Sleep And Public Health - Rutgers University

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WHAT’SHOTA Newsletter ofIn This Issue:Spotlight on OTCSleep Aids andSleep Health inOlder AdultsSleep: An Essential Component ofHealth . . . . . . . . . . . . . . . . . . . . . . . 1Sleep and Public Health. . . . . . . . . 2Insomnia in the Older AdultPopulation . . . . . . . . . . . . . . . . . . . . 3Negative Health Impacts of PoorSleep in Older Adults. . . . . . . . . . . 4Caregiver Sleep Quality . . . . . . . . . 6Nonpharmacologic Approachesto Managing Chronic Insomnia:Cognitive Behavioral Therapy . . . . . 7Use of Over-the-Counter Sleep Aidsby Older Adults. . . . . . . . . . . . . . . . 8Improving Medication-TakingBehaviors of Older Adults. . . . . . . 10Conclusions . . . . . . . . . . . . . . . . . . 11Supported bySleep: An Essential Component of HealthSleep, like nutrition and exercise, isa key determinant of health andwell-being. Sleep is a basic humanrequirement that affects endocrine, metabolic, neurological, and cognitive functionsthat are critical to health.Many adults find that they have difficultysleeping a healthy amount. Accordingto the Centers for Disease Control andPrevention, 25% of U.S. adults reportinsufficient sleep or rest at least 15 out ofevery 30 days.1 Despite myriad reasons forinadequate sleep, many adults who reportdisturbed sleep suffer from insomnia—unsatisfactory sleep that affects daytimefunctioning in an individual who has adequate opportunity to sleep.2 Patients withinsomnia may experience either difficultyfalling asleep or difficulty staying asleep.Among those who experience disturbedsleep, an estimated 50 million to 70 million Americans have chronic insomnia, asleep disruption occurring at least 3 timesa week and lasting for more than 1 month.In addition to hindering daily functioning,chronic insomnia has been associated witha wide range of harmful health effects,including an increased risk of hypertension, diabetes, obesity, depression, heartattack, stroke, and pain.2,3The physiologic sequelae of sleep lossand sleep disorders not only affect individual health but also have a significanteconomic impact. Billions of dollars a yearare spent on direct medical costs associated with doctor visits, hospital services,prescriptions, and over-the-counter (OTC)medications for treating disturbed sleep.4Compared with other individuals, thosewith chronic sleep loss or sleep disordersare less productive, have greater healthcare needs, and have an increased likelihood of injury.3,5The impact of disturbed sleep on healthand well-being is under-recognized, andchronic insomnia is underdiagnosed andundertreated.6 Barriers to appropriate recognition and treatment of insomnia includeinadequate physician training, lack of timedevoted to discussing sleep during officevisits, beliefs that sleep complaints are notappropriate, and concerns about risks oftreatments for insomnia.6 Solutions areneeded to address unmet needs througheducation, awareness, and advocacy.A number of strategies are used inthe treatment of insomnia, includingboth nonpharmacologic and pharmacologic approaches. Nonpharmacologicapproaches include cognitive behavioraltherapy, relaxation training, and exercise.2,7These interventions have been found toWorkgroupSteven M. Albert, PhDProfessor and ChairDepartment of Behavioral and CommunityHealth SciencesGraduate School of Public HealthUniversity of PittsburghMichael Toscani, PharmDFellowship Administrator, Pharmaceutical Industry FellowshipsRutgers Institute for Pharmaceutical Industry FellowshipsAdjunct Clinical Professor, Ernest Mario School of PharmacyPresident, Clinical Solutionz, and ConsultingMedical Director for KOL, LLCMorris Lewis (ex officio)Senior Director, External AffairsPfizer Consumer HealthMichael V. Vitiello, PhDProfessorPsychiatry & Behavioral Sciences, Gerontology & GeriatricMedicine, and Biobehavioral NursingCodirector, Center for Research on Management of SleepDisturbancesCodirector, Northwest Geriatric Education CenterThomas Roth, PhDHenry Ford Health SystemSleep Disorders and Research CenterPhyllis Zee, MD, PhDProfessor of Neurology, Neurobiology & PhysiologyDirector, Sleep Disorders Program 2013 by The Gerontological Society of America. All rights reserved. Printed in the U.S.A.1

