Prevalence of Uncoupled Sleep and Dysfunctional Sleep Beliefs in a Sample of Community-Dwelling Older Adults in Western Australia: A Cross-Sectional Study

Author(s):  
Yvonne Kutzer ◽  
Lisa Whitehead ◽  
Eimear Quigley ◽  
Shih Ching Fu ◽  
Mandy Stanley

Abstract Objectives: Individuals who complain of insomnia may not always have objectively measured poor sleep, and vice versa, a phenomenon which is referred to as uncoupled sleepers. This study assessed the prevalence of uncoupled sleepers and levels of dysfunctional sleep beliefs in a sample of older adults in Western Australia.Method: 80 adults aged 60-80 years (71 females, 89%) completed a questionnaire, sleep diary and actigraphy measurements. Sleep related dysfunctional beliefs and self-rated sleep quality were assessed using the Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS-16). Objective sleep quality was measured using an ActigraphTM model wGT3X-BT activity monitor and subjective sleep quality was assessed using a modified version of the Consensus Sleep Diary.Results: 52 of 80 participants (65%) were uncoupled sleepers. Individuals who complained of insomnia in the absence of objectively measured poor sleep showed worse self-reported sleep outcomes and higher dysfunctional beliefs, even though on actigraphy measurements there were no significant differences. Discussion: Future research should examine subjective and objective sleep parameters in older individuals. Interindividual differences in the relationship between perceived and measured sleep quality could present a target for potential therapeutic intervention.Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN 12619001509156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378451

2020 ◽  
Author(s):  
Kyungmi Chung ◽  
Seoyoung Kim ◽  
Eun Lee ◽  
Jin Young Park

BACKGROUND As an evidence-based psychotherapy for treating insomnia, cognitive behavioral therapy for insomnia (CBT-I), which helps people with sleep problems to change their unhelpful sleep-related beliefs and habits, has been well-established in older adults. Recently, the utilization of mobile CBT-I apps has been getting attention from mental health professionals and researchers; however, whether mobile CBT-I apps are usable among older users has yet to be determined. OBJECTIVE The aims of this study were to explore the relationships between subjective sleep quality and subjective memory complaints and depressive symptoms; to explore the relationship between perceived difficulty in mobile app use and usability of the mobile phone–based self-help CBT-I app, named MIND MORE, in urban community-dwelling Korean older adults; to compare changes in subjective sleep quality from pre-intervention to post-intervention, during which they used the mobile app over a 1-week intervention period; and evaluate adherence to the app. METHODS During the 2-hour training program delivered on 1 day titled “Overcoming insomnia without medication: How to use the ‘MIND MORE’ mobile app for systematic self-management of insomnia” (pre-intervention), 41 attendants were asked to gain hands-on experience with the app facilitated by therapists and volunteer workers. They were then asked to complete questionnaires on sociodemographic characteristics, subjective evaluation of mental health status (ie, depression, memory loss and impairment, and sleep problems), and app usability. For the 1-week home-based self-help CBT-I using the app (post-intervention), 9 of the 41 program attendants, who had already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the 1-week intervention, specifically 8 days after the training program ended. RESULTS Due to missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows. First, poor subjective sleep quality was associated with higher ratings of depressive symptoms (40/40; ρ=.60, <i>P</i>&lt;.001) and memory complaints (40/40; ρ=.46, <i>P</i>=.003) at baseline. Second, significant improvements in subjective sleep quality from pre-intervention to post-intervention were observed in the older adults who used the MIND MORE app only for the 1-week intervention period (9/9; <i>t</i><sub>8</sub>=3.74, <i>P</i>=.006). Third, apart from the program attendants who did not have a smartphone (2/40) or withdrew from their MIND MORE membership (3/40), those who attended the 1-day sleep education program adhered to the app from at least 2 weeks (13/35, 37%) to 8 weeks (2/35, 6%) without any further contact. CONCLUSIONS This study provides empirical evidence that the newly developed MIND MORE app not only is usable among older users but also could improve subjective sleep quality after a 1-week self-help intervention period.


