How age and daytime activities are related to insomnia in the general population: consequences for older people

Napping and circadian sleep-wake regulation during healthy aging

STUDY OBJECTIVES

Daytime napping is frequently reported among the older population and has attracted increasing attention due to its association with multiple health conditions. Here, we tested whether napping in the aged is associated with altered circadian regulation of sleep, sleepiness, and vigilance performance.

METHODS

Sixty healthy older individuals (mean age: 69 years, 39 women) were recruited with respect to their napping habits (30 nappers, 30 non-nappers). All participants underwent an in-lab 40-hour multiple nap protocol (10 cycles of 80 minutes of sleep opportunity alternating with 160 minutes of wakefulness), preceded and followed by a baseline and recovery sleep period. Saliva samples for melatonin assessment, sleepiness, and vigilance performance were collected during wakefulness and electrophysiological data were recorded to derive sleep parameters during scheduled sleep opportunities.

RESULTS

The circadian amplitude of melatonin secretion was reduced in nappers, compared to non-nappers. Furthermore, nappers were characterized by higher sleep efficiencies and REM sleep proportion during day- compared to nighttime naps. The nap group also presented altered modulation in sleepiness and vigilance performance at specific circadian phases.

DISCUSSION

Our data indicate that napping is associated with an altered circadian sleep-wake propensity rhythm. They thereby contribute to the understanding of the biological correlates underlying napping and/or sleep-wake cycle fragmentation during healthy aging. Altered circadian sleep-wake promotion can lead to a less distinct allocation of sleep into nighttime and/or a reduced wakefulness drive during the day, thereby potentially triggering the need to sleep at adverse circadian phase.

Insomnia and sleep characteristics in post COVID-19 fatigue: A cross-sectional case-controlled study

OBJECTIVE

Following COVID-19 many patients report persistent fatigue and insomnia. Given the overlapping features, insomnia can be underdiagnosed in post-COVID-19 fatigue patients. This study aimed to determine insomnia severity, prevalence of clinical insomnia and sleep characteristics of post-COVID-19 fatigue patients. Data of post-COVID-19 fatigue patients were compared with those of patients with chronic fatigue syndrome (ME/CFS), a condition resembling post-COVID-19 fatigue.

METHODS

In this cross-sectional case-controlled study, insomnia severity, assessed with the Insomnia Severity Index (ISI), and prevalence of clinical insomnia (ISI score ≥ 10), were determined in patients with post-COVID-19 fatigue (n = 114) and compared with ME/CFS (n = 59) using ANCOVA and logistic regression, respectively. Linear regression analyses were used to evaluate whether mood, concentration problems, pain, fatigue (assessed with questionnaires) and diagnosis were associated with insomnia. Sleep characteristics were determined with a sleep diary and accelerometer in post-COVID-19 fatigue and compared with ME/CFS using ANCOVA.

RESULTS

In patients with post-COVID-19 fatigue mean (SD) insomnia severity was 11.46 (5.7) and 64% reported clinical insomnia. Insomnia severity was significantly associated with depressive symptoms (ß = 0.49, p = 0.006) and age (ß = 0.08, p = 0.04). The mean (SD) subjective sleep duration was 7.4 (1.0) hours with a sleep efficiency of 82 (11)%. Several subjective sleep characteristics of the post-COVID-19 fatigue patients differed from ME/CFS patients; only sleep duration, being significantly shorter in post-COVID-19 fatigue patients (p = 0.003), seemed clinically relevant (d = 0.58).

CONCLUSION

Insomnia severity and prevalence of clinical insomnia are high in patients with post-COVID-19 fatigue. Insomnia should be assessed and if present treated with insomnia focused therapy.

Chronic Vestibular Hypofunction Is Associated with Impaired Sleep: Results from the DizzyReg Patient Registry

Temporary or permanent vestibular hypofunction has been hypothesized to affect circadian rhythm, sleep, and thermoregulation. Chronic or long-term vestibular disorders such as unilateral vestibular hypofunction may have an even greater negative impact on sleep quality than acute vestibular problems. This study examines self-reported sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PSQI), and its association with vestibular symptom duration in a group of patients with vestibular disorders. We used data from the cross-sectional DizzyReg patient registry of the German Center for Vertigo and Balance Disorders outpatient clinic. Vestibular diagnoses were ascertained based on the International Classification of Vestibular Disorders. A total of 137 patients were included (60% female, mean age 55.4 years, standard deviation, SD, 16.7). The mean PSQI total score was 6.3 (SD = 3.2), with 51% reporting overall poor sleep quality. Patients who had vertigo for two years or longer reported significantly poorer global sleep quality (63% vs. 37%, p = 0.021) and significantly more difficulties with sleep latency (79% vs. 56%, p = 0.013) and sleep efficiency (56% vs. 34%, p = 0.022). The association of poor sleep quality with a longer duration of vertigo remained significant after multivariable adjustment. Further research should investigate the interaction of vestibular disorders, sleep, and their potential mechanisms.

Reciprocal Effects between Sleep Quality and Life Satisfaction in Older Adults: The Mediating Role of Health Status

OBJECTIVES

to examine the causal relationship between sleep quality and life satisfaction and explore the mediating role of health status on the relationship between sleep quality and life satisfaction.

METHODS

A total of 1856 older Chinese people participating in 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. A cross-lagged panel analysis (CLPA) combined with mediator analysis was utilized.

RESULTS

The average sleep quality levels for the years 2011, 2014, and 2018 were 3.70, 3.63, and 3.47 out of 5, respectively. The corresponding average levels of health status were 3.47, 3.44, and 3.39 out of 5, and the average levels of life satisfaction were 3.75, 3.86, and 3.87 out of 5, respectively. In addition, sleep quality at prior assessment points was significantly associated with life quality at subsequent assessments, and vice versa. Also, health status partially mediated this prospective reciprocal relationship.

CONCLUSIONS

There is a nonlinear decreased trend in sleep quality and health status, while there exists a nonlinear increased trend in life satisfaction for older adults from 2011 to 2018. Reciprocal positive effects between sleep quality and life satisfaction in older adults exist and are mediated by health status.

