Sleep In Older Adults Research Articles

Sleep Pattern Differences Between Older Adult Dementia Caregivers and Older Adult Noncaregivers Using Objective and Subjective Measures

Informal caregivers of persons with dementia often complain about poor quality sleep; however, studies on caregivers have mixed results when examining sleep values. The purpose of this study was to describe the sleep patterns in a subset of dementia caregivers who provide care during the night, and compare those patterns to noncaregiving adults. Data from a study on dementia caregivers and from a study of sleep in older adults were used. Both studies used objective and subjective methods to measure sleep in the home setting over a 7-day period. Participants were over 60 years old and relatively healthy. Older dementia caregivers had worse objectively measured sleep than noncaregiving older adults, characterized by fewer minutes asleep and longer time to fall asleep. For subjectively measured sleep, depressive symptoms were the only predictive factor, with depressed participants reporting longer total sleep time, greater sleep onset latency, and wake after sleep onset. Caregivers' sleep had greater night-to-night variability. Caregivers consistently report poorer quality sleep and greater fatigue than noncaregivers. However, when sleep is measured objectively and subjectively, a mixed picture emerges regarding sleep deficits. Thus sleep changes are caused by a multitude of factors affecting sleep in a variety of ways. It is important for health care providers to assess sleep adequacy and depression in caregivers.

Chémoréflexes laryngés et contrôle cardio-respiratoire en période néonatale

Caffeine is the most widely consumed psychoactive substance in the world. It is readily available in coffee and other foods and beverages, and is used to mitigate sleepiness, enhance performance, and treat apnea in premature infants. This review systematically explores evidence from epidemiological studies and randomized controlled trials as to whether coffee and caffeine have deleterious effects on sleep. Caffeine typically prolonged sleep latency, reduced total sleep time and sleep efficiency, and worsened perceived sleep quality. Slow-wave sleep and electroencephalographic (EEG) slow-wave activity were typically reduced, whereas stage-1, wakefulness, and arousals were increased. Dose- and timing-response relationships were established. The sleep of older adults may be more sensitive to caffeine compared to younger adults. Pronounced individual differences are also present in young people, and genetic studies isolated functional polymorphisms of genes implicated in adenosine neurotransmission and metabolism contributing to individual sensitivity to sleep disruption by caffeine. Most studies were conducted in male adults of Western countries, which limits the generalizability of the findings. Given the importance of good sleep for general health and functioning, longitudinal investigations aimed at establishing possible causal relationships among coffee- and caffeine-induced changes in sleep quality and health development are warranted.

Evaluating Sleep Quality in Older Adults

Inadequate sleep-sleep of poor quality or insufficient duration or both-has been linked to health problems ranging from cognitive impairment to compromised immunity. Insomnia occurs more frequently after age 70, and more than half of adults ages 65 and older report at least one chronic sleep complaint. The Pittsburgh Sleep Quality Index is easily used to assess the quality and patterns of sleep in older adults. It consists of 18 questions covering seven areas in which sleep problems occur and can be completed in about 10 minutes. For a free online video demonstrating the use of this index, go to http://links.lww.com/A261.

Using Rasch Analysis to Validate the Revised PSQI to Assess Sleep Disorders in Taiwan’s Hi-tech Workers

The Pittsburgh Sleep Quality Index (PSQI) is an effective instrument for measuring the quality of sleep in older adults. In this study, we used Rasch analysis to validate the items of the revised PSQI (SC_PSQI) that contribute to a single construct. A total of 3,742 workers agreed to participate in this study. Both the appropriateness of the scoring rubrics and the unidimensionality of the SC_PSQI scale were investigated. All nine items fit the model's expectations rather well. These results indicate that the SC_PSQI with a 0 to 2 scoring scale can be used as a unidimensionality to assess sleep quality.

