was significantly associated with lower NPS, better cognitive function, and lower sleep disturbances. In total, 100% of Non-Hispanic Black and Hispanic participants reported praying at least once per week. Findings could be due to use of cognitive processes used in prayer during supplication, requesting aid, and through communication with the divine, reducing loneliness. Longitudinal studies including historically underrepresented populations are needed to examine these associations over time.

Sleep in Normal Aging.

Sleep is a key determinant of healthy and cognitive aging. Sleep patterns change with aging, independent of other factors, and include advanced sleep timing, shortened nocturnal sleep duration, increased frequency of daytime naps, increased number of nocturnal awakenings and time spent awake during the night, and decreased slow-wave sleep. The sleep-related hormone secretion changes with aging. Most changes seem to occur between young and middle adulthood; sleep parameters remain largely unchanged among healthy older adults. The circadian system and sleep homeostatic mechanisms become less robust with normal aging. The causes of sleep disturbances in older adults are multifactorial.

Factors associated with insomnia in older adult outpatients vary by gender: a cross-sectional study

BackgroundInsomnia is a common sleep disturbance in older adults and is associated with many poor health outcomes. This study aimed to explore factors associated with insomnia in older adult outpatient clinics, and to further analyze the influence of gender on factors associated with insomnia.MethodsThis cross-sectional study was conducted in the outpatient clinics of a tertiary hospital in Southern Taiwan from July to September 2018. A total of 400 consecutive subjects aged 60 years or older were recruited. Insomnia was defined as a score of ≥6 points on the Athens Insomnia Scale (AIS). Socio-demographics, health behaviors and clinical data were collected by face-to-face interview. Multivariable logistic regression was adopted for statistical analysis of the entire sample and stratified by gender.ResultsParticipants’ mean age was 74.74 ± 8.54 years, and the majority (93%) had more than one chronic disease. The prevalence of insomnia accounted for 30% (120/400) of all subjects, with males 22.9% (46/201) and females 37.2% (74/199). Gender, appetite, exercise, depressive symptoms, and sleep-related conditions such as short sleep duration, sleeping pills usage, medium-high risk of obstructive sleep apnea (OSA) and restless leg syndrome (RLS) were factors associated with insomnia in older adults. Exercise, sleeping pills usage, and RLS were independently associated with insomnia only in men, while appetite and medium-high risk of OSA were associated with insomnia in women only. In addition, after further adjusting for covariates, prevalence of the insomnia-related symptoms such as sleep induction, total sleep duration, sleep quality and sleepiness during the day was significantly higher in females than in males.ConclusionsInsomnia symptoms are highly prevalent among older adults, predominantly females. Significant differences are found between genders in factors associated with insomnia and insomnia-related symptoms. Understanding gender differences may help clinicians to modify associated factors when managing older adults with insomnia.

Development and validation of the sleep assessment instrument for older adults with pain.

The co-occurrence of chronic pain and sleep disturbance contribute to a significant functional and social impact in older adults. However, there are no validated instruments to measure sleep disturbance and pain in this population that could be used to screen or diagnose individuals or monitor treatment effectiveness. Our aim was to develop and validate a brief, practical, and comprehensive tool to assess the impact of co-occurring pain and sleep disturbance in older adults. Development and validation of a measurement tool for assessing pain and sleep in older adults consisting of seven items. We applied the "Sleep Assessment Instrument for Pain in older adults" (SAIOAP) in a sample of 100 older individuals. A Cronbach's alpha of 0.602 indicated a moderate level of reliability, and item-total correlations of ≥0.4 for all items indicated good homogeneity. There were statistically significant correlations between the SAIOAP and sleep quality (PSQI, r=61.5), pain intensity (VNS, r=30.5), the multidimensional impacts of pain (GPM, r=40.5), depression (GEAP, r=45.5), comorbidity (r=27.9), and medication use (r=30.4). A ROC curve indicated a sensitivity of 73.2% and a specificity of 79.1% in relation to the prediction of sleep disturbances associated with pain in older adults. The SAIOAP presented adequate metric properties and was demonstrated to be a simple and practical tool for the assessment of the impact of pain on sleep in older adults.

The impact of physical pain and depression on sleep quality in older adults with chronic disease.