2021 ◽  
Author(s):  
Yvonne Kutzer ◽  
Lisa Whitehead ◽  
Eimear Quigley ◽  
Shih Ching Fu ◽  
Mandy Stanley

BACKGROUND The current Covid-19 pandemic has brought about a marked interest in sleep health, as well as an increased demand for telehealth services, such as online Cognitive Behavioral Therapy for insomnia (CBT-I). Older adults in particular report a high rate of sleep problems. Recent studies have suggested that dysfunctional sleep beliefs could contribute to the high rates of self-reported insomnia in this age group. In addition, older adults have an increased rate of uncoupled sleep, e.g. displaying an insomnia complaint in the absence of objectively measured poor sleep. It is essential to determine the prevalence of coupled and uncoupled sleep in older adults and to examine the efficacy of online CBT-I to improve sleep outcomes. OBJECTIVE This study aims to assess objective and subjective sleep quality and dysfunctional sleep beliefs in a sample of community-dwelling older adults aged 60-80 years with and without uncoupled sleep in Western Australia following digitally delivered CBT-I. METHODS Objective sleep was measured using wrist actigraphy, and subjective sleep quality via sleep diaries and the Pittsburgh Sleep Quality Index (PSQI). Dysfunctional sleep beliefs were assessed by the Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS-16) prior to and following a four-week online CBT-I programme. Linear mixed model and generalised linear mixed model analyses were conducted to examine objective and subjective sleep onset latency, total sleep time, wake after sleep onset and number of awakenings as well as PSQI and DBAS16 scores, respectively. RESULTS 62 participants (55 females; 88.7%) completed the study. CBT-I effectively reduced dysfunctional sleep beliefs and PSQI scores across all sleep classifications, even in good sleepers without a sleep complaint. Objective and self-reported changes in sleep parameters were mainly demonstrated in complaining poor sleepers. Complaining good sleepers reported a decrease in the number of subjective sleep awakenings only. CONCLUSIONS Online CBT-I was effective in improving the sleep outcomes of individuals who had both subjective and objective poor sleep. However, as the online CBT-I reduced dysfunctional sleep beliefs in all sleep groups, further examination of dysfunctional sleep beliefs and whether they mediate the outcomes of digital CBT-I in older adults will need to be conducted. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN 12619001509156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378451 INTERNATIONAL REGISTERED REPORT RR2-32705


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S678-S678
Author(s):  
Melanie Stearns ◽  
Danielle K Nadorff

Abstract Recent evidence has shown that poor quality sleep is associated with depression, particularly among older individuals (Bao et al., 2017; Nadorff, Fiske, Sperry, & Petts, 2012). Moreover, given the high prevalence of depressive symptoms among older adults, it is important to identify possible risk factors of poor sleep quality. One possible risk factor is being a custodial grandparent (raising one’s grandchildren), as increased caregiving responsivities are associated with increased depressive symptoms (Brand-Winterstein, Edelstein, & Bachner, 2018). Based upon these previous findings, the current study examines the effect of custodial status on the relation between sleep quality and depressive symptoms. The sample (N = 466) was a subset of individuals recruited in the second wave of the MIDUS biomarkers project completed in 2009 who answered the sleep, caregiving, and depressive symptoms variables of interest. Measures included the Center for Epidemiological Studies Depression Scale (CESD), the Pittsburgh Sleep Quality Index (PSQI), and a question regarding custodial grandparent status. The current study aimed to examine whether poor sleep quality might serve as a risk factor for experiencing depressive symptoms and how custodial grandparents might differ from other older adults. Moderation analyses were conducted using SPSS’ Process macro on the sample. The interaction between global sleep quality and custodial grandparent status was significant in predicting depressive symptoms, t (1, 465) = 3.90, p = .04, such that custodial grandparents reported a stronger positive correlation between greater global sleep problems and depressive symptoms than non-custodial grandparents. Implications, future directions, and limitations are discussed.