Tips Can Help Treat Insomnia in the Elderly

Heidi Splete is a senior writer with Elsevier Global Medical News. MINNEAPOLIS — Metabolic changes and comorbid conditions are just a few of the factors that challenge clinicians when they treat insomnia in older adults. “The predictability of your giving drug X to patient A and knowing what is going to happen goes way down; that's the bottom line,” said Dr. Daniel Buysse, a professor of psychiatry and the director of the Clinical Neuroscience Research Center at the University of Pittsburgh. The physiologic changes that occur with aging affect how the body absorbs medication, he said at the annual meeting of the Associated Professional Sleep Societies. “As we get older, our lean body mass decreases and our adipose tissue increases,” he noted. Because the drugs used to treat insomnia are lipid soluble, older adults who have a greater proportion of adipose tissue will store the drug longer before processing it through the body, Dr. Buysse explained. Consequently, older patients may have more residual sleepiness the next day after taking a sleep medication the previous night, and dosages may need adjustment. Hypnotics have shown effectiveness in treating insomnia in adults, but be aware that the measured blood concentrations of drugs are much more variable in an older population, Dr. Buysse said. In addition, some studies have shown that hypnotics are associated with cognitive and psychomotor problems in older patients. Antidepressants such as trazodone may be helpful for some patients; but be aware of the risks of dizziness, which could lead to falls, and the risk of oversedation because of older adults' slower metabolisms. Choosing insomnia medications for older adults is tricky, said Dr. Alon Avidan, a neurologist at the University of California, Los Angeles. Drugs have their risks, but untreated insomnia can be just as risky, because it is linked to an increased risk of falls. Elderly people who wake up at night are likely to get out of bed, which means that they are at greater risk for falls. In fact, hypnotics may be protective in preventing falls in older adults with insomnia, Dr. Avidan said, based on data from his study of over 34,000 nursing home residents with an average age of 84 years (J. Am. Geriatr. Soc. 2005;53:955–62). The patients with untreated insomnia were 30% more likely to fall, compared with those who were treated with hypnotics. But treating insomnia had no measurable effect on the patients' risk for hip fractures, Dr. Avidan noted. Dr. Buysse shared his top clinical considerations when choosing drug therapies for elderly patients with insomnia. First, keep expectations realistic, he advised. “The fact that older adults have comorbidities may limit how well we can do with our treatments,” he noted. Comorbid conditions may affect how older adults feel, regardless of whether they have slept well. Second, remind patients that insomnia medication is not a general anesthesia. “Some older adults look at sleep as a behavioral alternative when they run out of things to do,” Dr. Buysse said. “Some patients take a pill at 8 p.m. and they think they will be out for the night.” Remember no evidence-based treatment guidelines exist to direct treatment of insomnia in older adults. Findings from a meta-analysis suggest that many of the drugs available for treating insomnia—including the nonbenzodiazepine hypnotics zolpidem and zaleplon, some benzodiazepines, and the antidepressant drug trazodone—have not shown consistent effectiveness in improving sleep in older adults (Ann. Clin. Psychiatry 2006;18:49–56). Dr. Buysse recommended starting with a benzodiazepine receptor agonist, then switching to a sedating antidepressant if the benzodiazepine doesn't help. “When people still don't improve, you could start moving to other methods such as behavioral therapy.”

Auricular Acupuncture for Insomnia: Duration and Effects in Korean Older Adults

This study examined the duration and effects of auricular acupuncture on insomnia in a sample of 28 Korean older adults. The design was a group, pretest-posttest, repeated-measures study. Measures were the Sleep State Tool and the Sleep Satisfaction Tool. The effects of auricular acupuncture on insomnia among Korean older adults were significant. The duration effects of auricular acupuncture were maintained for 2 weeks. Clinicians should consider providing auricular acupuncture as an alternative method for improving quality of sleep in older adults.

SLEEP DISRUPTION IN OLDER ADULTS

Insomnia is not a normal part of aging, but nighttime sleep in older adults is often disrupted, leading to excessive daytime sleepiness and other physical, psychological, and cognitive changes that affect overall health. Even so, clinicians often pay little attention to sleep in this population. The sleep of older adults tends to be less deep than that of younger people, and coexisting conditions and treatment effects can more easily disrupt sleep. This article reviews the current literature on sleep disruption in older adults and suggests ways that nurses can apply the information in intervening to improve sleep in their older patients.

Respiratory Periodicity and Electroencephalogram Arousals During Sleep in Older Adults

The aim of this exploratory study was to examine the relationship of electroencephalogram (EEG) arousals to breathing patterns and the relationship of both arousals and breathing patterns to arterial oxygenation during sleep in older adults. Five older adults were monitored using standard polysomnography. Records were divided into 5-min segments and breathing patterns identified based on the level of respiratory periodicity and the variability in the frequency of breathing cycles. Standard criteria were used to determine sleep states and occurrence of EEG arousals. High respiratory periodicity was seen in 23% of the segments, whereas 24% had low respiratory periodicity with minimal variability in the frequency of breathing (Type A low respiratory periodicity) and 53% had low respiratory periodicity with high variability in the frequency of breathing (Type B low respiratory periodicity). Nearly all (97%) segments with high respiratory periodicity had EEG arousals, whereas fewer segments (33%) with low respiratory periodicity had arousals, regardless of the stage of sleep. Desaturations occurred more often in segments with high respiratory periodicity, F((2,4)) = 57.3, p < .001, but overall, the mean SaO(2) of segments with high respiratory periodicity did not differ from levels seen in segments with low respiratory periodicity, F((2,4)) = 0.77, ns. Our findings suggest that high respiratory periodicity is a common feature of EEG arousals and, in older adults, may be important for maintaining oxygen levels during desaturations during sleep.

