Long-Term Implications of Poor Sleep

Disrupted sleep increases risk of seniors moving to assisted living

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) The list of ways sleep can affect a person's health is almost endless. Yet the quality and amount of sleep people get also affects their future.

A recent study found that poor or disturbed sleep among the elderly is linked to a higher likelihood of them ending up in an assisted care facility.

"Get 7-9 hours of sleep a night, or talk to a doctor."

The study, led by Adam P. Spira, PhD, an assistant professor in the Department of Mental Health at Johns Hopkins University's Bloomberg School of Public Health, involved a population of 1,664 older women, with an average age of 83.

For an average of four nights (minimum three), the women wore actigraphs on their wrists. Actigraphs are devices which measure the movement of the body part they're on and are frequently used to estimate when someone is asleep or awake.

Although actigraphs do not provide the most precise measurements of sleep and wakefulness, they have been determined to be fairly reliable in objectively estimating a person's amount of sleep.

These women slept an average of 6.8 hours a night, give or take 1.2 hours.

On average, they were awake for about 1.2 hours throughout the night after the first time they fell asleep.

After this initial assessment, when all the women had been living in a community independently, the researchers followed up with them five years later.

At this follow-up, 4 percent of the women were living in a nursing home, and 8 percent were in a personal care home.

When the researchers analyzed their data, they found that the women who spent the most amount of time awake after the first time they fell asleep, during their initial assessment, were almost three times as likely to be living in a nursing home five years later.

These women, who were ranked in the top quarter in terms of how much time they spent awake during the night, were also a little over twice as likely to be living in a personal care home at the follow-up.

The researchers also measured the sleep efficiency of the women during the initial 4-night study and found similar results.

Those with the lowest sleep efficiency were more than three times more likely to be in a nursing home and twice as likely to be in a personal care home.

These results remained even after the researchers took into account other demographic variables that might have influenced their likelihood of living in a facility.

Yet there was no link between how long the women slept and whether they ended up in an assisted care facility. It was simply the fragmentation of their sleep that was linked to the higher risk.

"Sleep disturbances are common in older people," said Dr. Spira. "Our results show that in community-dwelling older women, more fragmented sleep is associated with a greater risk of being placed in a nursing home or in a personal care home."

The study established an association but could not establish that poor sleep caused the women to end up in a nursing home.

"It's important to remember that this is an observational study, so our findings cannot demonstrate a conclusive causal link between sleep disturbance and placement in long-term care facilities," Dr. Spira said. "We need more research to explain how sleep disturbance might lead to this outcome, and whether interventions to improve sleep might prevent it."

According to William Kohler, MD, the director of the Florida Sleep Institute in Spring Hill, Florida, past research has already shown links between poor sleep and early entrance into a nursing home, though those studies relied on recall rather than objective measurements of sleep.

"It's been known for quite a while that disrupted sleep is associated with early nursing home placement not only because of the patient themselves needing the nursing home care but also because of the caregiver," said Dr. Kohler, who was not associated with this study.

"If the patient disrupts the caregiver, the caregiver is going to fatigue and not be able to give the care that the patient needs," he said. "They will end up having to place them in a nursing home or assisted living facility because of the inability to take care of them."

He added that the use of actigraphy made this study more valuable.

"[Actigraphy] does not absolutely define sleep, but it is a very good indicator of when the person is asleep and when they're awake based on the movement," Dr. Kohler told dailyRx. "This study is important in that it confirms previous literature that sleep disruption does interfere with the ability to continue to live independently in your own home setting."

Other conditions linked to poor sleep range from cardiovascular disease and depression to obesity and diabetes.

The study was published July 19 in the Journal of the American Geriatrics Society. The research was funded by the National Institute on Aging, the National Institutes of Health and an Alzheimer's Association Award.

One author works for a sleep publication that receives support from pharmaceutical companies and has received funds for a presentation at a private sleep medicine practice. Another author has received funding from Novartis, and most of the authors have received other grants from the National Institutes of Health.

Reviewed by: 
Review Date: 
July 25, 2012
Last Updated:
February 11, 2013