NSF's Latest Poll Shows That Sleep, Health and Aging are Linked.

HEALTHY OLDER ADULTS TEND TO SLEEP WELL, BUT THOSE WITH HEALTH PROBLEMS ALSO TEND TO HAVE SLEEP PROBLEMS. IS THERE A CONNECTION?

Nan Jansen is an active retired woman in her 80s, living in Bethesda, MD. She volunteers several days a week, delivering Meals on Wheels, serving on the auxiliary board of a center for children with emotional problems, and playing chauffeur to some of her older friends who have difficulty getting around.

She sleeps about seven hours each night and rarely has difficulty sleeping. Once in awhile, she wakes up during the night and can't get back to sleep. Back pain is often the cause of her sleep disturbance. She doesn't usually take a nap during the day.

Nan Jansen is similar to many of the respondents to NSF's 2003 Sleep in America poll, which is the first NSF poll to look at the sleep habits of older Americans -- those between the ages of 55 and 84 -- and the association between their sleep behavior, their medical and physical conditions, their outlook and their lifestyles.

The poll results suggest that, like Nan, many older Americans are sleeping well and may actually sleep better than adults aged 18-54. More older adults are sleeping 7-9 hours on both weeknights and weekends (56% vs. 51% for weeknights and 60% vs. 55% for weekends). Additionally, the 32% of older adults who nap 1–3 days a week or more get an average of 41-51 minutes of supplemental sleep time.

A closer look at the NSF poll data, however, found a striking relationship between two sets of factors infrequently considered together in medical care: the health and quality of life of older adults, and their sleep quantity and quality. The NSF poll found that the better the health of older adults, the more likely they are to sleep well. Conversely, the greater the number of diagnosed medical conditions, the more likely they are to report sleep problems. Additionally, among older adults, more positive moods and outlooks as well as having more active and "engaged" lifestyles (having someone to speak with about a problem, exercise, volunteer activity, etc.) are associated with sleeping 7–9 hours and fewer sleep complaints.

"In spite of the emerging science linking sleep quality and health status," says NSF President James K. Walsh, PhD, "Most people believe that poor sleep is an inevitable consequence of getting older. But NSF’s poll findings reinforce the relationship between good sleep and good overall health, particularly in older individuals.

"Rather than a consequence of aging, poor sleep among older Americans appears to be an indicator of health status." Dr. Walsh is Executive Director and Senior Scientist of the Sleep Medicine and Research Center at St. Luke's Hospital in Chesterfield, MO.

Sleep and Health

In the 2003 poll, NSF profiled the sleep patterns and sleep complaints of 1,506 older Americans. About two-thirds of older adults (67%) report experiencing one or more of the following symptoms of a sleep problem at least a few nights a week:

In spite of the abundance of these sleep complaints, only a small fraction (one out of eight) say that they have been diagnosed with a sleep disorder and fewer are treated.

When NSF also asked respondents to rate their health, those who rate their health as good to excellent are less likely to report a sleep problem than those who say their health is fair to poor (59% vs. 85%).

For instance, those who report having excellent or very good health are less likely to sleep less than six hours than those who describe their health as fair or poor (11% vs. 22%).

Similar findings occurred when health assessments were compared to symptoms of sleep disorders. For instance, among those who rate their health as excellent or very good, 38% say they have one or more symptoms of insomnia, but nearly double (71%) have such symptoms if they report their health as fair or poor. Similar patterns occurred for all reported symptoms of sleep disorders such as those associated with sleep apnea or restless legs syndrome: those who report better health report fewer symptoms of sleep disorders.

NSF also asked respondents if they had been told by a doctor that they have any one of 11 common medical conditions, including high blood pressure, heart disease, stroke, diabetes, arthritis, lung disease, cancer, depression, memory problems, enlarged prostate and osteoporosis.

The number of reported medical conditions increases with age, but 19% of all respondents reported having four or more conditions. When compared to those who have no medical conditions, those with four or more conditions have a greater likelihood of sleeping less than six hours (22% vs. 10%), are more likely to rate their sleep as fair or poor (40% vs. 10%), are more likely to report a sleep problem (80% vs. 53%) and are more likely to experience daytime sleepiness (27% vs. 5%).

Often such signs of sleepiness and sleep problems have been assumed to result from the medical condition that is being treated. But the poll data suggest that many older Americans who have been diagnosed with a variety of medical conditions may be suffering as much or more from poor sleep.

NSF also questioned respondents about their mood, outlook on life, cognitive function, social involvement, exercise frequency, and financial security. In general, those who assess themselves positively in these areas—people like Nan Jansen—also are more likely to sleep seven to nine hours each night, rate their sleep quality as excellent or very good, and report fewer sleep problems and diagnoses of a sleep disorder.

So, what does the Sleep in America poll tell us about the connection between sleep, health and aging? "We reaffirm what we know from the epidemiology of aging that there is a very strong correlation between common medical conditions and a predisposition to sleep disturbances," says Daniel Foley, an epidemiologist at the National Institute on Aging who assisted NSF with the 2003 Sleep in America poll. "A person may have several medical conditions that they're seeing their doctor about and they may be getting treatment, but they don't feel they're getting better. What may go unrecognized is a tremendous amount of sleep disturbance and daytime sleepiness. What may go overlooked is a major sleep disorder that may be complicating treatment of the other conditions.

"The poll results show we need to educate the public and healthcare professionals about the connection between sleep, health and aging."

The poll was conducted by WB&A Market Research.