Cross-Sectional and Longitudinal Associations between Subjective Sleep Difficulties and Self-Perceptions of Aging

BACKGROUND

Only one study has explored the associations of subjective sleep difficulties with self-perceptions of aging. It focused on a global indicator of self-perceptions of aging (subjective age) despite individuals reporting different experiences of aging in relation to different life domains. The concept of awareness of negative age-related change, capturing perceived losses across five domains (e.g., physical health, cognition), may be more appropriate when relating subjective sleep difficulties to self-perceptions of aging. We examined whether nine different indicators of subjective sleep difficulties predict levels of awareness of negative age-related change and subjective age, measured concurrently and one year later, while controlling for covariates (mood and daily function).

PARTICIPANTS/METHODS

We used data from the PROTECT cohort study; 4,482 UK residents (mean age = 66.1; SD = 6.9) completed measures of awareness of age-related change, subjective age, mood, daily function, and subjective sleep difficulties.

RESULTS

Based on linear regression analyses, poorer quality of sleep, lower alertness after awakening, satisfaction with sleep, depth of sleep, more frequent early awakening, difficulty falling asleep, more times awake during a night, fewer hours of sleep during the night and more hours of sleep during the day predicted higher awareness of negative age-related change at baseline and follow-up (p< .001). Associations were small in size. Associations between subjective sleep difficulties and subjective age were either negligible or statistically non-significant.

CONCLUSIONS

Although subjective sleep difficulties are one of the many factors associated with awareness of negative age-related change, addressing sleep difficulties, alongside negative mood, and poor daily functioning, may promote a small additional increase in positive self-perceptions of aging.

Australian Consultant Pharmacists' Potential Roles in Sleep Health Care: Exploring a New Avenue for Improving the Management of Insomnia

BACKGROUND

The first-line treatment for insomnia is cognitive-behavioral therapy. However, there is persistent use of pharmacotherapy, particularly, sedative-hypnotics. Consultant pharmacists can provide medication review services for people using multiple medications. Therefore, they are well placed to provide sleep health/insomnia care with regard to sedative-hypnotic use and behavioral treatment recommendations/sleep health education. However, this avenue is, as yet, unexplored.

OBJECTIVES

To explore consultant pharmacists' current sleep health-related provisions and what their perspectives are around developing/implementing a consultant pharmacist-led behavioral service for insomnia.

METHODS

Qualitative semi-structured interviews were conducted with a convenience-based sample of consultant pharmacists. Interviews were audio-recorded, transcribed, and inductively analyzed.

RESULTS

Twenty-four consultant pharmacists were interviewed. Three themes were gauged: 1) Trivializing insomnia and sleep health, 2) Providing patient-centered care, 3) Service implementation - What do we need to consider? Participants commonly dealt with older patients and frequently encountered patients with sleep complaints/taking sleep medications. Generally, it was believed that sleep health was given minimal priority, with other comorbidities taking precedence in health provisions. Patients' attitudes toward management approaches were regarded critical to future treatment developments. While interested in expanding their sleep health/insomnia practice, participants expressed the need for appropriate education/training, funding, and collaborative treatment frameworks.

CONCLUSION

Insomnia/sleep health concerns are growing. Primary health professionals need to scale up their sleep health-care provisions to accommodate for this health demand. Consultant pharmacists are interested/willing to expand their sleep-related practice and provide evidence-based insomnia therapies; however, factors such as education/training, service configuration support, and patient attitudes should be addressed.

Daytime napping and cardiovascular risk factors, cardiovascular disease, and mortality: A systematic review

Associations between night sleep duration and cardiovascular risk factors in adults have been well documented. However, the associations for daytime napping remain unclear. In this review, six databases were searched for eligible publications to April 8, 2022. A total of 11 articles were identified for umbrella review on the association of daytime napping with diabetes, metabolic syndrome (MetS), cardiovascular disease (CVD), and mortality in adults, 97 for systematic review on the association with CVD and several CVD risk factors. Our umbrella review showed that the associations of daytime napping with diabetes, MetS, CVD, and mortality in most meta-analyses were mainly supported by weak or suggestive evidence. Our systematic review showed that long daytime napping (≥1 h/d) was associated with higher odds of several CVD risk factors, CVD, and mortality, but no significant association was found between short daytime napping and most of the abovementioned outcomes. Our dose-response meta-analyses showed that daytime napping <30 min/d was not significantly associated with higher odds of most CVD risk factors and CVD among young and middle-aged adults. However, among older adults aged >60 years, we observed significant dose-response associations of daytime napping with higher odds of diabetes, dyslipidemia, MetS, and mortality starting from 0 min/d.

Types of social activities associated with fewer insomnia symptoms and the mediating role of loneliness in older adults

BACKGROUND

A positive association has been known to exist between social activity engagements and fewer insomnia symptoms in later life. However, little is known about which social activities are associated with insomnia symptoms. Investigating mediating factors in this relationship may contribute to developing effective strategies for the reduction of sleep complaints in older adults. This study aimed to examine the mediating role of loneliness on the relationship between engagement in different social activities and insomnia symptoms.

METHODS

We used secondary data from the 2018 Health and Retirement Study. The study sample included 3236 older adults who responded to a survey on social activity engagement, insomnia symptoms, and loneliness. After adjusting for covariates, simple mediation analyses were performed with bootstrapping to identify the mediating role.

RESULTS

Among the several types of social activities, higher levels of engagement in educational courses and community arts group had a significant and direct relationship with fewer insomnia symptoms in older adults. Mediation analyses confirmed the mediating role of loneliness in the relationship between these specific social activity engagements and insomnia symptoms.

CONCLUSION

These findings provide new evidence for associations among social activity, loneliness, and insomnia symptoms in older adults.

Sleep in times of crises: A scoping review in the early days of the COVID-19 crisis

During the early days of the pandemic and in the context of a seemingly unknown global threat, several potential major sleep disruptors were identified by sleep researchers and practitioners across the globe. The COVID-19 pandemic combined several features that, individually, had been shown to negatively affect sleep health in the general population. Those features included state of crisis, restrictions on in-person social interactions, as well as financial adversity. To address the lack of a comprehensive summary of sleep research across these three distinctive domains, we undertook three parallel systematic reviews based on the following themes: 1) Sleep in times of crises; 2) Sleep and social isolation; and 3) Sleep and economic uncertainty. Using a scoping review framework, we systematically identified and summarized findings from these three separated bodies of works. Potential moderating factors such as age, sex, ethnicity, socioeconomic status, psychological predisposition, occupation and other personal circumstances are also discussed. To conclude, we propose novel lines of research necessary to alleviate the short- and long-term impacts of the COVID-19 crises and highlight the need to prepare the deployment of sleep solutions in future crises.

