Regular Research Articles
Insomnia Symptoms in Older Adults: Associated Factors and Gender Differences

https://doi.org/10.1097/JGP.0b013e3181e049b6Get rights and content

Objectives

The aim of this study was to examine the factors associated with insomnia in community-dwelling elderly as a function of the nature and number of insomnia symptoms (IS), e.g., difficulty with initiating sleep (DIS), difficulty with maintaining sleep (DMS), and early morning awakening (EMA).

Methods

IS were assessed in a sample of 2,673 men and 3,213 women aged 65 years and older. The participants were administered standardized questionnaires regarding the frequency of IS and other sleep characteristics (snoring, nightmares, sleeping medication, and sleepiness) and various sociodemographic, behavioral and clinical variables, and measures of physical and mental health.

Results

More than 70% of men and women reported at least one IS, DMS being the most prevalent symptom in both men and women. Women reported more frequently two or three IS, whereas men reported more often only one IS. Multivariate regression analyses stratified by gender showed that men and women shared numerous factors associated with IS, sleeping medication, nightmares, sleepiness, chronic diseases, and depression being independently associated with two or three IS. For both sexes, age was associated with only one IS in all age categories. Loud snoring was strongly associated with increased DMS in men only. High body mass index increased the risk for DIS in men but tended to decrease it in women. In women, hormonal replacement therapy, Mediterranean diet, and caffeine and alcohol intake had a protective effect.

Conclusion

Our data suggest that women may have specific predisposition factors of multiple IS, which may involve both behavioral and hormonal factors. Identification and treatment of these risk factors may form the basis of an intervention program for reduction of IS in the elderly.

Section snippets

Participants

Subjects were recruited as part of a multisite cohort study of community-dwelling persons aged 65 years and older, randomly selected from the electoral rolls of three French cities (Bordeaux, Dijon, and Montpellier) between 1999 and 2001 (3C Study). The study design has been described elsewhere.22 The study protocol was approved by the Ethics Committee of the University-Hospital of Bicêtre (France), and written informed consent was obtained from each participant. A total of 9,294 subjects,

Participant Characteristics

Of the 9,294 participants initially recruited in the 3C Study, 217 diagnosed with dementia were excluded, 2,308 had not fully completed the sleep questionnaire, and 883 had missing data for confounding variables. The remaining 5,886 participants (54.59% of women) were included in the analysis. Compared with the analyzed sample, the subjects not included were significantly (p < 0.0001) more often women, older, widowed or separated, depressed, with low education level, more likely to have more

Distribution of IS in the Elderly General Population

In our study, IS were found to be highly prevalent, more than 70% of elderly reporting at least one IS. Similar result was reported in another study with 69% of subjects reporting at least one IS.26 In our study, the prevalence was higher in women than in men (75% versus 70%, χ2 test = 18.48, df = 1, p <0.0001). As already reported, DMS was the most frequent IS,1, 4, 27, 28, 29, 30, 31 and we further observed a comparable prevalence in men and women. As an isolated symptom, it was independently

CONCLUSION

Complaints of IS are common in the elderly general population, with more than 70% of men and women in our study reporting IS with a significantly higher prevalence in women than in men. Women more frequently experience two or three symptoms, whereas men more frequently complain of only one symptom. As insomnia is frequently determined by a cutoff point on a scale, this could explain why the prevalence rates are often reported to be higher in women. Factors associated with IS are very similar

References (54)

  • MB Scharf et al.

    Effects of estrogen replacement therapy on rates of cyclic alternating patterns and hot-flush events during sleep in postmenopausal women: a pilot study

    Clin Ther

    (1997)
  • KJ Brower

    Insomnia, alcoholism and relapse

    Sleep Med Rev

    (2003)
  • T Roehrs et al.

    Caffeine: sleep and daytime sleepiness

    Sleep Med Rev

    (2008)
  • MS Aloia et al.

    Examining the construct of depression in obstructive sleep apnea syndrome

    Sleep Med

    (2005)
  • DJ Foley et al.

    Sleep complaints among elderly persons: an epidemiologic study of three communities

    Sleep

    (1995)
  • MV Vitiello

    Sleep disorders and aging: understanding the causes

    J Gerontol A Biol Sci Med Sci

    (1997)
  • AB Newman et al.

    Sleep disturbance, psychosocial correlates, and cardiovascular disease in 5201 older adults: the Cardiovascular Health Study

    J Am Geriatr Soc

    (1997)
  • S Maggi et al.

    Sleep complaints in community-dwelling older persons: prevalence, associated factors, and reported causes

    J Am Geriatr Soc

    (1998)
  • MM Ohayon et al.

    How age and daytime activities are related to insomnia in the general population: consequences for older people

    J Am Geriatr Soc

    (2001)
  • R Stewart et al.

    Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16 to 74 years

    Sleep

    (2006)
  • M Ganguli et al.

    Prevalence and persistence of sleep complaints in a rural older community sample: the MoVIES project

    J Am Geriatr Soc

    (1996)
  • TP Su et al.

    Prevalence and risk factors of insomnia in community-dwelling Chinese elderly: a Taiwanese urban area survey

    Aust N Z J Psychiatry

    (2004)
  • E Lindberg et al.

    Sleep disturbances in a young adult population: can gender differences be explained by differences in psychological status?

    Sleep

    (1997)
  • M Piccinelli et al.

    Gender differences in depression. Critical review

    Br J Psychiatry

    (2000)
  • DE Ford et al.

    Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?

    JAMA

    (1989)
  • B Zhang et al.

    Sex differences in insomnia: a meta-analysis

    Sleep

    (2006)
  • LA Reyner et al.

    Gender- and age-related differences in sleep determined by home- recorded sleep logs and actimetry from 400 adults

    Sleep

    (1995)
  • Cited by (0)

    The 3C Study is conducted under a partnership agreement between Inserm, the Victor Segalen–Bordeaux II University, and Sanofi-Synthélabo. The Fondation pour la Recherche Médicale funded the preparation and first phase of the study. The 3C Study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, Institut de la Longévité, Agence Française de Sécurité Sanitaire des Produits de Santé, the Regional Governments of Aquitaine, Bourgogne and Languedoc-Roussillon, and the Fondation de France, the Ministry of Research-Inserm Programme “Cohorts and collection of biological material.” The Lille Génopôle received an unconditional grant from Eisai. Part of this project is supported by a grant from the Agence Nationale de la Recherche (ANR project 07 LVIE 004).

    The funding organizations played no role in the design or conduct of the study or in the collection, management, analysis, or interpretation of the data and did not participate in preparation, review, or approval of the manuscript.

    View full text