Tossing and turning over geriatric sleep research: Issues in assessment of sleep complaints

Sleep is a modifiable health behavior critical to healthy aging, yet is rarely addressed in geriatric rehabilitation or chronic disease management programs. While questionnaires have been validated for self-reported assessment of sleep, many are not appropriate for frail older adults due to length and item complexity. In a larger study of sleep in VA Adult Day Health Care (ADHC), we screened 54 individuals (mean age=78, 94% male) for sleep complaints using qualitative feedback ("Tell me about your sleep.") and 4 items from the Pittsburgh Sleep Quality Index (minutes to fall asleep, minutes awake at night, hours of sleep, sleep quality). Qualitatively, 37 respondents (69%) indicated one or more sleep disturbances, most commonly trouble staying asleep (n=18), physical health problems interrupting sleep (n=13), trouble falling asleep (n=9), and sleep apnea (n=8). Quantitatively, many endorsed characteristics of clinically-defined insomnia: 28 (52%) respondents spent ≥30 minutes awake at night, 23 (43%) took ≥30 minutes to fall asleep, and 20 (37%) slept 6 hours or less. 12 (22%) endorsed "poor" sleep quality. Those who took ≥30 minutes to fall asleep were more likely to report one or more sleep problems on the qualitative item (X²=49.6, p=.002), but not to report trouble falling asleep, specifically (X²=2.6, p=.110). There were no other significant relationships among items. While ADHC participants frequently reported sleep-related difficulties, there are challenges to quantifying these complaints. Our findings highlight the need to develop appropriate methods to screen for sleep difficulties in this population and to identify those most appropriate for sleep interventions.