Lifestyle Factors and Sleep Health across the Lifespan

Sleep health, operationalized as a multidimensional construct consisting of sleep regularity, satisfaction, alertness, timing, efficiency, and duration, is an emerging concept in the field of sleep medicine which warrants further investigation. The purpose of the present study was to: (1) compare sleep health across the lifespan, (2) determine lifestyle factors associated with sleep health, and (3) examine whether lifestyle factors associated with sleep health varied between and within age groups. Participants consisted of 3284 individuals (Mean age = 42.70; 45% male) who participated in a cross-sectional online survey of sleep and health. Sleep health was measured using the RU-SATED scale, while demographic and lifestyle factors (e.g., daily social media use, sedentary activity, fast food consumption, etc.) were all self-reported. Sleep health was the highest among older adults (M = 8.09) followed by middle-aged (M = 7.65) and younger adults (M = 7.16). Across age groups, fast-food consumption, daily regularity, and daily TV, social media, or internet use were all negatively correlated with sleep health (ps < 0.05). Few differences in the association between lifestyle factors and sleep health across age groups were found. Overall, these findings may help to inform sleep health promotion efforts by targeting the most pertinent lifestyle factors for promoting sleep health.

Prevalence and associated factors of DSM-5 insomnia disorder in the general population of Qatar

BACKGROUND

Epidemiological studies of insomnia in the Middle East remain scarce. The present study aimed to estimate the prevalence of insomnia and explore its associations in the general population of Qatar. With almost 100 nationalities, Qatar is one of the most culturally diverse, richest, and fastest developing countries in the Arabian Peninsula.

METHODS

A probability sample of community-dwelling adults were surveyed in February of 2019. A total of 1611 respondents completed face-to-face interviews in Arabic or English. Logistic regression modeled associations with insomnia, our dependent variable, as defined by a score of ≤16 on the eight-item Sleep Condition Indicator or according to criteria for insomnia in the Diagnostic & Statistical Manual of Mental Disorders, fifth edition or DSM-5.

RESULTS

Approximately, 5.5% of the sample screened positive for insomnia and the 30-day prevalence of those who met all the DSM-5 criteria for insomnia disorder was 3.0%. In addition, 2.0% of the sample screened positive for depression and 3.4% for anxiety in the past 2 weeks. Multivariable analysis showed the following were significantly associated with insomnia: Arab ethnicity, young age, unemployment, being married, having less than high school education, fair or poor health, anxiety, and depression.

CONCLUSIONS

Insomnia prevalence was in the lower range of previously reported DSM-defined estimates from developed Western countries. Our findings highlight the need for raising awareness and improving sleep hygiene in potential risk groups such as younger adults and those of Arab ethnicity, in addition to incorporating insomnia screening in the provision of mental health services.

Relationships among types of activity engagement and insomnia symptoms among older adults

Background

An increasing awareness exists that lack of activity engagement is associated with insomnia symptoms. However, the majority of studies have focused on the association between a single type of activity engagement and insomnia symptoms.

Methods

This is a cross-sectional study using secondary data from the Health and Retirement Study examining the relationships among different types of activity engagement and insomnia symptoms among older adults. The sample for this study included 3321 older adults who responded to survey modules on activity engagement and insomnia symptoms in 2016. Activity engagement was measured using items for three types of activities (i.e., social, cognitive, and physical) validated in this study. Insomnia symptoms were measured using four items (i.e., difficulty of falling asleep, waking up during the night, waking up too early, and feeling rested). Independent t-tests were conducted to identify the differences in insomnia symptoms according to activity engagement level. Regressions were conducted to examine the associations among three types of activity engagement and insomnia symptoms after adjusting for covariates such as demographics, chronic disease, activities of daily living difficulty, cognitive function, sleep disorder, loneliness, and caregiving.

Results

The respondents in the high-level social, cognitive, and physical activity engagement groups were found to show fewer insomnia symptoms. Furthermore, higher social (β = − 0.04, p = 0.040) and cognitive (β = − 0.06, p = 0.007) activity engagements were associated with fewer insomnia symptoms even after adjusting for other types of activity engagement and all covariates.

Conclusions

This study suggests that older adults with higher social and cognitive activity engagements may be likely to have fewer insomnia symptoms. Based on these results, future research is needed to develop multi-component intervention programs that can encourage older adults to engage in these activities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02042-y.

Sleep in the Aging Population

There are normal changes to sleep architecture throughout the lifespan. There is not, however, a decreased need for sleep and sleep disturbance is not an inherent part of the aging process. Sleep disturbance is common in older adults because aging is associated with an increasing prevalence of multimorbidity, polypharmacy, psychosocial factors affecting sleep, and certain primary sleep disorders. It is also associated with morbidity and mortality. Because many older adults have several factors from different domains affecting their sleep, these complaints are best approached as a multifactorial geriatric health condition, necessitating a multifaceted treatment approach.

The contested meanings of race and ethnicity in medical research: A case study of the DynaMed Point of Care tool

Although the use of race and ethnicity for diagnostic purposes remains a controversial practice given the socially contingent meaning of the terms (Bowker and Star, 1999), health researchers continue to report possible relationships between health outcomes and race/ethnicity in the literature. As summaries of these types of studies are incorporated into commercial databases designed to provide medical practitioners with actionable information, there is a risk that the algorithms that drive the databases may unintentionally incorporate racist biases (O'Neil, 2016) in search reports that use race and ethnicity as query terms to identify findings to help in the diagnosis and treatment of particular patients. As a first step to unpacking this risk, we conducted a content analysis of the records and related citation trails in DynaMed's Point of Care (PoC) tool that refer to racial and ethnic research findings. Our analysis demonstrates that DynaMed does not control for how meanings of race and ethnicity are constructed in its entries, does not always accurately represent the nuanced and contingent nature of the findings about race/ethnicity that it cites, and relies on sources that are not always consistent with the 'evidence-based' criterion that the company self-promotes as a feature of its PoC tool. We conclude that, by failing to acknowledge the complex and contradictory ways that race and ethnicity may, or may not, correlate with the risk of a medical ailment, algorithmically-driven tools that use these concepts to establish group risks for medical ailments may unintentionally work to 'resuscitat[e] biological theories of race by modernizing old racial typologies that were based on observations of physical differences with cutting-edge genomic research' (Roberts, 2011: 567).