Manipulating REM sleep in older adults by selective REM sleep deprivation and physiological as well as pharmacological REM sleep augmentation methods

Experimental approaches to manipulate REM sleep within the cognitive neuroscience of sleep are usually based on sleep deprivation paradigms and focus on younger adults. In the present study, a traditional selective REM sleep deprivation paradigm as well as two alternative manipulation paradigms targeting REM sleep augmentation were investigated in healthy older adults. The study sample consisted of 107 participants, male and female, between the ages of 60 and 82 years, who had been randomly assigned to five experimental groups. During the study night, a first group was deprived of REM sleep by selective REM sleep awakenings, while a second group was woken during stage 2 NREM sleep in matched frequency. Physiological REM sleep augmentation was realized by REM sleep rebound after selective REM sleep deprivation, pharmacological REM sleep augmentation by administering an acetylcholinesterase inhibitor in a double-blind, placebo-controlled design. Deprivation and augmentation paradigms manipulated REM sleep significantly, the former affecting more global measures such as REM sleep minutes and percentage, the latter more organizational aspects such as stage shifts to REM sleep, REM latency, REM density (only pharmacological augmentation) and phasic REM sleep duration. According to our findings, selective REM sleep deprivation seems to be an efficient method of REM sleep manipulation in healthy older adults. While physiological rebound-based and pharmacological cholinergic REM sleep augmentation methods both failed to affect global measures of REM sleep, their efficiency in manipulating organizational aspects of REM sleep extends the traditional scope of REM sleep manipulation methods within the cognitive neuroscience of sleep.

Dose-Response Effects of Tiagabine on the Sleep of Older Adults

To evaluate the dose- response effects of tiagabine on sleep and safety measures in healthy older adults. Randomized, double-blind, Latin-square design. Sleep laboratory. Twenty-four healthy older adults (11 men, 13 women; mean age 68.0 +/- 6.2 years) Tiagabine 2, 4, or 8 mg, or placebo, each given on two consecutive nights. Polysomnography revealed that compared with placebo, tiagabine 4 mg increased total sleep time, reduced wake after sleep onset, and increased minutes of slow-wave sleep. Tiagabine 8 mg decreased wake after sleep onset, increased slow-wave sleep, and improved a sleep-continuity index. No differences were seen between the 2-mg dose and placebo. Subjective ratings indicated fewer awakenings with the 8-mg dose. Central nervous system adverse events were somewhat higher in the 8-mg condition only. Measures of morning performance were minimally affected. Research with tiagabine at dosages of 8 mg or less appears warranted in elderly clinical populations.

Circadian and Homeostatic Modulation of Sleep in Older Adults During a 90-Minute Day Study

To identify age-associated changes in circadian and homeostatic characteristics of sleep in healthy elderly and young adults using electroencephalogram (EEG) power spectral analysis during a 90-minute sleep-wake schedule. Controlled clinical experiment. University sleep laboratory. 16 older (77 +/- 5 years) and 19 younger adults (23 +/- 3 years). Subjects followed a 90-minute sleep-wake schedule (30 minutes in bed, 60 minutes awake) for 60 hours. Sleep was recorded for each bed-rest episode, and core body temperature was continuously recorded. The EEG power density was determined for non-rapid eye movement sleep in each bed-rest episode. Power density data were analyzed with mixed-effects models to assess rhythmic and linear components. Younger subjects had greater power in delta, theta, and sigma power bands across the study interval. Significant circadian rhythms were observed in delta, sigma, and beta power bands. Age-related differences in circadian modulation of EEG activity, indicated by significant interaction terms, were present in alpha and beta bands. A significant linear component was present in delta and theta power bands, with no significant age-interaction effect. Despite overall differences in the level of EEG power, older and younger adults exhibited similar rhythmic and linear patterns in most frequency bands. Age appears to affect circadian rhythmicity in higher EEG frequencies and homeostatic drive in lower EEG frequencies.