be as efficacious as some prescriptionoptions, and they produce a sustainedresponse. In cases where these interventions do not provide an adequateresponse, or if an immediate responseis desired, OTC or prescription medications may be used.7OTC sleep aids include first-generation antihistamines, such as diphenhydramine and doxylamine. Severaldrawbacks are associated with theseproducts—they may reduce the quality of sleep and can cause residualdaytime drowsiness and functionalimpairment.7,8 Furthermore, tolerancedevelops after using these products fora few nights.9 These agents also areassociated with anticholinergic effects,including blurred vision, constipation,dry mouth, urinary retention, and riskof increased intraocular pressure inpatients with narrow-angle glaucoma.8Although these agents are indicatedfor treatment of occasional sleeplessness (and are not indicated for chronicinsomnia), many patients use them ona regular basis. Patients with chronicinsomnia may be appropriate candidates for prescription therapies, suchas benzodiazepines, sedative-hypnotics,and melatonin receptor agonists.Beyond FDA-approved therapies, several dietary supplements, including valerian and melatonin, are used as sleepaids. In general, strong evidence to support their use is lacking and questionsremain about their safety, especiallywhen used chronically.7,8Many adults use alcohol to promotesleep, a behavior that may further com-plicate the use of OTC sleep aids. Onesurvey found that 13% of adults 18 to 45years of age reported using alcohol as asleep aid in the past year; 5% reportedusing a combination of alcohol andmedications intended to treat insomnia.10 In other surveys, up to 28% ofpatients have reported using alcoholto promote sleep.10 Although alcoholmay reduce sleep-onset latency, it is notrecommended as a sleep aid becauseit fragments sleep in the second partof the night and can increase daytimesleepiness and promote future sleepdisturbances.10This special newsletter will featuresnapshots of the latest key research,initiatives, campaigns, and programsfocused on the risk and benefits of current OTC sleep aids for older adults. Sleep and Public HealthTo explore the public healthimpact of sleep loss and insomnia on direct and indirect medical costs, the American Academy ofSleep Medicine, the National Center onSleep Disorders Research at the NIH,the National Sleep Foundation, and theSleep Research Society requested thatthe Institute of Medicine (IOM) conduct a study.3 The resulting IOM studyexamined the following areas:1. The public health significance ofsleep, sleep loss, and sleep disorders.Sleep Disorders and SleepDeprivation: An Unmet PublicHealth Problem.A Report from the Institute ofMedicineThis report recognizes that along with thecontinued leadership of the National Centeron Sleep Disorders Research, a coordinatedstrategy is required to ensure continuedscientific and clinical advances. There mustbe incremental growth in the capacity ofthe field to meet the public health andeconomic burden caused by sleep loss andsleep disorders. This strategy will require2The Gerontological Society of America2. Gaps in the public health system andadequacy of the current resourcesand infrastructures for addressingthe gaps.3. Barriers and opportunities forimproving interdisciplinary research,as well as medical education andtraining, in the area of sleep andsleep medicine.4. Efforts to develop a comprehensiveplan for enhancing sleep medicineand sleep research.concurrent commitment to the followingactivities: Establish the workforce required to meetthe clinical and scientific demands of thefield. Increase awareness of the burden ofsleep loss and sleep disorders among thegeneral public. Improve surveillance and monitoring ofthe public health burden of sleep loss andsleep disorders. Expand awareness among health care professionals through education and training.The 2006 IOM report recognized sleeploss as a public health issue and calledfor a national strategy to address it.To stress the crucial importance ofsleep to public health, sleep health wasadded as a topic to the HealthyPeople2020 initiative.11 In addition to addressing the proportion of adults who experience insufficient sleep, the objectivesalso address obtaining medical help forsleep apnea and focus on a selectedconsequence of poor sleep—motorvehicle crashes. Develop and validate new and existingdiagnostic and therapeutic technologies.Expand accreditation criteria to emphasizetreatment, long-term patient care, andchronic disease management strategies. Strengthen the national research infrastructure to connect individual investigators, research programs, and researchcenters. Increase the investment in interdisciplinary sleep programs in academic healthcenters that emphasize long-term clinicalcare, training, and research.