Smoking and risk of sleep-related issues: a systematic review and meta-analysis of prospective studies

OBJECTIVES

Smoking has many deleterious consequences on health, one of which can be sleep-related issues. Therefore, a meta-analysis was performed with the aim of pooling results from studies on the relationship between smoking and sleep-related issues.

METHODS

The present study follows PRISMA guidelines. Databases were searched by both researchers to find the articles. The review was done up to December 2018. In order to analyze the results of the screened articles, statistical indexes were converted to logarithms and the studies were combined with each other. Finally, several analyses were conducted with respect to various subgroups. In the subgroup analysis, the pool index of the studies was determined and the degree of heterogeneity in each subgroup was presented. Meta-regression was also used.

RESULTS

Smoking is associated with a risk of developing sleep-related issues. Risk ratio (1.47; 1.20-1.79) for smokers was higher than for non-smokers. Egger's test and Begg's test indicated publication bias.

CONCLUSIONS

Smoking is associated with sleep-related issues. Informing smokers about the effects of smoking on sleep issues can be effective in reducing and preventing its consequences.

Sleep Quality and Daytime Functioning in Older European Adults

Abstract. The aim of this article was to review research studies related to the issues of sleep in older adults, examining the relationship between sleep quality and a set of psychological variables of daytime functioning in healthy older adults: quality of life, subjective health, functional ability, cognitive function, and emotional state, in Europe. Combined scoping review search strategies resulted in a total of 84 articles selected for review. We conclude there is a considerable amount of European research on sleep quality and its correlates in older adults’ population. Studying these relationships may be the basis for the targeted planning of psychological interventions aiming at raising the quality of life in older adults. The selected domains of older adults’ everyday functioning were all well represented in the retrieved research studies.

Relationship of spouses' weekly working hours and sleep problems in Korean wage workers: the 5th Korean working conditions survey

Background

Sleep disorders are common and serious problems for mental health. This study investigated the relationship between spouses' weekly working hours (SWWH) and sleep problems by using the data from the 5th Korean Working Conditions Survey.

Methods

Data from 14,921 wage workers were used in the 5th Korean Working Conditions Survey. General and occupational characteristics, sleep problems are included in the questionnaire. Multivariate logistic regression analysis was used after adjustment for general and occupational characteristics to find the relationship between SWWH and sleep problems.

Results

Compared to those whose spouses worked less than 40 hours per week, risk of trouble falling asleep, waking up repeatedly while sleeping, and waking up with a feeling of exhaustion and fatigue was significantly higher as SWWH increase among those whose spouses worked 53 or more hours per week (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.16-1.70; OR: 1.50, 95% CI: 1.23-1.82; OR: 1.51, 95% CI: 1.24-1.83).

Conclusions

SWWH were related to sleep problems among Korean wage workers.

Clinical pharmacology of the dual orexin receptor antagonist ACT-541468 in elderly subjects: Exploration of pharmacokinetics, pharmacodynamics and tolerability following single-dose morning and repeated-dose evening administration

BACKGROUND

The dual orexin receptor antagonist ACT-541468 showed sedative pharmacodynamic effects during initial clinical testing in adult subjects. The present study explored pharmacokinetics, pharmacodynamics and tolerability in healthy elderly subjects.

METHODS

Double-blind, placebo-controlled, randomised, single-ascending dose study in 24 male/female elderly (65-80 years, 5, 15 and 25 mg in the morning, 6/2 active/placebo per group). Additionally, 10 subjects (8/2 active/placebo) received 25 mg for 7 days in the evening. Pharmacokinetics, pharmacodynamics (saccadic peak velocity, adaptive tracking, body sway, visual analogue scales according to Bowdle and Bond and Lader, Karolinska Sleepiness Scale) and tolerability were assessed. In particular, pharmacodynamics results are to be interpreted exploratorily.

RESULTS

Absorption was quick with a median time to maximum concentration of ∼ 1.0 h. The mean elimination half-life was 8.5-9.8 h, the area under the curve and the maximum plasma concentration increased proportionally with dose. Following repeated evening administration of 25 mg, minimal accumulation was observed. There were no pharmacodynamic effects at 5 mg. At 15 mg, saccadic peak velocity (degree/s; SD) was reduced (69; 38), while other variables showed no effects. At 25 mg, effects on all objective pharmacodynamic parameters were observed. At 8-12 h post-dose, there were no differences to placebo and no next-day effects on pharmacodynamic variables after evening administration. Elderly subjects reported fewer adverse events compared to adults in previous studies.

CONCLUSION

ACT-541468 in elderly subjects was well tolerated and pharmacokinetics and pharmacodynamics are compatible with a drug for the treatment of insomnia. Clinicaltrials.gov: NCT02571855.

Relationship between chronic diseases and sleep duration among older adults in Ghana

PURPOSE

Aging increases the prevalence of health problems that are often chronic, resulting in more sleep problems for people with poor health or chronic conditions. Relatively fewer studies have been conducted on the relationship between sleep duration and chronic conditions in Sub-Saharan Africa compared to Western or Asian populations. This study uses a nationally representative sample of older adults in Ghana to examine the association between sleep duration and chronic conditions.

METHOD

Data were gathered from the World Health Organization Study on Global AGEing and Adult Health (SAGE) Wave 1 in Ghana (n = 3617). Data on duration of sleep and chronic conditions were derived from self-reported data and validated symptom reporting. Multinomial logistic regression was conducted to examine the association between sleep duration and chronic conditions.

RESULTS

Women had a significantly longer period of sleep than men. Older people (> 60 years) were more likely than people under 60 years old to sleep for longer periods. The prevalence of stroke, depression, and chronic lung disease among long sleepers was high compared with short and medium sleepers. Our study found that respondents with stroke, arthritis, depression, chronic lung disease, asthma, and hypertension were likely to sleep for a long time.

CONCLUSION

This study showed a significant association between long hours of sleep and chronic conditions. To health professionals, paying particular attention to this association among older adults is medically important.

Sleep disorders among educationally active elderly people in Bialystok, Poland: a cross-sectional study

BACKGROUND

Sleep disorders in an ageing society constitute a significant public health problem. It is estimated that approximately 50% of people aged 55 years and older have trouble sleeping, including initiating and maintaining sleep. The aim of this study was to determine the prevalence of sleep disorders in a group of educationally active elderly people living in Bialystok, Poland.

