Age-related sleep change: Gender and estrogen effects on the subjective–objective sleep quality relationships of healthy, noncomplaining older men and women

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Abstract

Objective

The sleep of a large group of healthy older men and women was studied in an effort to better understand the relationship between self-reported subjective and objectively measured sleep quality.

Methods

We examined the baseline subjective and objective sleep quality of 150 healthy older (67.5±0.5) men (n=55) and women (n=95). Subjects were carefully screened to exclude sleep disorders and did not complain of significant sleep disturbance.

Results

Despite their noncomplaining status, significant proportions of both women (33%) and men (16%) endorsed Pittsburgh Sleep Quality Index (PSQI) scores of >5, a criterion indicative of significant sleep disturbance. When examined as a function of this criterion, objective sleep was significantly impaired with longer sleep latency, less total sleep time, and lower sleep efficiency, for the high-PSQI (H-PSQI) men compared to low-PSQI (L-PSQI) men. These L-PSQI versus H-PSQI differences were much weaker for women and disappeared completely in women on estrogen replacement therapy.

Conclusions

This large group of healthy, noncomplaining older adults manifested significantly disturbed sleep relative to healthy younger subjects, indicating that while aging results in significant changes in sleep, it does not of necessity result in complaints of insomnia and that many healthy older individuals apparently adapt their perception of what is “acceptable” sleep. A considerable correspondence between subjective and objective sleep quality was observed for men but not for women, despite women more frequently endorsing the presence of significant sleep disturbance. This finding is provocative and suggests that what we consider objective measures of good-quality sleep may be appropriate for older men but that older women may be evaluating their sleep quality using other criteria.

Introduction

Numerous epidemiological studies suggest that up to 50% of elderly individuals complain of poor sleep [1]. This is unlikely the result of the aging process, per se, as this same statistic suggests that more than half of the elderly population do not consider their sleep to be particularly poor, or at least do not readily volunteer such complaints. Recent studies by Foley and colleagues [2], [3] suggest that much of this observed complaint is likely secondary to, and waxes and wanes, with health burden.

Previously we reported that a large group of healthy, noncomplaining older men and women manifested significantly disturbed sleep relative to healthy younger subjects [4]. This is consistent with Foley et al., indicating that while aging, per se, results in significant changes in sleep, it does not of necessity result in complaint about sleep quality [2], [3]. This also agrees with Buysee et al., who suggested that despite their objectively disturbed sleep, healthy noncomplaining older individuals appear to adapt their perception of what is “acceptable” sleep and therefore do not necessarily complain [5].

Previously, we examined the relationship between self-reported endorsement of significant sleep disturbance and objectively measured sleep in a moderately sized sample (n=95) of carefully screened healthy older men and women who did not complain of significant sleep disturbance. We reported significant correlations between subjective sleep quality and an objective measure of sleep fragmentation [4]. In order to better examine the subjective–objective sleep relationship in older noncomplaining men and women, we examined the baseline self-reported and objectively measured sleep quality of a new, larger sample (N=150) of healthy older noncomplaining men and women who participated in one of three studies that assessed the impact of various interventions on the sleep quality of older adults. A much abbreviated report of these findings has previously been published elsewhere in abstract form [6].

Section snippets

Methods

We examined the baseline subjective (self-report) and objective (polysomnography) sleep quality of 150 healthy, community-dwelling, noncomplaining older (67.5±0.5 years, mean±standard error) men (n=55) and women (n=95), during their participation in the baseline conditions of two NIMH and one NIA intervention studies. MH45186, “Aerobic Fitness: Sleep and Its Correlates in the Aged” (MVV, PI) investigated the impact of 6 months of endurance versus stretching/flexibility fitness training on

Results

Table 1 shows PSQI values and objective sleep variables for the entire study sample. Bivariate analyses of the total study sample revealed significant correlations between PSQI subjective estimates and polysomnographic objective estimates of sleep variables, specifically: time in bed (TIB; r=.44, P<.000), total sleep time (r=.29, P<.000), total wake time (r=.27, P<.001), sleep efficiency (r=.24, P<.003) and sleep latency (r=.16, P<.05). Given that the objective sleep from a single night's sleep

Discussion

Healthy, carefully screened noncomplaining older men and women, that is, those who denied having any significant sleep complaints during a rigorous screening protocol, revealed significantly disturbed objective sleep profiles relative to those seen in healthy younger noncomplaining adults. Significant proportions of both the men and the women of this carefully screened, noncomplaining sample endorsed PSQI scores indicative of sleep disturbance, with significantly more women than men endorsing

Acknowledgements

This work was supported by the National Institutes of Health (RO1-MH45186, RO1-MH53575 and KO2-MH01158 to MVV and R01-AG15357 to KEM) and the American Sleep Medicine Foundation (to MVV). A portion of this work was conducted through the Clinical Research Center facility at the University of Washington and supported by NIH grant M01-RR-00037. We thank Drs. George R. Merriam and Robert S. Schwartz and Suzanne Barsness, Maria Bjelke, Jane Corkery Hahn, Gwen Drolet, Rebecca Green, David Hammerstein,

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