HealthyPeople 2020 ObjectivesObjectiveBaselineGoalIncrease the proportion of persons withsymptoms of obstructive sleep apneawho seek medical evaluation25.5% of persons with symptoms of obstructive sleep apnea soughtmedical evaluation in 2005–08 (age adjusted to the year 2000standard population)28.0%Reduce the rate of vehicular crashes per100 million miles traveled that are due todrowsy driving2.7 vehicular crashes per 100 million miles traveled involveddrowsy driving in 20082.1 vehicular crashesper 100 million milestraveledIncrease the proportion of students ingrades 9 through 12 who get sufficientsleep30.9% of students in grades 9 through 12 got sufficient sleep(defined as 8 or more hours of sleep on an average school night)in 200933.2%Increase the proportion of adults whoget sufficient sleep69.6% of adults got sufficient sleep (defined as 8 or more hoursfor those ages 18 to 21 years and 7 or more hours for those ages 22years and older, on average, during a 24-hour period) in 200870.9%Insomnia in the Older Adult PopulationThe prevalence of disturbed sleephas been shown to increase asindividuals age, due to reasonsincluding declining health, institutionalization, stress, and normal changesin circadian rhythms associated withaging.[NIH] According to the NationalSleep Foundation, 44% of older individuals experience disturbed sleep at leasta few nights each week.12Research presented at SLEEP 2013,the 27th Annual Meeting of theAssociated Professional Sleep Societies,Patterns of similaritiesand differences in geriatricversus adult sleepSiebert PS, Valerio JL, Rafia Y, et al.Presented at SLEEP 2013, the 27th AnnualMeeting of the Associated Professional SleepSocieties, LLC;June 1–5, 2013, Baltimore, MD.INTRODUCTION: It is commonplace forolder individuals to complain that theirsleep is not as good as it was when theywere younger. Indeed, previous researchhas demonstrated that sleep architecturechanges with the aging process. Emergingevidence suggests that escalating problematic health conditions, use of medications, and social challenges observed inthe geriatric population are directly relatedto sleep disorders (SD). Evaluations of SDLLC, addressed sleep-related topicsranging from basic sleep science, suchas cell and molecular genetics, to suchclinical topics as sleep disorders andsleep and aging.Selected abstracts from this meetingprovide new insights regarding distinctions between adult and geriatricsleep. For example, data from Siebertand colleagues reveal that older adultstook longer to fall asleep, spent significantly less time asleep, and were morelikely to be diagnosed with nocturnalare compromised by under reporting andby relying on self-report rather than professional sleep studies (i.e., nocturnal polysomnography (NPS) and multiple sleep latencytests (MSLT)). Moreover, there is a paucityof data specific to older adults.METHODS: We constructed a 111 itemquestionnaire to use in conjunction withNPS, MSLT, the Epworth Sleepiness Scale,(ESS) and medical chart reviews of peoplereferred for evaluation of SDs. We categorized participants into two broad agegroups: adult (N 568, age 19-65, M 46.2)and geriatric (N 151, age 66-90, M 71.6).RESULTS: Our results revealed a pattern ofsimilarities and differences. For example,the geriatric population experienced longersleep latencies and spent significantly lesstime asleep, yet reported fewer sleeprelated complaints. The geriatric group washypoxemia. Yet, they reported fewersleep-related complaints than youngeradults, suggesting underreporting ofsleep disturbances by this population.Additionally, presenters highlighted datafrom the National Health and NutritionExamination Survey describing olderadults’ use of medications to treat disturbed sleep. These data found that,among older adults, 23% self-reportedtaking sleep medications in the past4 weeks. more likely to be diagnosed with nocturnalhypoxemia, poor sleep efficiency, periodiclimb movement, and restless leg syndrome.Still they reported waking rested morefrequently than the adult group. The adultgroup reported greater incidence of sleepdisturbances and reported significantly morepsychiatric distress, such as depression,anxiety, irritability, and stress.CONCLUSION: This pattern of results couldbe a product of under-reporting by thegeriatric population or perhaps habituationto the challenges associated with sleepdisturbances. Our sample differed dramatically in size suggesting that proportionallyfewer older adults are referred for sleepstudies. We contemplate whether sleepcomplaints by older adults are marginalized,disregarded, or regarded as simply part ofthe aging process.WHAT’S HOT: Spotlight on OTC Sleep Aids and Sleep Health in Older Adults3