METHODS

The study included a total of 182 people - residents of Bialystok - aged 60 or older; 146 women (80.22%) and 36 men (19.78%). The study used three standardized psychometric scales: The Athens Insomnia Scale (AIS), The Epworth Sleepiness Scale (ESS) and The Insomnia Severity Index (ISI).

RESULTS

More than half of the respondents scored 6 or more points on the AIS, which is considered a value that indicates a high probability of insomnia symptom occurrence. A similar percentage of respondents obtained a point value on the ISI indicating the presence of insomnia. The vast majority of respondents scored below 11 points on the ESS, which means no symptoms of excessive sleepiness. There was a significant correlation between the results of the above scales in the examined group in total and also by sex.

CONCLUSIONS

Sleep disorders, particularly insomnia, constitute a significant social and health problem in the group of educationally active elderly people living in Bialystok. In light of the obtained study results, it is recommended to conduct and improve existing health education programs aimed at the elderly regarding sleep disorders to improve the quality of their sleep, and thus quality of life, and raise the awareness of the elderly about the importance of sleep in everyday life. There is a need for further research in the field of sleep disorders in the elderly to determine the prevalence of these disorders on a national scale.

Poor Sleep Quality and Compromised Visual Working Memory Capacity

OBJECTIVES

Reduction in the amount of information (storage capacity) retained in working memory (WM) has been associated with sleep loss. The present study examined whether reduced WM capacity is also related to poor everyday sleep quality and, more importantly, whether the effects of sleep quality could be dissociated from the effects of depressed mood and age on WM.

METHODS

In two studies, WM was assessed using a short-term recall task, producing behavioral measures for both the amount of retained WM information (capacity) and how precise the retained WM representations were (precision). Self-report measures of sleep quality and depressed mood were obtained using questionnaires.

RESULTS

In a sample of college students, Study 1 found that poor sleep quality and depressed mood could independently predict reduced WM capacity, but not WM precision. Study 2 generalized these sleep- and mood-related WM capacity effects to a community sample (aged 21-77 years) and further showed that age was associated with reduced WM precision.

CONCLUSIONS

Together, these findings demonstrate dissociable effects of three health-related factors (sleep, mood, and age) on WM representations and highlighte the importance of assessing different aspects of WM representations (e.g., capacity and precision) in future neuropsychological research.

[Sleep habits and lifestyle of elderly patients with insomnia]

Certain inappropriate routines can have a negative impact on sleep, leading to sleep disorders or even aggravating pre-existing sleep pathologies. An observational study of 176 patients aged 60 or over, suffering from chronic insomnia, has been carried out in order to find out more about these patients' sleep habits and lifestyles and to identify those that can be corrected to improve insomnia in this population.

Insomnia Disorder Among Older Veterans: Results of a Postal Survey

STUDY OBJECTIVES

To estimate the prevalence of insomnia disorder among older veterans and to study relationships among age and self-rated health, with insomnia disorder, self-reported sleep duration and sleep efficiency.

METHODS

A cross-sectional postal survey of community-dwelling older veterans (older than 60 years) seen at one VA Healthcare System in the prior 18 months was performed, which was constructed to align with the general diagnostic criteria for insomnia disorder (International Classification of Sleep Disorders, Second Edition [ICSD-2]). The survey also queried self-reported sleep duration, bedtime, and wake time, which were used to calculate sleep efficiency. The survey also asked about race/ethnicity and self-rated health (using the general health item from the Short Form-36).

RESULTS

A completed survey was returned by 4,717 individuals (51.9% response rate; mean age 74.1 years). Of those, 2,249 (47.7%) met ICSD-2 diagnostic criteria for insomnia disorder. In logistic regression analyses, insomnia disorder was more likely among younger age categories (odds ratios [OR] 1.4-2.5) and in those with worse self-rated health (OR 2.1-14.4). Both total nocturnal sleep time and time in bed increased with older age (all P < .001), whereas sleep efficiency did not differ. Worse self-rated health was associated with shorter total nocturnal sleep time, more time in bed, and lower (worse) sleep efficiency.

CONCLUSIONS

Results of the postal survey suggest that almost half of community-dwelling older veterans have insomnia disorder, which was more common in young-old and among those with worse self-rated health. Additional work is needed to address the high burden of insomnia among older adults, including those with poor health.

Impact of Sleep and Dialysis Mode on Quality of Life in a Mexican Population

BACKGROUND

Health-related quality of life (HR-QOL) is reduced with end-stage renal disease (ESRD) but little is known about the impact of sleep disorders, dialysis modality and demographic factors on HR-QOL of Mexican patients with ESRD.

METHODS

121 adults with ESRD were enrolled from 4 dialysis units in the state of Guanajuato, Mexico, stratified by unit and dialysis modality (hemodialysis [HD], continuous ambulatory peritoneal dialysis [CAPD] and automated peritoneal dialysis [APD]). Analysis included clinical information and data from the Sleep Heart Health Study Sleep Habits Questionnaire, the Medical Outcomes Study (MOS) short form (SF-36) HR-QOL measure and Epworth Sleepiness Scale.

RESULTS

Overall, sleep symptoms and disorders were common (e.g., 37.2% insomnia). SF-36 scores were worse versus US and Mexican norms. HD patients reported better, while CAPD patients poorer HR-QOL for Vitality. With multivariate modelling dialysis modality, sleep disorders as a group and lower income were significantly associated with poorer overall SF-36 and mental health HR-QOL. Overall and Mental Composite Summary models showed HR-QOL was significantly better for both APD and HD with small to moderate effect sizes. Cost-effectiveness analysis demonstrated an advantage for APD.

CONCLUSIONS

Mexican ESRD patients have reduced HR-QOL, and sleep disorders may be an important driver of this finding. APD should be the preferred mode of dialysis in Mexico.

Efficacy of brief behavioral treatment for insomnia in older adults: examination of sleep, mood, and cognitive outcomes

OBJECTIVE

The aim of the present study was to examine the effects of a brief behavioral intervention for insomnia (BBTi) on sleep parameters, mood, and cognitive functioning in older adults.

METHODS

Older adults (aged 65 years or more) underwent four weekly sessions of BBTi or self-monitoring control (SMC). Participants completed 14 days of sleep diaries and actigraphy measuring sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE), and sleep quality ratings at baseline, post-treatment, and three month follow-up. Participants also completed mood scales (Geriatric Depression Scale [GDS]; Beck Depression Inventory-II; and State Trait Anxiety Inventory) and neuropsychological testing (measuring global cognition, language, memory, attention and processing speed, and executive function) at the three timepoints.