This study's purpose was to identify the correlates of sleep quality in older adults with chronic disease. Sleep quality is a common problem in older adults that may be affected by physical and mental status. A cross-sectional correlational design was employed. The study was conducted between July 2019 and April 2020 in a teaching hospital of southern Taiwan. The Geriatric Depression Scale, Pittsburgh Sleep Quality Index and Numerical Rating Scale were used to assess depression, sleep quality and physical pain respectively. Of the 120 older adults (age >65years) with chronic disease, the average Pittsburgh Sleep Quality Index score was 5.67. A total of 45.8% subjects had sleep disturbance. Older adults who were living with a partner and those who urinated at night were significantly more likely to report sleep disturbance. The presence of sleep disturbance was associated with greater levels of depression and higher levels of physical pain. Living with a partner, nocturia, physical pain and depression were associated with the presence of sleep disturbance in older adults with chronic disease. The results of this study can help healthcare providers understand the factors associated with sleep disturbance in older adults with chronic disease, thereby facilitating the early resolution of sleep disturbance issues in this population.

Feasibility of 3-month melatonin supplementation for brain oxidative stress and sleep in mild cognitive impairment: protocol for a randomised, placebo-controlled study

IntroductionMelatonin has multiple proposed therapeutic benefits including antioxidant properties, synchronisation of the circadian system and lowering of blood pressure. In this protocol, we outline a randomised controlled trial to assess...

Sleep Disturbance in Older Adults With or Without Mild Cognitive Impairment and Its Associated Factors Residing in Rural Area, China.

To evaluate the prevalence of sleep disturbance in older adults with or without mild cognitive impairment (MCI) and associated factors among residents in rural central China. A cross-sectional survey was conducted in adults in rural areas of the Hunan province aged≥60 years. Study participants (N = 1213) included 479 individuals meeting the criteria for MCI and 734 with normal cognitive abilities. The participants completed the Athens Insomnia Scale, Stress Resilience Quotient Scale, Affect Balance Scale and Activities of Daily Living (ADL) Scale. Chi-square test, Wilcoxon rank sum analyses and multiple logistic regression were used in this study. A total of 60.33% of participants with MCI demonstrated sleep disturbance (60.33%, 95% CI: 0.559-0.649), which was significantly higher than in the non-MCI group (43.73%, 95% CI: 0.759-0.838). Multiple logistic regression conducted separately in the populations of older adults with or without MCI showed that age, drinking habits, affect balance and activities of daily life were correlates of self-reported sleep disturbance in rural older adults with MCI (B = -5.469), whereas age, ADL, living arrangement and resilience were the main influencing factors in older adults without MCI (B = 2.991). Sleep disturbance is more common in older adults with MCI than without MCI in rural areas of China. The factors influencing sleep disturbances vary between older adults with or without MCI, with age and ADL representing common factors influencing sleep disturbance in both groups. Interventions focusing on the age, drinking habits, affect balance and ADL may improve sleep quality in MCI older adults.

Positive Encounters as a Buffer: Pain and Sleep Disturbances in Older Adults' Everyday Lives.

Objectives: To test whether older adults' pain was bidirectionally associated with nighttime sleep disturbances and whether daily positive encounters attenuated these associations. Methods: Participants (N = 292, mean = 73.71years old) from the Daily Experiences and Well-being Study indicated pain and positive encounters with close partners (e.g., family and friends) and nonclose partners (e.g., acquaintances and service providers) every 3hours throughout each day across 4-6days. They also reported nighttime sleep disturbances the following morning. Results: Multilevel models revealed that participants with more prior nighttime sleep disturbances reported more severe pain the next day. This link was attenuated on days when participants had a greater proportion of positive encounters or viewed encounters as more pleasant, especially when these encounters occurred with close partners. Discussion: This study identifies benefits of positive encounters to older adults and sheds light on ways that may alleviate their pain from a social perspective.

Correlates of Sleep Disturbance among Older Adults with Mild Cognitive Impairment: A Cross-Sectional Study.