Insomnia medication useand physical activity in olderadults in the National Healthand Nutrition-ExaminationSurvey 2005–2006Tom SE, Martin KR, Spiegel A, Rattinger GB.Presented at SLEEP 2013, the 27th AnnualMeeting of the Associated Professional SleepSocieties, LLC;June 1–5, 2013, Baltimore, MD.INTRODUCTION: Most prescription insomnia medications are either recommendedon a limited basis or not recommended toolder adults because of adverse outcomes,including cognitive impairment, poor balance, and daytime somnolence. Becausephysical activity (PA) may decrease asa result of such problems, we examinewhether insomnia medication use, measured through inventory and self-report, isrelated to lower PA levels in older adults.METHODS: Data are from a sample of 798adults aged 65 years from the 2005-2006NHANES who had 4 valid days ( 10hours/day) of hip-worn accelerometer weartime. We identified prescription medicationsused in the past month that were indicativeof insomnia from NHANES interview inventory data. In addition, self-reported sleepmedication frequency in the past monthwas treated as a separate outcome. PAwas examined using average counts perminute (CPM) during wear-time and time(min/day) spent in sedentary, light, lifestyle,and moderate/vigorous physical activity.Weighted regression analyses adjusted forpotential confounding variables, includingsociodemographic characteristics, healthcharacteristics and behaviors, self-reportedsleep characteristics of insomnia, daytimesleepiness, sleep duration, and sleep disordered breathing symptoms.in the past 4 weeks: 11% reported rarely/sometimes; 12% reported often/always.However, only 13% of respondents wereusing an observed prescription medicationindicative of insomnia. Respondents weremostly sedentary, with means of 582.6 minutes/day (95% CI: 565.1, 600.2) and 574.6minutes/day (95% CI: 544.7, 604.5) for thosenot using prescription insomnia medicationsversus those who did, respectively. Neitherobserved prescription sleep medication usenor self-reported use was related to PA atany level, including CPM.CONCLUSION: Insomnia medication usedid not significantly contribute to lowerphysical activity levels among older adults inthis nationally representative U.S. sample.The mechanisms contributing to similarphysical activity levels between the twogroups are unclear.RESULTS: Nearly one quarter of respondents(23%) self-reported taking sleep medicationsNegative Health Impacts of Poor Sleep in Older AdultsIn addition to the chronic conditionsassociated with insomnia, elders withinsomnia are more likely to experience cognitive dysfunction, falls, earlyinstitutionalization, decreased quality oflife, and increased mortality.9 Recent datahave helped to better define the extent ofthe impact of poor sleep in older adults.Issues explored include mobility, risk offalls, health care use, risk of institutionalization, and driving ability.Stenholm and colleagues found thatboth too much sleep and too little sleepwere associated with reduced mobility.In either case, “weakness or tiredness”appeared to be the most importantdeterminant. These findings suggestthat complex issues related to sleep,health, and daytime fatigue may affectmobility. Similarly, Beck reports thatpoor sleep quality was a significant predictor of increased likelihood of falls.Miller and colleagues captured the overall impact of poor sleep on functioning;they found that poor sleep in cognitivelyintact adults was a more powerful predictor of placement in a long-term carefacility than either pain or depression.Additionally, Kaufmann and colleaguesfound that poor sleep was associated4The Gerontological Society of Americawith increased health care utilizationand proposed that adequate interventions to prevent and treat sleep-relatedproblems may reduce health carespending in older adults.The ability to drive is critical for olderadult independence. However, a number of impairments that increase inprevalence with age can interfere withsafe driving ability. The AAA SeniorDriver program encourages older adultsto consider a number of factors thatmay affect their ability to drive, including vision, hearing, reaction time,medical conditions and medications,and cognition. Within the category ofmedical conditions, AAA acknowledgesthat sleep apnea may cause drowsiness,which can impair driving, but does notdiscuss the impact of disturbed sleepdue to other causes.13 (It is importantto note that disturbed sleep is often thepresenting symptom of sleep apneain elders.) Vaz Fragoso and colleaguesfound that disturbed sleep and drowsiness itself can result in lower levels ofdriving capacity in older individuals, afinding that strongly suggests a needfor interventions to improve sleep inthis population.