RESULTS

Significant condition (BBTi vs. SMC) x time (baseline vs. post-treatment vs. follow-up) interactions revealed that BBTi improved relative to baseline in sleep diary-reported SOL, WASO, SE, and sleep quality, and these improvements were maintained at follow-up. SMC showed no change in these measures. A main effect of time showed that actigraphy-measured WASO improved from baseline for both BBTi and SMC at post-treatment. A main effect of time revealed that both BBTi and SMC patients endorsed fewer GDS symptoms relative to baseline at post-treatment and follow-up. We observed no change in performance on neuropsychological measures.

CONCLUSIONS

A four-week BBTi is an efficacious intervention for reducing insomnia symptoms in older adults. BBTi does not selectively improve mood or cognitive functioning. Future work should examine effects of BBTi on physiological measures of sleep architecture and day-to-day cognition.

CLINICAL TRIAL IDENTIFER

NCT02967185.

A nonpharmacological approach to improve sleep quality in older adults

OBJECTIVES

Poor sleep quality is highly prevalent among older adults and is associated with poor quality of life, cognitive and physical decline, depression, and increased mortality. Medication options commonly used are not ideal, and alternative treatment strategies are needed. We evaluate a community-based psychosocial intervention program and its effect on sleep quality in older adults.

METHOD

Elderly participants aged 60 and above were included. Those with Geriatric Depression Scale and Geriatric Anxiety Inventory scores above 5 and 10, respectively, were excluded. The community program included tai chi exercise, art therapy, mindfulness awareness practice, and music reminiscence therapy. Pittsburgh Sleep Quality Index, Geriatric Depression Scale, and Geriatric Anxiety Inventory were administered at baseline and at 1 year.

RESULTS

A hundred and eighty-nine subjects (44 men, 145 women; mean age = 69 years, SD = 5.7, range = 60-89) participated. The proportion of participants with good sleep quality had increased from 58.2% to 64.6%. Sleep disturbance was significantly reduced (baseline, 1.04; postintervention, 0.76; mean difference 0.28; P < .01); men experienced greater improvement (P < .001). Improvements were independent of changes in depressive and anxiety symptoms.

CONCLUSION

Participation in this community program led to positive effects on sleep disturbances after a year. Psychosocial interventions have potential as a nondrug intervention approach for sleep problems, and further research is needed to understand its mediating mechanisms.

The Bidirectional Relationship between Positive Mental Health and Social Rhythm in College Students:A Three-Year Longitudinal Study

Social rhythm refers to the general regularity of engaging in basic social activities during the week, and was found to be associated with individuals' positive mental health. The present study investigated the relationship between social rhythm and emotional well-being in a cohort of 2,031 college students over 3 years with a cross-lagged longitudinal panel design. Results revealed that regularity of social rhythm positively predicted emotional well-being in the following year, and vice versa, when the level of both factors in the previous year was controlled. Our study provides evidence of a longitudinal positive reciprocal relationship between social rhythm and positive mental health in younger adult populations.

The effects of age and gender on the prevalence of insomnia in a sample of the Saudi population

OBJECTIVES

The aim of this study was to determine the prevalence of insomnia among the Saudi adult population.

STUDY DESIGN

A cross-sectional insomnia survey was conducted at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. The presence of insomnia was defined by difficulty initiating sleep, early morning awakening, or frequent awakening, in addition to the second-day effect in the form of fatigue, tiredness, or changes in the mode because of lack of sleep.

RESULTS

The crude prevalence of insomnia was 77.7% (95% CI = 75.9-79.5%). The gender-adjusted prevalence of insomnia was higher for females, 88.7% (95% CI = 86.4-90.7%) than for males, 70.4% (95% CI = 67.8-72.9%), p-value = .001. The age-adjusted prevalence of insomnia was higher for the elderly, 93.7% (95% CI = 90.6-96.0%) than for the middle aged, 79.8% (95% CI = 77.4-82.1%), or for the young group, 64.2% (95% CI = 59.9-68.4%), p-value = .001. The Chi-square analyses revealed that (1) being elderly, widowed/divorced, females, or housewives, (2) having a lack of education, and (3) excessive tea consumption were significantly associated with elevated risks for insomnia (p-values < .05).

CONCLUSIONS

Insomnia is most prevalent among Saudi females and the elderly Saudi population.

Subjective age and sleep in middle-aged and older adults

OBJECTIVE

Chronological age is commonly used to explain change in sleep. The present study examines whether subjective age is associated with change in sleep difficulties across middle adulthood and old age.

DESIGN

Participants were drawn from the second (2004-2005) and third (2013-2014) waves of the Midlife in the United States Survey (MIDUS, N = 2350; Mean Age: 55.54 years), the 2008 and 2014 waves of the Health and Retirement Study (HRS, N = 4066; Mean Age: 67.59 years) and the first (2011) and fourth (2014) waves of the National Health and Aging Trends Survey (NHATS, N = 3541; Mean Age: 76.46). In each sample, subjective age, sleep difficulties, depressive symptoms, anxiety and chronic conditions were assessed at baseline. Sleep difficulties was assessed again at follow-up.

MAIN OUTCOME MEASURES

Sleep difficulties.

RESULTS

An older subjective age at baseline was related to an increase in sleep difficulties over time in the three samples, and was mediated, in part, through more depressive symptoms, anxiety and chronic conditions. Feeling older was associated with an increased likelihood of major sleeping difficulties at follow-up in the three samples.

CONCLUSION

Subjective age is a salient marker of individuals' at risk for poor sleep quality, beyond chronological age.

Qualitative Experience of Sleep in Individuals With Spinal Cord Injury

Poor sleep contributes to adverse health outcomes making it important to understand sleep in medically vulnerable populations, including those with spinal cord injury (SCI). However, little attention has been paid to circumstances specific to SCI that may negatively affect sleep, or to consequences of poor sleep in this population. The objective of this study was to examine the experience of sleep among individuals with SCI. Secondary analysis using thematic coding of qualitative data from an ethnographic study of community-dwelling adults with SCI was conducted. Sleep-related data were found in transcripts for 90% of the sample. Participants described diminished sleep duration and irregular sleep patterns. Several factors contributing to poor sleep were identified, including SCI-related circumstances and sleep environment. Participants also discussed how poor sleep affected occupational engagement. This study highlights the extent of sleep disturbance experienced after SCI and the subsequent impact on occupational performance, and provides direction for clinical practice.

