Determinants of insomnia in relatively healthy elderly. A literature review

A review is presented based on the findings resulting from interview and questionnaire research concerning factors that determine insomnia in relatively healthy elderly. The investigated factors include modes of living, sleep wishes and personality aspects. During the period 1988-1997 18 published reports were found. Based on the findings it is difficult to claim that elderly persons with insomnia are characterized by inappropriate modes of living. There were, however, some (inconsistent) indications that tea consumption, smoking and lack of exercise predicted insomnia. There were also scarce indications for less realistic sleep expectations in bad than in good sleepers. More bad sleepers perceived their sleep as uncontrollable and unpredictable than than good sleepers. Bad sleepers had significantly higher scores for anxiety, neuroticism and depression than good sleepers. Anxiety as well as depression correlated positively with insomnia and negatively with sleep duration. Depression, anxiety or neuroticism often were better predictors of insomnia than health indicators such as perceived health and number of prescribed drugs. The findings suggest that insomnia in relatively healthy elderly is more tightly associated with psychological factors than with modes of living or health indicators. This has some consequences for therapy. In addition to advice concerning modes of living and sleep hygiene, one has to be alert for the possible presence of depression or anxiety. In that case depression or anxiety has to be treated, pharmacologically or nonpharmacologically.     

Circadian rhythms and insomnia

Sleep and Biological Rhythms - Circadian rhythms strongly influence when we are sleepy and when we are alert. If the timing of these rhythms is later than normal, it can contribute to sleep onset...     

The impact of insomnia and sleep disturbances on depression and suicidality.

Previous research has demonstrated an association between suicidality and sleep, suggesting that sleep disturbances may exacerbate mood dysregulation in participants suffering from mood disorders. The purpose of this study was to investigate the impact of sleep disturbances and insomnia on depression and suicidality in a nontreatment seeking sample of college students. Results indicated that insomnia and nightmares were significant predictors of symptoms of depression, while only nightmares significantly predicted suicidal ideation. Further analysis indicated that participants with elevated scores on insomnia, nightmares, or both experienced differing levels of depression and suicidal ideation. Future directions and treatment implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dreaming and insomnia: Polysomnographic correlates of reported dream recall frequency.

This study assesses which polysomnographic variables are associated with changes in reported dream recall frequency in patients meeting diagnostic criteria for primary insomnia. Data analyzed included sleep latency, total sleep time, sleep efficiency, time in REM, time in sleep stages (1&2 vs. 3&4), and periodic limb movement. For the grouping meeting ICD-10 diagnostic criteria for primary insomnia, a significant decrease in dream recall was found compared to the noninsomniac group. A decline in polysomnographic sleep quality was associated with a decline in reported dream or nightmare recall frequency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical significance and management of insomnia

Sleep and Biological Rhythms - Several epidemiological studies have shown that more than 20% of the general adult population has symptoms of insomnia, but only about 5% of them are receiving...     

Subjective sleep characteristics in primary insomnia versus insomnia with comorbid anxiety or mood disorder

Sleep and Biological Rhythms - We assessed subjective sleep measures in a cohort of 146 patients with chronic insomnia and hypothesized that these measures may differ depending on the presence as...     

The association between work burnout and insomnia: how to prevent workers’ insomnia

Sleep and Biological Rhythms -     

Assessment of preoperative cases.

A total of 200 outpatients in Aberdeen were invited to complete a simple preoperative anaesthetic assessment questionnaire. Of these patients 45-5% had significant medical histories and 59% were on concurrent drug therapy. The form was thought to be valuable for day-case anaesthetists and surgeons.     

Variations in circadian genes and individual nocturnal symptoms of insomnia. The HUNT study

Insomnia is a condition characterized by three nocturnal symptoms: problems with sleep onset or maintenance and early morning awakenings (terminal insomnia). Affected individuals may present one or more of these symptoms. Several studies have shown that insomnia is moderately heritable and that proxy phenotypes for the three insomnia symptoms show different heritabilities. This suggests that different nocturnal symptoms of insomnia may arise from different genetic and biological backgrounds. Circadian genes are good candidates to account for these differences as they regulate the periodicity of several physiological functions including sleep. Evidence from studies in animals and humans have suggested that circadian genes might be involved in sleep disturbances such as insomnia. In this study, we investigated the association between Single Nucleotide Polymorphisms (SNPs) in circadian genes and individual symptoms of insomnia and their combinations using data from the Nord-Trøndelag Health Study 3 (the HUNT3 study, N = 50807). Participants (N = 6029) provided information about sleep onset insomnia, maintenance insomnia, and terminal insomnia. Participants who responded “several times a week” to at least one question regarding the mentioned symptoms were classified as cases (N = 3577) and categorized in seven subgroups according to possible symptom combinations. Controls (N = 2452) answered “Never/Seldom” to all sleep-related questions. Using multinomial regression, we assessed 73 SNPs in nine circadian genes (PER1, 2, 3, CRY1, 2, TIMELESS, CLOCK, REV-ERBα, ARNTL) for differences among symptoms subgroups. Twenty-five SNPs showed significant p-values and supportive odds-ratios. All significant SNPs in PER3 were associated with reporting all three symptoms simultaneously. SNPs in CRY genes were associated with terminal insomnia alone or in combination with other symptoms. Genes PER1 and two were mostly associated with sleep maintenance insomnia. However, none of the SNPs remained significant after False Discovery Rate (FDR) correction for multiple statistical testing. In conclusion, even though none of the SNPs remained significant after FDR correction, the clustering of some genes around specific symptoms points to the need for additional research on these relationships.