2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Louise Marron ◽  
Ricardo Segurado ◽  
Paul Claffey ◽  
Rose Anne Kenny ◽  
Triona McNicholas

Abstract Background Benzodiazepines (BZD) are associated with adverse effects, particularly in older adults. Previous research has shown an association between BZDs and falls and BZDs have been shown to impact sleep quality. The aim of this study is to assess the association between BZD use and falls, and the impact of sleep quality on this association, in community dwelling adults aged over 50. Methods Data from the first wave of The Irish Longitudinal Study on Ageing were used. Participants were classed as BZD users or non-users and asked if they had fallen in the last year, and whether any of these falls were unexplained. Sleep quality was assessed via self-reported trouble falling asleep, daytime somnolence, and early-rising. Logistic regression assessed for an association between BZD use and falls, and the impact of sleep quality on this association was assessed by categorising based on BZD use and each sleep quality variable. Results Of 8,175 individuals, 302 (3.69%) reported taking BZDs. BZD use was associated with falls, controlling for con-founders (OR 1.40; 1.08, 1.82; p-value 0.012). There was no significant association between BZDs and unexplained falls, controlling for con-founders (OR 1.41; 95% CI 0.95, 2.10; p-value 0.09), however a similar effect size to all falls was evident. Participants who take BZDs and report daytime somnolence (OR 1.93; 95% CI 1.12, 3.31; p-value 0.017), early-rising (OR 1.93; 95% CI 1.20, 3.11; p-value 0.007) or trouble falling asleep (OR 1.83; 95% CI 1.12, 2.97; p-value 0.015), have an increased odds of unexplained falls. Conclusion BZD use is associated with falls, with larger effect size in BZD users reporting poor sleep quality in community dwelling older adults. Appropriate prescription of and regular review of medications such as BZDs is an important public health issue.


2019 ◽  
Vol 31 (06) ◽  
pp. 779-788 ◽  
Author(s):  
Sonya Kaur ◽  
Nikhil Banerjee ◽  
Michelle Miranda ◽  
Mitchell Slugh ◽  
Ni Sun-Suslow ◽  
...  

ABSTRACTObjectives:Frailty is associated with cognitive decline in older adults. However, the mechanisms explaining this relationship are poorly understood. We hypothesized that sleep quality may mediate the relationship between frailty and cognition.Participants:154 participants aged between 50-90 years (mean = 69.1 years, SD = 9.2 years) from the McKnight Brain Registry were included.Measurements:Participants underwent a full neuropsychological evaluation, frailty and subjective sleep quality assessments. Direct relationships between frailty and cognitive function were assessed using linear regression models. Statistical mediation of these relationships by sleep quality was assessed using nonparametric bootstrapping procedures.Results:Frailty severity predicted weaker executive function (B = −2.77, β = −0.30, 95% CI = −4.05 – −1.29) and processing speed (B = −1.57, β = −0.17, 95% CI = −3.10 – −0.16). Poor sleep quality predicted poorer executive function (B = −0.47, β = −0.21, 95% CI = −0.79 – −0.08), processing speed (B = −0.64, β = −0.28, 95% CI = −0.98 – −0.31), learning (B = −0.42, β = −0.19, 95% CI = −0.76 – −0.05) and delayed recall (B = −0.41, β = −0.16, 95% CI = −0.80 – −0.31). Poor sleep quality mediated the relationships between frailty severity and executive function (B = −0.66, β = −0.07, 95% CI = −1.48 – −0.39), learning (B = −0.85, β = −0.07, 95% CI = −1.85 – −0.12), delayed recall (B = −0.47, β = −0.08, 95% CI = −2.12 – −0.39) and processing speed (B = −0.90, β = −0.09, 95% CI = −1.85 – −0.20).Conclusions:Relationships between frailty severity and several cognitive outcomes were significantly mediated by poor sleep quality. Interventions to improve sleep quality may be promising avenues to prevent cognitive decline in frail older adults.


2017 ◽  
Vol 48 (3-4) ◽  
pp. 147-154 ◽  
Author(s):  
V. Eloesa McSorley ◽  
Jayant Pinto ◽  
L. Philip Schumm ◽  
Kristen Wroblewski ◽  
David Kern ◽  
...  

