Objective It is known that osteoarthritis (OA) increases risk of sleep disturbance, and that both pain and sleep problems may trigger functional disability and depression. However, studies examining all four variables simultaneously are rare. This research therefore examined cross-sectional and longitudinal associations of self-reported sleep disturbance with OA-related pain and disability, and depressive symptoms. Methods At baseline, 367 persons with physician-diagnosed knee OA reported sleep disturbances, pain, functional limitations, and depressive symptoms. All measures were repeated a year later (N = 288). Baseline analyses examined the independent and interactive associations of sleep disturbance with pain, disability and depression, net of demographics and general health. Longitudinal analyses used baseline sleep disturbance to predict one-year change in pain, disability and depression. Results At baseline, sleep was independently associated with pain and depression, but not disability. The sleep-pain relationship was mediated by depressive symptoms; sleep interacted with pain to exacerbate depression among persons with high levels of pain. Baseline sleep disturbance predicted increased depression and disability, but not pain, at follow-up. Conclusions These data confirm known cross-sectional relationships of sleep disturbance with pain and depression, and provide new insights on longitudinal associations among those variables. Depression appears to play a strong role in the sleep-pain linkage, particularly where pain is severe. The unique predictive role of sleep in progression of disability requires further study, but may be an important point of intervention to prevent OA-related functional decline among persons whose sleep is disrupted by OA pain.

Increased age is associated with normative declines in both sleep and cognitive functioning. Although there are some inconsistencies in the literature, negative sleep changes are associated with worse cognitive functioning. This negative relationship holds true across normal-sleeping older adults, older adults with insomnia, older adults with sleep disordered breathing, cognitively healthy older adults, and older adults with dementia. There are mixed results regarding potential benefits of sleep treatments on cognitive functions; however, this line of research deserves added attention because the potential mechanisms of action are likely distinct from other interventions to improve cognition.

We examined sleep complaints, subjective and objective sleep patterns, health, psychological adjustment, and daytime functioning in 103 community-dwelling older adults to identify factors associated with sleep complaints. We collected 2 weeks of sleep diaries and actigraphy. Only health distinguished complaining from noncomplaining sleepers. Noncomplaining good sleepers had poorer objective sleep quantity than complaining poor sleepers. Actigraphy distinguished noncomplaining good and complaining poor sleepers only. Subjective and objective sleep quantities were related for noncomplainers only; this relationship was stronger for women. Implications include a need for research exploring: 1. sleep complaints, sleep perceptions, and health; 2. interventions focusing on older individuals with insomnia secondary to/comorbid with poor health; 3. gender differences in subjective sleep estimates and in "single-shot" versus longitudinal sleep measures.

To truly assess and understand individual differences in the sleep of older adults, future research needs to take into account night-to-night variability (including what makes sleep vary from one night to the next), in addition to average sleep.

In this study, insomnia symptoms experienced by middle-aged and older adults were associated with greater future use of costly health services. Our findings raise the question of whether treating or preventing insomnia in older adults may reduce use of and spending on health services among this population.

Objectives To compare objective and subjective measurements of napping, and to examine the relationship between evening napping and nocturnal sleep in older adults. Design For twelve days, participants wore actigraphs and completed sleep diaries. Setting Community Participants 100 individuals who napped, 60–89 years (including good and poor sleepers with typical age-related medical comorbidities). Measurements Twelve days of sleep diary and actigraphy provided subjective and objective napping and sleep data. Results Evening naps (within 2 hours of bedtime) were characteristic of the sample with peak nap time occurring between 20:30–21:00 (average nap time occurred between 14:30–15:00). Two categories of nappers were identified: 1) day/evening – those who took both daytime and evening naps, and 2) daytime-only. Interestingly, no participants napped during the evening only. Day/evening nappers significantly underreported evening napping and demonstrated lower objectively measured sleep onset latencies (20 vs 26.5 minutes), less wake after sleep onset (51.4 vs 72.8 minutes), and higher sleep efficiencies (76.8 vs 82%) than daytime-only nappers. Conclusion Day/evening napping was prevalent amongst this sample of community-dwelling good/poor sleepers, but was not associated with impaired nocturnal sleep. Although the elimination or restriction of napping is a common element of cognitive-behavioral therapy for insomnia (CBTi), these results suggest that a uniform recommendation to restrict/eliminate napping (particularly evening napping) may not meet the needs of all older individuals with insomnia.

NCT02967185.

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