Effectiveness of strategies to manage sleep in residents of aged care facilities

Executive summaryBackground The promotion of sleep in older adults is a significant issue in high‐level residential aged care facilities, with as many as 67% of residents experiencing disruptions to their sleep patterns. Not only do health concerns such as cognitive impairment, pain and incontinence impact upon this population's sleep quality and quantity, but environmental factors including noise, light and night‐time nursing care also affect sleep of those residing in institutions. In order to address the issue of sleep disruption, assessment and diagnosis of sleep problems and implementation of interventions that are effective in promoting sleep are essential.Objectives The objective of this review was to determine the most effective tools for the assessment and diagnosis of sleep in older adults in high‐level aged care. The review also sought to determine the most effective strategies for the promotion of sleep in this population. Outcome measures for this review were: indicators of improved sleep quality and quantity, including an improvement in daytime functioning and improved night‐time sleep; reduction in use of hypnotics and sedatives; and increased satisfaction with sleep.Search strategy A literature search was performed using the following databases for the years 1993–2003: AgeLine, APAIS Health, CINAHL, Cochrane Library, Current Contents, Dissertation Abstracts International, Embase, Medline, Proquest, PsycInfo, Science Citations Index. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language.Selection criteria The review was limited to papers addressing sleep diagnosis, assessment and/or management in adults aged 65 or over who were residing in high‐level aged care. The review included randomised controlled trials (RCTs) and, due to the limited number of RCTs available, non‐RCTs, cohort and case control studies and qualitative research were also considered for inclusion. Research was included if it addressed the assessment, diagnosis or management of sleep using outcome measure of improved night‐time sleep or daytime function, improvements in resident satisfaction with sleep or reduction in medication use associated with sleep. The types of interventions considered by this review were alternative therapies including massage, aromatherapy and medicinal herbs; behavioural or cognitive interventions; biochemical interventions; environmental interventions; pharmacological interventions and related nocturnal interventions such as continence care. Instruments and strategies to diagnose and assess the sleep of older high‐level care residents, including objective and subjective assessment tools, were considered by this review.Data collection and analysis All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Papers were grouped according to the type of intervention or type of assessment tool used and findings were presented in a narrative summary.Findings Wrist actigraphy was found to be the most accurate objective sleep assessment tool for use in the population of interest, and issues surrounding its use are presented. Although no subjective sleep assessment tools were identified in this review, the evidence suggested that subjective reports of sleep quality are an important consideration in sleep assessment. Evidence suggested that behavioural observations may be an effective assessment strategy when conducted on a frequent basis. The review found no evidence on the effectiveness of any assessment tools for the diagnosis of specific sleep problems in older adults. The use of multidisciplinary strategies including reduction of environmental noise, reduction of night‐time nursing care that disrupts sleep and daytime activity is likely to be the most effective strategy for the promotion of sleep in older high‐level care residents. The use of sedating medications did not appear to have a substantial effect in promoting sleep, and health practitioners in high‐level aged care should consider their use cautiously.

Effectiveness of strategies to manage sleep in residents of aged care facilities.

The promotion of sleep in older adults is a significant issue in high-level residential aged care facilities, with as many as 67% of residents experiencing disruptions to their sleep patterns. Not only do health concerns such as cognitive impairment, pain and incontinence impact upon this population's sleep quality and quantity, but environmental factors including noise, light and night-time nursing care also affect sleep of those residing in institutions. In order to address the issue of sleep disruption, assessment and diagnosis of sleep problems and implementation of interventions that are effective in promoting sleep are essential. The objective of this review was to determine the most effective tools for the assessment and diagnosis of sleep in older adults in high-level aged care. The review also sought to determine the most effective strategies for the promotion of sleep in this population. Outcome measures for this review were: indicators of improved sleep quality and quantity, including an improvement in daytime functioning and improved night-time sleep; reduction in use of hypnotics and sedatives; and increased satisfaction with sleep. A literature search was performed using the following databases for the years 1993-2003: AgeLine, APAIS Health, CINAHL, Cochrane Library, Current Contents, Dissertation Abstracts International, Embase, Medline, Proquest, PsycInfo, Science Citations Index. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language. The review was limited to papers addressing sleep diagnosis, assessment and/or management in adults aged 65 or over who were residing in high-level aged care. The review included randomised controlled trials (RCTs) and, due to the limited number of RCTs available, non-RCTs, cohort and case control studies and qualitative research were also considered for inclusion. Research was included if it addressed the assessment, diagnosis or management of sleep using outcome measure of improved night-time sleep or daytime function, improvements in resident satisfaction with sleep or reduction in medication use associated with sleep. The types of interventions considered by this review were alternative therapies including massage, aromatherapy and medicinal herbs; behavioural or cognitive interventions; biochemical interventions; environmental interventions; pharmacological interventions and related nocturnal interventions such as continence care. Instruments and strategies to diagnose and assess the sleep of older high-level care residents, including objective and subjective assessment tools, were considered by this review. All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Papers were grouped according to the type of intervention or type of assessment tool used and findings were presented in a narrative summary. Wrist actigraphy was found to be the most accurate objective sleep assessment tool for use in the population of interest, and issues surrounding its use are presented. Although no subjective sleep assessment tools were identified in this review, the evidence suggested that subjective reports of sleep quality are an important consideration in sleep assessment. Evidence suggested that behavioural observations may be an effective assessment strategy when conducted on a frequent basis. The review found no evidence on the effectiveness of any assessment tools for the diagnosis of specific sleep problems in older adults. The use of multidisciplinary strategies including reduction of environmental noise, reduction of night-time nursing care that disrupts sleep and daytime activity is likely to be the most effective strategy for the promotion of sleep in older high-level care residents. The use of sedating medications did not appear to have a substantial effect in promoting sleep, and health practitioners in high-level aged care should consider their use cautiously.

