Poor Sleep in Elderly Patients Linked to Anxiety, Sleep Medications, Pain

older woman trying to sleep
Previous studies have shown that sleep efficiency decreases with age, but additional factors may have an important role.

Several factors may increase the risk for poor sleep efficiency in elderly people, including pain, nocturia, sleep medication use, bad dreams, painful illness, and sex, according to study results published in Sleep. Furthermore, typically prescribed sleep hygiene behaviors made no significant contribution.

Sleep efficiency is defined as the ratio of total sleep time to time in bed. Previous studies have shown that sleep efficiency decreases with age, but additional factors may have an important role. The goal of the current study was to explore various factors to predict sleep efficiency in the elderly, as well as possible sex difference.

The cross-sectional study was based on data from the Quebec Survey on Seniors’ Health, conducted from 2005 to 2006. The survey included community-dwelling participants aged >65 years. Of 3675 potential responders contacted, the study sample included 2785 participants, of whom 2468 were included in the final analysis cohort (mean age, 73.7 years; 59.3% women).

Of the study participants, 28.4% had lower than 80% sleep efficiency, calculated on the basis of interview responses.

Seven factors were found to be significantly associated with sleep efficiency. Pain and nocturia were associated with a roughly 2-fold increased risk for poor sleep efficiency (adjusted odds ratio [aOR], 2.01 [95% CI, 1.61-2.50] and aOR, 1.98 [95% CI, 1.63-2.40], respectively). Poor sleep efficiency was also associated with sleep medication use (aOR, 1.82; 95% CI, 1.48-2.22), bad dreams (aOR, 1.32; 95% CI, 1.28-2.15), painful illness (aOR, 1.32; 95% CI, 1.08-1.62), sex (aOR, 1.32; 95% CI, 1.06-1.61), and age (aOR, 1.23; 95% CI, 1.01-1.49).

There were several factors that were associated with sleep efficiency that differ significantly between men and women: anxiety disorder (aOR, 1.69; 95% CI, 1.04-2.75) and age ≥75 years were each associated with poor sleep efficiency for women only, and painful illness (aOR, 1.69; 95% CI, 1.21-2.37) and being single (aOR, 1.54; 95% CI, 1.11-2.13) were each associated with increased risk for poor sleep efficiency in men. Except for sex, all the factors that showed associations with sleep efficiency affected younger and older elderly people similarly.

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The researchers acknowledged several limitations to the study, including the cross-sectional design, assessment of sleep efficiency based on subjective reports, possible recall bias as some questions targeted a period of 1 month previously, and lack of assessment of the presence of other sleep disorders.

“These findings can orient researchers and clinicians toward a deeper understanding of sleep efficiency in the elderly and the development of new ways to help them improve it,” concluded the researchers.


Desjardins S, Lapierre S, Hudon C, Desgagné A. Factors involved in sleep efficiency: a population-based study of community-dwelling elderly persons. Sleep. 2019;42(5):zsz038. doi:10.1093/sleep/zsz038

This article originally appeared on Neurology Advisor