Background: Sleep and olfaction are both critical physiological processes that tend to worsen with age. Decline in olfaction can be an early indicator of neurodegenerative diseases, whereas poor sleep quality is associated with reduced physical and mental health. Given associations with aging-related health declines, we explored whether variations in sleep were associated with olfactory function among older adults. Methods: We assessed the relationship between sleep characteristics and olfaction among 354 community-dwelling older adults. Olfaction was measured using a validated field and survey research tool. Sleep characteristics were measured using wrist actigraphy and with self-report of sleep problems. We fit structural equation models of latent constructs of olfaction based on olfactory task items and let this be a function of each sleep characteristic. Results: Actigraph sleep quality measures were associated with odor identification, but not with odor sensitivity. Longer duration sleepers had worse odor sensitivity compared to medium (58 h) sleepers, but sleep duration was not associated with odor identification. Reported sleep problems and reported usual duration were not associated with olfaction. Conclusions: Diminished sleep quality was associated with reduced capacity to identify odors. Determining whether this is a causal association will require further study and longitudinal data.


2017 ◽  
Author(s):  
Cameron Brick

The aim of the current study was to determine whether subjective sleep quality was reduced in medical students, and whether demographics and sleep hygiene behaviors were associated with sleep quality. A web-based survey was completed by 314 medical students, containing questions about demographics, sleep habits, exercise habits, caffeine, tobacco and alcohol use, and subjective sleep quality (using the Pittsburgh Sleep Quality Index). Correlation and regression analyses tested for associations among demographics, sleep hygiene behaviors, and sleep quality. As hypothesized, medical students’ sleep quality was significantly worse than a healthy adult normative sample (t=5.13, p&lt;.001). Poor sleep quality in medical students was predicted by several demographic and sleep hygiene variables, and future research directions are proposed.Brick, C., Seely, D. L., &amp; Palermo, T. M. (2010). Association between sleep hygiene and sleep quality in medical students. Behavioral Sleep Medicine, 8(2), 113–121. https://www.tandfonline.com/doi/abs/10.1080/15402001003622925


10.2196/17755 ◽  
2020 ◽  
Vol 8 (8) ◽  
pp. e17755
Author(s):  
Kyungmi Chung ◽  
Seoyoung Kim ◽  
Eun Lee ◽  
Jin Young Park

Background As an evidence-based psychotherapy for treating insomnia, cognitive behavioral therapy for insomnia (CBT-I), which helps people with sleep problems to change their unhelpful sleep-related beliefs and habits, has been well-established in older adults. Recently, the utilization of mobile CBT-I apps has been getting attention from mental health professionals and researchers; however, whether mobile CBT-I apps are usable among older users has yet to be determined. Objective The aims of this study were to explore the relationships between subjective sleep quality and subjective memory complaints and depressive symptoms; to explore the relationship between perceived difficulty in mobile app use and usability of the mobile phone–based self-help CBT-I app, named MIND MORE, in urban community-dwelling Korean older adults; to compare changes in subjective sleep quality from pre-intervention to post-intervention, during which they used the mobile app over a 1-week intervention period; and evaluate adherence to the app. Methods During the 2-hour training program delivered on 1 day titled “Overcoming insomnia without medication: How to use the ‘MIND MORE’ mobile app for systematic self-management of insomnia” (pre-intervention), 41 attendants were asked to gain hands-on experience with the app facilitated by therapists and volunteer workers. They were then asked to complete questionnaires on sociodemographic characteristics, subjective evaluation of mental health status (ie, depression, memory loss and impairment, and sleep problems), and app usability. For the 1-week home-based self-help CBT-I using the app (post-intervention), 9 of the 41 program attendants, who had already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the 1-week intervention, specifically 8 days after the training program ended. Results Due to missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows. First, poor subjective sleep quality was associated with higher ratings of depressive symptoms (40/40; ρ=.60, P<.001) and memory complaints (40/40; ρ=.46, P=.003) at baseline. Second, significant improvements in subjective sleep quality from pre-intervention to post-intervention were observed in the older adults who used the MIND MORE app only for the 1-week intervention period (9/9; t8=3.74, P=.006). Third, apart from the program attendants who did not have a smartphone (2/40) or withdrew from their MIND MORE membership (3/40), those who attended the 1-day sleep education program adhered to the app from at least 2 weeks (13/35, 37%) to 8 weeks (2/35, 6%) without any further contact. Conclusions This study provides empirical evidence that the newly developed MIND MORE app not only is usable among older users but also could improve subjective sleep quality after a 1-week self-help intervention period.


