Subjective and Objective Napping and Sleep in Older Adults: Are Evening Naps “Bad” for Nighttime Sleep?

Abstract

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.

Daytime napping and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis of prospective cohort studies

“…First, collecting information on daytime napping was accomplished through self-reports in all included studies. Previous studies suggested that older subjects tended to underreport their napping behaviors [43]. Consequently, our meta-analysis might underestimate the risk estimates for the association between daytime napping and mortality.…”

Sleep in Older Adults

“…For example, a patient may develop increased pre-sleep anxiety due to fear of having another night of insomnia (conditioning), or they may use TV or radio to help “relax” or occupy their time while waiting to fall asleep. Others may start to have variable bed times to deal with insomnia or take daytime naps; while naps are generally not recommended for patients with insomnia, for older adults without insomnia complaints, it is important to note that naps have minimal side effects 36 and improve vigilance/performance post-naps. 37 Addressing these perpetuating factors is an important goal of non-pharmacologic insomnia treatment as discussed further below.…”

Epidemiology of Bedtime, Arising Time, and Time in Bed: Analysis of Age, Gender, and Ethnicity

“…The majority of studies that have collected data on bedtime and arising time typically focus on a specific age group (Campbell, Gillin, Kripke, Erikson, & Clopton, 1989;Dautovich, McCrae, & Rowe, 2008;Ishihara, Miyasita, Inugami, Fukuda, & Miyata, 1987;Ohayon & Vecchierini, 2005), although a few studies exist that have included more diverse age groups Hume, Van, & Watson, 1998;Lichstein, Durrence, Reidel, Taylor, & Bush, 2004). Thus, there is a dearth of literature regarding basic behavioral circadian parameters.…”