Long-term follow-up of periodic limb movements in sleep in older adults.

The goal of this study was to examine the natural history of periodic limb movements in sleep (PLMS) in older adults. Prospective, longitudinal design. San Diego area. Community-dwelling older adults. NA MEASUREMENTS AND RESULTS: Subjects participated in follow-up visits every few years. Sleep disorders were assessed at each visit using sleep questionnaires and overnight sleep recordings. Changes in PLMS over time were examined as well as variables that were associated with change. Average PLMS did not change over time, although there was considerable variability within the sample. In women, changes in PLMS were associated with changes in sleep-disordered breathing. This relationship was not found in men. Although the prevalence of PLMS is high for older adults, the severity of the disorder does not progressively worsen with increasing age.

Sleep hygiene or compensatory sleep practices: An examination of behaviours affecting sleep in older adults

The purpose of this research was to examine differences in levels of compensatory (sleep hygiene) sleep practices between older insomniacs and older 'normal sleepers'. Two assumptions were tested. First, that compensatory sleep practices differentiate insomniacs from normal sleepers and second, that these practices relate to the long-term maintenance of chronic insomnia. The participants were 414 older adults who responded to an advertisement in a periodical targeted at older people. They were given a questionnaire to determine their insomnia status, use of compensatory practices and levels of daytime sleepiness. A series of chi-square analyses, t -tests and regression analyses showed both assumptions to be predominantly false. There were however relationships between pre-sleep cognitive activity, irregular sleep patterns, use of medication, and a noisy bedroom environment with insomnia classification. In addition, caffeine use after 2pm was associated with a longer duration of insomnia. The results are discussed in relation to sleep medicine education, interventions for older people in primary care settings, and recent models of insomnia.

Evaluation of variables to characterize respiratory periodicity during sleep in older adults.

Reliable markers of early neurological decline might guide interventions to prevent or reverse cognitive decline in older adults. Because cognitive decline is associated with hypoxemia during sleep, the authors examined 3 respiratory periodicity variables in 5 older adults. Subjects were monitored overnight using standard polysomnography. From the inductance band signal, the authors calculated the variability in duration of breathing cycles measured by standard deviation of interbreath intervals (sdIBI), frequency of breathing cycles measured by standard deviation of interbreath frequencies (sdIBF), and amplitude of breathing cycles measured by standard deviation of breathing cycle amplitudes (sdAMP). Logistic regression analysis and kappa coefficients identified variables that reliably detected 5-minute segments having central or obstructive apneas or body movements. An sdIBF > or = 4.5 cpm identified body movements (sensitivity = 0.96, specificity = 0.96, kappa = 0.90). An sdIBI > 1.2 seconds identified central apneas (sensitivity = 0.86, specificity = 0.99, kappa = 0.86), and an sdIBI > or = 1.68 seconds identified segments with 3 central apneas (sensitivity = 0.90, specificity = 0.89, kappa = 0.89). An sdAMP > or = 0.1 V and an sdIBF > or = 1.5 cpm identified obstructive apneas (kappa = 0.91). Data support the potential of these variables to identify central and obstructive apneas and to classify individuals according to different patterns of respiratory periodicity.