Negative Health Impacts ofPoor Sleep in Older AdultsStenholm S, Kronholm E, Sainio P, et al.Sleep-related factors and mobility in older menand women. J Gerontol A Biol Sci Med Sci. 2010Jun;65(6):649-57.BACKGROUND: To examine the associationbetween sleep-related factors and measured and self-reported mobility in a representative sample of older adults.METHODS: This study included 2,825 menand women aged 55 years and older participating in a cross-sectional representativepopulation-based Health 2000 Survey inFinland. Sleep duration, insomnia-relatedInsomnia and health servicesutilization in middle-aged andolder adults: Results from theHealth and Retirement StudyKaufmann CN, Canham SL, Mojtabai R, et al.J Gerontol A Biol Sci Med Sci. 2013 May 9; epubahead of print.BACKGROUND: Complaints of poor sleepare common among older adults. We investigated the prospective association betweeninsomnia symptoms and hospitalization,use of home health care services, use ofnursing homes, and use of any of theseservices in a population-based study ofmiddle-aged and older adults.Sleep well: The effect of sleepquality on falls in older adultsBeck P, Ailshire JA.Presented at The Gerontological Society ofAmerica 66th Annual Scientific Meeting;November 20–24, 2013; New Orleans, LA.Falls are the leading cause of injuriousdeath in older adults. Sleep problems area common disorder among older adultsand poor sleep, which can reduce cognitive and motor performance and decreaseproprioception, may increase fall risk. Weuse data from the 2002 and 2004 wavesof the Health and Retirement Study todetermine if older adults who report sleepsymptoms, and fatigue were inquired.Maximal walking speed was measured,and mobility limitation was defined as selfreported difficulties in walking 500 m orstair climbing.RESULTS: Insomnia-related symptomsand fatigue were prevalent among personsaged 65 years and older in particular. Afteradjusting for lifestyle factors and diseases,longer sleep ( / 9 hours) was associatedwith a decreased walking speed in womenaged 65 or more years (p .04) and shortersleep ( / 6 hours) with a higher odds formobility limitation in women aged 65 ormore years (odds ratio [OR] 1.68, 95%confidence interval [CI] 1.02–2.75) andin men aged 55-64 years (OR 3.62, 95%METHODS: We studied 14,355 adults aged55 and older enrolled in the 2006 and 2008waves of the Health and Retirement Study.Logistic regression was used to study theassociation between insomnia symptoms(0, 1, or 2) in 2006 and reports of healthservice utilization in 2008, after adjustmentfor demographic and clinical characteristics.RESULTS: Compared with respondentsreporting no insomnia symptoms, thosereporting one symptom had a greaterodds of hospitalization (adjusted odds ratio[AOR] 1.28, 95% confidence interval[CI] 1.15–1.43, p .001), use of homehealth care services (AOR 1.29, 95% CI 1.09–1.52, p .004), and any health serviceuse (AOR 1.28, 95% CI 1.15–1.41, p .001). Those reporting greater than or equalto two insomnia symptoms had a greaterproblems in 2002 have increased risk offalling between 2002 to 2004. We focus onthree dimensions of poor sleep: frequentnighttime awakenings, frequency of wakingtoo early, and feeling rested upon waking.We use logistic regression to examineassociations between multiple indicatorsof sleep quality and risk of experiencinga fall, and experiencing an injurious fall.Frequent trouble sleeping through the night(OR: 1.17, 95% CI: 1.04–1.32) and wakingup too early (OR: 1.17, 95% CI: 1.01–1.35)increased likelihood of having experienceda fall since the previous wave, suggestingthat poor sleep quality increases the futurerisk of falls. Education (OR: 1.15, 95% CI:0.99–1.33), being Hispanic (OR: 0.88, 95%CI 1.40–9.37) compared with those having a mid-range sleep duration. Sleepingdisorders or insomnia was independentlyassociated with both decreased walkingspeed