Sleep in the Aging Population

There are normal changes to sleep architecture throughout the lifespan. There is not, however, a decreased need for sleep and sleep disturbance is not an inherent part of the aging process. Sleep disturbance is common in older adults because aging is associated with an increasing prevalence of multimorbidity, polypharmacy, psychosocial factors affecting sleep, and certain primary sleep disorders. It is also associated with morbidity and mortality. Because many older adults have several factors from different domains affecting their sleep, these complaints are best approached as a multifactorial geriatric health condition, necessitating a multifaceted treatment approach.

The Effects of a Cluster Randomized Controlled Workplace Intervention on Sleep and Work-Family Conflict Outcomes in an Extended Care Setting

OBJECTIVES

To evaluate the effects of a workplace-based intervention on actigraphic and self-reported sleep outcomes in an extended care setting.

DESIGN

Cluster randomized trial.

SETTING

Extended-care (nursing) facilities.

PARTICIPANTS

US employees and managers at nursing homes. Nursing homes were randomly selected to intervention or control settings.

INTERVENTION

The Work, Family and Health Study developed an intervention aimed at reducing work-family conflict within a 4-month work-family organizational change process. Employees participated in interactive sessions with facilitated discussions, role-playing, and games designed to increase control over work processes and work time. Managers completed training in family-supportive supervision.

MEASUREMENTS

Primary actigraphic outcomes included: total sleep duration, wake after sleep onset, nighttime sleep, variation in nighttime sleep, nap duration, and number of naps. Secondary survey outcomes included work-to-family conflict, sleep insufficiency, insomnia symptoms and sleep quality. Measures were obtained at baseline, 6-months and 12-months post-intervention.

RESULTS

A total of 1,522 employees and 184 managers provided survey data at baseline. Managers and employees in the intervention arm showed no significant difference in sleep outcomes over time compared to control participants. Sleep outcomes were not moderated by work-to-family conflict or presence of children in the household for managers or employees. Age significantly moderated an intervention effect on nighttime sleep among employees (p=0.040), where younger employees benefited more from the intervention.

CONCLUSION

In the context of an extended-care nursing home workplace, the intervention did not significantly alter sleep outcomes in either managers or employees. Moderating effects of age were identified where younger employees' sleep outcomes benefited more from the intervention.

Interrelationships among common symptoms in the elderly and their effects on health-related quality of life: a cross-sectional study in rural Korea

Background

Because the world population is aging, it has become increasingly important to focus on and meet the healthcare needs of elderly individuals. This study aims to evaluate the relationships among common symptoms experienced by the elderly, including fatigue, pain, sleep disturbance, indigestion, and depression/anger/anxiety, and to assess how these symptoms affect health-related quality of life (HRQoL) in the elderly population after adjusting for sociodemographic characteristics and diagnosed diseases.

Methods

In a cross-sectional study conducted in 2014 in a rural area of Korea, we extracted data on 1328 elderly individuals aged 60 years or older. Their HRQoL was assessed using the EuroQol Five-Dimension (EQ-5D) questionnaire. The pairwise associations between each symptom and the influence of the symptoms on HRQoL were measured using logistic regression and multiple regression analysis.

Results

Each symptom was positively correlated with the other symptoms. The strongest association was observed between fatigue and pain (adjusted odds ratio = 8.127), and the weakest correlation was observed between sleep and indigestion (adjusted odds ratio = 2.521). Of the individuals experiencing symptoms other than sleep disturbance, those who reported comorbid symptoms tended to report higher symptom severity and a higher prevalence of symptoms persisting for ≥ 3 days compared with individuals who reported only one symptom. The number of symptoms was significantly correlated with the EQ-5D index (Spearman correlation coefficient = −0.370, p < 0.01) and the EQ Visual Analog Scale (EQ VAS) scores (Spearman correlation coefficient = −0.226, p < 0.01). Fatigue, pain, and sleep disturbance showed negative effects on all dimensions of EQ-5D. In multiple regression analysis, fatigue (β = −0.073, p < 0.01), pain (β = −0.140, p < 0.01), sleep disturbance (β = −0.061, p < 0.05), and depression/anger/anxiety (β = −0.065, p < 0.05) showed significant independent effects on the EQ-5D index when we adjusted for socioeconomic characteristics and diagnosed diseases.

Conclusions

Fatigue, pain, sleep disturbance, and depression/anger/anxiety were correlated with one another, and they presented significant independent effects on the HRQoL of elderly individuals. Thus, multidisciplinary healthcare programs are required to address these common symptoms.

Sleep duration, life satisfaction and disability

BACKGROUND

Although sleep is considered an essential part of individuals' lives, there are no previous studies analysing how sleep duration affects the levels of life satisfaction reported by males and females with disabilities.

OBJECTIVE/HYPOTHESIS

To analyse and compare the impact of hours of sleep on life satisfaction scores reported by people without and with disabilities (stratified by sex) in Germany.

METHODS

Using data taken from the German Socio-Economic Panel for the period 2008-2013, we estimate life satisfaction equations for males and females (running a fixed-effects model) which include a set of variables measuring the number of sleep hours on workdays and weekends.

RESULTS

A higher number of sleep hours on workdays increase life satisfaction for all males and females. However, the contribution of each hour of sleep on workdays is greater for males with disabilities in terms of life satisfaction, whereas for females no significant differences by disability status have been found. Although sleep hours on weekends also increase life satisfaction, the magnitude of the coefficients is relatively higher than that found for the corresponding hours of sleep on workdays, but only for the male sample (disabled or not).

CONCLUSIONS

The participation and commitment of policymakers, governments, trade unions, employers, and health care professionals are key aspects for developing and formulating new guidelines and specific measures that promote a healthy lifestyle and increase sleep duration. Such guidelines and measures are of essence for people with disabilities who are employed (e.g. using brief sleep opportunities during prolonged work periods, which can contribute to reducing fatigue, stress and anxiety).

The association between insomnia and cardiovascular risk factors in bus drivers in Iran

BACKGROUND

Road accidents are one of the most important issues in Iran which more than eighteen thousand persons are died annually because of this problem. Among the major reasons for this issue, sleepiness and cardiovascular disorder can be mentioned.