How is good and poor sleep in older adults and college students related to daytime sleepiness, fatigue, and ability to concentrate?

We compared good sleepers with minimally and highly distressed poor sleepers on three measures of daytime functioning: self-reported fatigue, sleepiness, and cognitive inefficiency. In two samples (194 older adults, 136 college students), we tested the hypotheses that (1) poor sleepers experience more problems with daytime functioning than good sleepers, (2) highly distressed poor sleepers report greater impairment in functioning during the day than either good sleepers or minimally distressed poor sleepers, (3) daytime symptoms are more closely related to psychological adjustment and to psychologically laden sleep variables than to quantitative sleep parameters, and (4) daytime symptoms are more closely related to longer nocturnal wake times than to shorter sleep times. Results in both samples indicated that poor sleepers reported more daytime difficulties than good sleepers. While low- and high-distress poor sleepers did not differ on sleep parameters, highly distressed poor sleepers reported consistently more difficulty in functioning during the day and experienced greater tension and depression than minimally distressed poor sleepers. Severity of all three daytime problems was generally significantly and positively related to poor psychological adjustment, psychologically laden sleep variables, and, with the exception of sleepiness, to quantitative sleep parameters. Results are used to discuss discrepancies between experiential and quantitative measures of daytime functioning.

Daily Social and Physical Activity Increases Slow-Wave Sleep and Daytime Neuropsychological Performance in the Elderly

Decreased levels of physical and social activity associated with aging can be particularly pronounced in residents of assisted living facilities. Reduced exposure to important behavioral and time-giving cues may contribute to the age-related changes in circadian rhythmicity and sleep. The present study was conducted to test the hypothesis that an enforced schedule of structured social and physical activity (0:900 to 10:30 and 19:00 to 20:30 daily for two weeks) can have beneficial effects on circadian rhythmicity, nocturnal sleep, daytime functioning, mood, and vigor. The subjects were 14 elderly residents of continued-care retirement facilities while a similar group of 9 elderly residents served as controls. The group exposed to structured activities had increased amounts of slow-wave sleep and demonstrated improvement in memory-oriented tasks following the intervention. Conversely, no significant changes were noted in the amplitude and phase of the body temperature rhythm or in subjective measures of vigor and mood. These results indicate that short-term exposure to structured social intervention and light physical activity can significantly improve memory performance and enhance slow-wave sleep in older adults without alterations to the circadian phase or amplitude of body temperature. This is the first report to demonstrate that low intensity activity in an elderly population can increase deep sleep and improve memory functioning. The high degree of interest in these activities paired with the simple nature of the tasks makes this a potentially practical intervention which can be adapted for both community dwelling and assisted-living elders.

Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial

Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial

Moderate-Intensity Exercise and Self-rated Quality of Sleep in Older Adults

To determine the effects of moderate-intensity exercise training on self-rated (subjective) sleep quality among healthy, sedentary older adults reporting moderate sleep complaints. Randomized controlled trial of 16 weeks' duration. General community. Volunteer sample of 29 women and 14 men (of 67 eligible subjects) aged 50 to 76 years who were sedentary, free of cardiovascular disease, and reported moderate sleep complaints. No participant was withdrawn for adverse effects. Randomized to 16 weeks of community-based, moderate-intensity exercise training or to a wait-listed control condition. Exercise consisted primarily of four 30- to 40-minute endurance training sessions (low-impact aerobics; brisk walking) prescribed per week at 60% to 75% of heart rate reserve based on peak treadmill exercise heart rate. Pittsburgh Sleep Quality Index (PSQI). Compared with controls (C), subjects in the exercise training condition (E) showed significant improvement in the PSQI global sleep score at 16 weeks (baseline and posttest values in mean [SD] for C=8.93 [3.1] and 8.8 [2.6]; baseline and posttest values for E=8.7 [3.0] and 5.4 [2.8]; mean posttest difference between conditions=3.4; P<.001; 95% confidence interval, 1.9-5.4), as well as in the sleep parameters of rated sleep quality, sleep-onset latency (baseline and posttest values for C=26.1 [20.0] and 23.8 [15.3]; for E=28.4 [20.2] and 14.6 [13.0]; net improvement=11.5 minutes), and sleep duration baseline and posttest scores for C=5.8 [1.1] and 6.0 [1.0]; for E=6.0 [1.1] and 6.8 [1.2]; net improvement=42 minutes) assessed via PSQI and sleep diaries (P=.05). Older adults with moderate sleep complaints can improve self-rated sleep quality by initiating a regular moderate-intensity exercise program.