and mobility limitation in men aged55 or more years but only with mobilitylimitation in women aged 65 or more years.Of the sleep-related daytime consequences,“weakness or tiredness” was associatedwith a decreased walking speed and a higher odds for mobility limitation both in menand in women aged 55 or more years.CONCLUSIONS: Several sleep-related factors, such as sleep duration, insomnia-related symptoms, and fatigue, are associatedwith measured and self-reported mobilityoutcomes.odds of hospitalization (AOR 1.71, 95% CI 1.50–1.96, p .001), use of home healthcare services (AOR 1.64, 95% CI 1.32–2.04, p .001), nursing home use (AOR 1.45, 95% CI 1.10–1.90, p .009), andany health service use (AOR 1.72, 95%CI 1.51–1.95, p .001) after controllingfor demographics. These associations weakened, and in some cases were no longerstatistically significant, after adjustment forclinical covariates.CONCLUSIONS: In this study, insomniasymptoms experienced by middle-aged andolder adults were associated with greaterfuture use of costly health services. Ourfindings raise the question of whether treating or preventing insomnia in older adultsmay reduce use of and spending on healthservices among this population.CI: 0.72–1.05) or Asian/Other (OR: 0.82,95% CI: 0.57-1.16), or having trouble falling asleep (OR: 1.14, 95% CI, 0.99–1.33)did not increase risk of falling. Chronicconditions (OR: 0.99, 95% CI: 0.93–1.06),trouble falling asleep (OR: 1.04, 95% CI:0.82–1.31), education (OR: 1.06, 95% CI:0.95–1.18), being Hispanic (OR: 1.24, 95%CI: 0.89–1.17) or Asian/Other (OR: 1.01, 95%CI: 0.48–2.15) did not influence risk of fallinjury. Sleep quality appears to impact riskof falling among older adultsWHAT’S HOT: Spotlight on OTC Sleep Aids and Sleep Health in Older Adults5

Risk of placement in a carefacility: The roles of socialactivity, sleep, pain,and depressionMiller L, Dieckmann NF, Mattek NC, et al.Presented at The Gerontological Society ofAmerica 66th Annual Scientific Meeting;November 20–24, 2013; New Orleans, LA.Placement in a long-term care facility isa costly and often undesirable outcomefor many older adults. The purpose of thisstudy was to determine whether severalmodifiable factors–social activity, sleep,pain, and depression–predicted placementPrevalence of sleep disturbances in a cohort of olderdriversVaz Fragoso CA, Araujo KL, Van Ness PH,et al.J Gerontol A Biol Sci Med Sci. 2008 Jul;63(7):715–723.BACKGROUND: Lower levels of drivingcapacity in older persons are typically attributed to cognitive, visual, and/or physicalimpairments, with sleep disturbances rarelyconsidered. This is in contrast to the generaladult population for whom sleep disturbances are established risk factors for crashes.We thus set out to determine the prevalence of sleep disturbances in the form ofinsomnia symptoms, daytime drowsiness,and sleep apnea risk in a cohort of olderin a care facility, over and above cognitiveimpairment, functional impairment, medicalconditions, and age. The data were derivedfrom the Intelligent Systems for AssessingAging Changes study, a prospective cohort(n 229) of community-residing olderadults (mean age 83.4 5.6), with a lowrate of cognitive impairment (n 34,15%)at baseline. Within 5 years, a total of 44(19%) of the 229 participants had moved toassisted living or nursing home care and 55(24%) were cognitively impaired. Findingsof a multivariate logistic regression analysiscontrolling for cognitive impairment, functional impairment, medical conditions, andage, indicated that each unit decrease on a20-point social activity scale was associatedwith a 25% increase in the risk of placement in a care facility (p 0.002), and eachunit decrease on a 5-point scale indicatingthe frequency of restful sleep was associated with a 60% increase in the risk of placement in a care facility (p 0.008). Althoughpain and depression significantly