OBJECTIVE

To investigate the association between insomnia and cardiovascular risk factors among professional drivers who are at high risk during driving.

METHODS

A total of 1232 male bus drivers were included in the study and two different kinds of data sets were collected: (1) Sleep disorder information using Athens Insomnia Scale (AIS) and (2) Cardiovascular parameters such as systematic measurement of blood pressure, electrocardiography (ECG), total cholesterol, and triglyceride.

RESULTS

Our study demonstrated that the prevalence of insomnia in professional bus drivers was 8 percent. The study showed significant association between age, diastolic hypertension and work experience with final awakening earlier than desired (P < 0.05), the rate of the triglyceride level and total sleep duration (p = 0.02), and BMI and sleepiness during the day (P < 0.05).

CONCLUSIONS

Our study suggested that elevated serum triglyceride levels and increased diastolic blood pressure may be associated with some sleep complaints in drivers.

Prevalence and clinical characteristics of insomnia and its subtypes in the Korean elderly

BACKGROUND

Insomnia is known to be associated with psychiatric disorders, other sleep disorders and medical conditions, but the prevalence of insomnia diagnosis has never been estimated according to its subtypes. We studied the prevalence and clinical characteristics of insomnia diagnosis and its subtypes in the Korean elderly population.

METHODS

Among 1423 sampled elderly individuals aged 60 years or older, 881 subjects participated in this study. The Athens Insomnia Scale was applied to detect insomnia symptoms, and insomnia diagnosis was finally evaluated using the international classification of sleep disorders, 2nd edition. To define insomnia subtypes, the DSM-IV-based interview, detailed history on sleep disorders and semi-structured interview for medical conditions were performed. Subsyndromal depression was defined when depressive symptoms did not meet the criteria for depressive disorders.

RESULTS

The prevalence of insomnia disorder was 32.8% in all subjects, with the prevalence being significantly higher in women than in men (37.9% vs. 25.2%; p<0.001). The prevalence of insomnia subtypes was as follows; psychophysiological insomnia (PI), 20.5%; insomnia due to mental disorder 7.2%; insomnia due to general medical conditions 2.9%; insomnia in other sleep disorders 2.2%, and insomnia due to substance use 0.2%. Among subjects with PI, subsyndromal depression was diagnosed in 53.7%.

CONCLUSIONS

Nearly one third of Korean elderly individuals suffer from insomnia and insomnia patients showed diverse comorbid conditions, especially depressive symptoms. By establishing insomnia subtypes, we can plan to treat comorbid conditions as well as insomnia itself.

Lifestyle Practices and Nocturnal Sleep in Midlife Women with and without Insomnia

Relationships between common lifestyle practices important to sleep hygiene (e.g., smoking cigarettes, drinking alcohol, ingesting caffeine, exercising, bedtimes, getting-up times) and nocturnal sleep have not been documented for women with insomnia in their home environments. This community-based sample of 121 women, ages 40 to 55 years, included 92 women who had experienced insomnia for at least 3 months and 29womenwith good-quality sleep. Women recorded lifestyle practices and sleep perceptions (time to fall asleep, awakenings during sleep, feeling rested after sleeping, and overall sleep quality) in diaries while undergoing 6 nights of somnographic sleep monitoring at home. Compared to women with good-quality sleep, women with insomnia reported greater nightto-night variation in perceived sleep variables, poorer overall sleep quality (M = 2.8,SD = 0.7 vs.M = 1.9,SD = 0.5,P < 0.05), and longer times to fall asleep (M = 25 min,SD = 14.2 vs.M = 12.9 min,SD = 5.8,P < 0.05). Correlations between mean individual lifestyle practice scores and mean perceived or somnographic sleep variables were low, ranging from 0 to 0.20. An aggregated sleep hygiene practice score was not associated with either perceived or somnographic sleep variables. Regression analysis using dummy variables showed that combinations of alcohol, caffeine, exercise, smoking, and history of physical disease explained 9% to 19% of variance in perceived or somnographic sleep variables. Lifestyle practices, and combinations thereof, do warrant consideration when assessing or treating insomnia, but these data fail to support a dominant relationship between lifestyle practices and either perceived or somnographic sleep variables.

Age differences in fatigue, decrements in energy, and sleep disturbance in oncology patients receiving chemotherapy

OBJECTIVE

The number of older adults with cancer is increasing. Given the limited amount of research and the inconsistent findings regarding age differences in common physical symptoms associated with cancer and its treatments, the purposes of this study, in a sample of oncology outpatients receiving chemotherapy (CTX), were to evaluate for age differences in demographic and clinical characteristics, as well as in occurrence rates of and severity ratings for fatigue, decrements in energy, and sleep disturbance. In addition, using regression analysis techniques, within and across age groups, demographic and clinical characteristics associated with the severity of each symptom were evaluated.

METHODS

Patients (n = 1343) were dichotomized into younger (<65 years) and older (≥65 years) age groups. Patients completed self-report questionnaires prior to their next dose of CTX.

RESULTS

Overall, our findings suggest that compared to younger patients, older adults experience a lower or similar level of fatigue, decrements in energy, and sleep disturbance. However, it should be noted that both age groups experienced high occurrence rates and moderate to severe levels of all three symptoms.

CONCLUSIONS

Clinicians need to assess all oncology patients receiving CTX for these three symptoms. Future research needs to determine the biopsychosocial reasons that underlie these age-related differences in fatigue, decrements in energy, and sleep disturbance.

Age and work environment characteristics in relation to sleep: Additive, interactive and curvilinear effects

Although additive combinations of age and work environment characteristics have been found to predict sleep impairment, possible age x work environment interactions have been largely disregarded. The present study examined linear and curvilinear interactions of age with work environment measures in relation to sleep quality and duration. Survey data were collected from offshore day-shift personnel (N = 901). Main effects and interactions of the age terms with work environment measures (job demand, control, and social support, physical environment and strenuous work) were evaluated. Sleep duration was predicted by a curvilinear interaction, age(2) x job demand (p < .005), and by the age x social support interaction (p < .002); sleep quality was predicted by age x job demand (p < .002). Job control and physical environment showed significant additive effects. At a time when older employees are encouraged to remain in the workforce, the findings serve to increase understanding of how ageing and work demands jointly contribute to sleep impairment.