Individuals with mild cognitive impairment (MCI) are at high risk for dementia development. Sleep disturbance is often overlooked in MCI, although it is an important risk factor of cognitive decline. In the absence of a cure for dementia, managing the risk factors of cognitive decline in MCI is likely to delay disease progression. To develop interventions for sleep disturbance in MCI, its related factors should be explored. This study aimed to identify and compare the correlates of sleep disturbance in older adults with MCI and those in cognitively healthy older adults. A comparative cross-sectional study was adopted. Data were obtained from 219 Chinese community-dwelling older adults (female: 70.3%), which consisted of 127 older adults with MCI and 92 age-matched cognitively healthy controls. The candidate correlates of sleep disturbance included socio-demographic correlates, health-related factors, lifestyle-related factors and psychological factor. Descriptive, correlational and regression statistics were used for data analysis. The prevalence of sleep disturbance in MCI was 70.1% compared to that of 56.5% in cognitively healthy controls (p < 0.001). The multivariate analysis indicated that, in participants with MCI, depressive symptoms (Beta = 0.297, p = 0.001), comorbidity burden (Beta = 0.215, p = 0.012) and physical activity (Beta = −0.297, p = 0.001) were associated with sleep disturbance. However, in the cognitively healthy controls, only depressive symptoms (Beta = 0.264, p = 0.028) and comorbidity burden (Beta = 0.361, p = 0.002) were associated with sleep disturbance. This finding highlights that sleep disturbance is sufficiently prominent to warrant evaluation and management in older adults with MCI. Furthermore, the findings elucidate several important areas to target in interventions aimed at promoting sleep in individuals with MCI.

Sleep Disturbances Following Traumatic Brain Injury in Older Adults: A Comparison Study.

To compare the prevalence of sleep disturbances in older adults with traumatic brain injury (TBI) with that of age- and gender-matched controls and to determine the risk factors for post-TBI sleep disturbances and the effects of post-TBI disturbances on quality of life (QOL). Cross-sectional case-comparison study. Eighty older adults (aged ≥65 years) with first-time TBI more than 3 months since injury and 80 older adults controls without TBI who completed sleep and health-related QOL questionnaires. Older adults with TBI showed a higher prevalence of obstructive sleep apnea (OSA), insomnia, and daytime sleepiness than older adult controls. Being male, having higher levels of depression and pain, and the presence of insomnia were significantly correlated with the risks of OSA, insomnia, and daytime sleepiness following TBI, respectively. Both OSA and insomnia were significantly correlated with low QOL in older adults with TBI. Sleep disturbances are highly prevalent in older adults with TBI. Gender differences, depression severity, and pain level are correlated with the occurrence of post-TBI sleep disturbances. Both OSA and insomnia are regarded as major contributors to low QOL in older people with TBI. Interventions targeted at post-TBI sleep disturbances may improve QOL of older adults.

Home-based self-administered transcranial direct current stimulation in older adults with knee osteoarthritis pain: An open-label study

Clinic-based transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has been shown to improve pain. However, no published studies have reported using home-based self-administered tDCS in older adults with knee osteoarthritis (OA). The present study aimed to evaluate the preliminary efficacy and feasibility of home-based self-administered tDCS with real-time remote supervision on clinical pain, anxiety, depression, and sleep disturbances in older adults with knee OA. Twenty 50- to 85-year-old community-dwelling participants with knee OA received 10 daily home-based sessions of 2 mA tDCS for 20 min with real-time remote supervision. We measured clinical pain severity via the Visual Analog Scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Short-Form McGill Pain Questionnaire. We assessed anxiety, depression, and sleep disturbances using the Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety-short form, depression-short form, and sleep disturbance-short form, respectively. All 20 participants completed all 10 home-based tDCS sessions without serious adverse effects. Both clinical pain severity and sleep disturbances were improved after completion of the 10 tDCS sessions. Anxiety and depression scores were not significantly improved. We demonstrated that home-based self-administered tDCS with real-time remote supervision was feasible and beneficial in alleviating clinical pain in older adults with knee OA. These findings support future studies with larger samples and longer-term follow-up evaluations.

Treatment of sleep disturbance in older adults

AbstractSleep and circadian rhythm disturbances are prevalent in older populations. Numerous factors can affect sleep, including medications, living environment and physical, mental and psychosocial factors (e.g. loneliness and stress). Sleep architecture changes with aging, with less deep sleep (slow wave sleep) and an increased frequency of awakenings after sleep onset. Benzodiazepines, Z‐drugs and low doses of the tricyclic antidepressant doxepin have modest positive benefits for sleep complaints, but side effects are a concern in older people because they include an increased risk of falls, fractures and cognitive impairment. Somnolence can be prolonged in older adults. Melatonin has very modest effects on sleep initiation in older adults, although appears safe. Overall, the effects of pharmacological treatments are modest and there are concerns about the efficacy and safety of their ongoing use. There is strong evidence for non‐pharmacological interventions, including cognitive and behavioural strategies, to improve sleep. These have at least comparable efficacy to pharmacological interventions, fewer adverse effects and are more likely to have longer‐term, sustained benefits. Sleep complaints in older adults need to be approached on a patient‐by‐patient basis, and medication should be reviewed frequently, with preference to limit pharmacological intervention as far as practicable.