increasedrisk of placement in the unadjusted analysis, they were not significant individualpredictors of placement in the multivariatemodel. Findings will be discussed withregard to minimizing risk of placement byimproving restful sleep and increasing socialactivity outside of the home for communitydwelling older adults.drivers and to assess how these relate toself-reported driving capacity.ing, the most consistent finding was forlower levels of nighttime driver self-ratingsin participants with insomnia symptoms ordrowsiness. Lower levels of driving mileagewere also noted but only with difficulty falling asleep. Otherwise, sleep disturbanceswere not associated with prior adverse driving events.METHODS: Participants included 430 activedrivers aged or 70 years. Questionnairesmeasured self-reported insomnia symptoms(Insomnia Severity Index [ISI]), drowsiness(Epworth Sleepiness Scale [ESS]), apnearisk (Sleep Apnea Clinical Score [SACS]),driving mileage, driver self-ratings (overalland nighttime), and prior adverse drivingevents.RESULTS: Mean age was 78.5 years, with85% being male. Overall, 64% were dissatisfied with sleep patterns and 26% had anabnormal ISI ( or 8). A large proportion(60%) reported a moderate to high chanceof dozing in the afternoon, and 19% had anabnormal ESS ( or 10). Habitual snoringwas noted by 43%, with 20% at risk forsleep apnea (SACS 15). Regarding driv-CONCLUSION: In our cohort of older drivers, insomnia symptoms and daytimedrowsiness were prevalent and associatedwith lower levels of nighttime driver selfratings. Although sleep apnea risk was alsoprevalent, it was not associated with selfreported driving capacity. These preliminaryfindings suggest that insomnia symptomsand drowsiness merit continued consideration as risk factors for lower levels of drivingcapacity in older persons, particularly giventhat effective interventions are available.Caregiver Sleep QualityActing as a caregiver is a common experience for older adults.According to the CaregiverAction Network, more than 65 millionpeople in the United States provide carefor a chronically ill, disabled, or agedfamily member or friend.14 Caregiversare 49 years of age on average—illustrating that a large proportion ofcaregivers are in fact adults approaching old age themselves, with their ownhealth issues.14Although caregiving can be a laborof love, it also can be incredibly stress6The Gerontological Society of Americaful. Emerging data illustrate the heavytoll caregiving can have on sleep. Forexample, Peng found that 92% of caregivers for individuals with dementiaexperienced poor sleep quality. Thestress associated with caregiving maybe an important predictor for sleepproblems—Peng and Chang, as wellas Fredman and colleagues, found thatdepressive symptoms were associatedwith increased sleep problems. Theinterrelationships between caregiving,depression, and poor sleep can be complex. Some data suggest that 40% to70% of family caregivers have clinicallysignificant symptoms of depression,with approximately a quarter to half ofthese caregivers meeting the diagnosticcriteria for major depression.14 Otherdata suggest that the prevalence of clinical depression among caregivers maybe lower, in the range of 12% to 22%.15Difficulty sleeping is well establishedas a significant risk for depression.16,17Although the causative factor is notclear, poor sleep may ultimately lead todeclining function for caregivers.

Predictors of sleep in familycaregivers of indivi

uals experience disturbed sleep at least a few nights each week12 . Research presented at SLEEP 2013, the 27th Annual Meeting of the Associated Professional Sleep Societies, LLC, addressed sleep-related topics ranging from basic sleep science, such as cell and molecular genetics, to such clinical topics as sleep disorders and sleep and aging .

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