2018 ◽  
pp. 1-6
Author(s):  
M. LOCQUET ◽  
C. BEAUDART ◽  
L. DELANDSHEERE ◽  
J.-Y. REGINSTER ◽  
O. BRUYÈRE

Background: It seems that sleep quality could impact the physiological process related to loss of muscle mass. Objectives: We seek to compare subjective sleep quality of sarcopenic and non-sarcopenic subjects diagnosed according to 6 definitions. Design: Cross-sectional data used in this analysis were collected from the SarcoPhAge (Sarcopenia & Physical Impairment with Advancing Age) cohort, a prospective study aiming to assess clinical parameters linked to sarcopenia. Participants: The present study was interested in community-dwelling older adults with and without sarcopenia. Measurements – A diagnosis of sarcopenia was established according to 6 definitions. Three assessments were carried out: an evaluation of lean mass, a measurement of muscle strength and an assessment of physical performance. In addition, to evaluate the parameters of subjective sleep, we used the Pittsburgh Sleep Quality Index (PSQI), a self-administered questionnaire evaluating 7 components of sleep architecture. Results: A total of 255 individuals aged 74.7±5.8 years were included. Based on the 6 different definitions, the prevalence of sarcopenia ranged from 5.9% to 32.5%. There was no significant difference between sarcopenic and non-sarcopenic subjects regarding most of the components of subjective sleep quality. However, the definition of Cruz-Jentoft et al. (2010) indicated that sarcopenic subjects had higher scores than non-sarcopenic subjects for two components: sleep latency and day-time dysfunction (p=0.03 and p=0.04, adjusted for confounders). Moreover, some parameters of sleep quality were correlated with components of sarcopenia. Conclusions: Some properties of subjective sleep quality seem to be associated with sarcopenia and seem correlated with at least one of the three components of the condition.


SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A118-A119
Author(s):  
Mara Egeler ◽  
Andrew Kubala ◽  
Subashan Perera ◽  
Sanjay Patel ◽  
Martica Hall ◽  
...  

Abstract Introduction Both poor sleep and sedentary behavior lead to negative health outcomes. While some previous studies have observed an association between poor sleep and greater sedentary behavior, few studies have assessed this relationship using an objective measure of sedentary behavior. We examined the association of both self-reported and objectively-measured sleep with objectively-measured sedentary behavior. Methods In a secondary analysis of baseline data from an ongoing clinical trial, the present analysis included 157 physically inactive adults with elevated blood pressure (120–159 mmHg systolic or 90–99 diastolic) and desk jobs (82.8% white, 65.6% female, age 45.5±12.0). To assess sedentary behavior, participants wore an accelerometer/inclinometer (activPAL3 micro) on the upper thigh continuously for 7 days. Variables included total sedentary time, prolonged sedentary time (≥30 minute bouts), and sit-to-stand transitions; these were averaged across all waking hours as well as the workday. To assess sleep, participants completed the Pittsburgh Sleep Quality Index (PSQI) and a subsample (n=57) wore an Actiwatch Spectrum for 7 nights. Variables examined included the PSQI global score, actigraphy-based total sleep time (TST) and sleep efficiency (SE). Linear regression examined associations between sleep and sedentary behavior, with adjustments for age, gender, race, body mass index, and activPAL3 wear time. Results Participants had (mean±standard deviation) 11.1±1.5 hours sedentary time per day, with 6.3±2.0 occurring in ≥30 minute bouts, and 51.3±13.4 sit-to-stand transitions. During the workday, participants had 6.6±1.3 hours sedentary time with 3.8±1.7 occurring in ≥30 minute bouts and 27.2±11.2 sit-to-stand transitions. PSQI global score was 4.9±2.9; 32.5% were classified as poor sleepers. Actigraphic TST was 6.7±0.8 hours, with SE of 85.4±6.3%.Greater SE was associated with less sit-to-stand transitions during the workday (β=-0.36, p=0.01) and during the full day (β=-0.37, p=0.01). Subjective sleep quality and actigraphic TST were not associated with sedentary behavior. Conclusion We did not find a cross-sectional association between sedentary behavior and sleep in insufficiently active adults, potentially due to restricted range of sedentary behavior and physical activity in the sample. The association between greater sleep efficiency with fewer sit-to-stand transitions is counterintuitive and warrants further exploration. Support (if any) This study was funded by National Institutes of Health (NIH) grants R01HL134809 and R01HL147610.


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