Perception of sleep in the elderly

Background: Discrepancies between objectively and subjectively measured sleep variables make diagnosing insomnia in the elderly difficult. Also relevant to diagnosing insomnia in the elderly are expectations about sleep, gender and use of sedative-hypnotic medication. The present study focuses on how these variables relate to insomnia and sleep satisfaction. Method: A questionnaire focusing on the subjective experience of sleep was administered to 116 older (60 years and above) visitors at 4 senior centres in Bergen, Norway. Results: For those generally satisfied with their sleep, mean sleep onset latency was 37 minutes and mean wake after sleep onset was 38 minutes. It was further demonstrated that 59.2% of the sample had unrealistic positive expectations (did not expect worsening of sleep with age) regarding sleep in old age. Those using sedative-hypnotic medication (23.3%) were less satisfied with their sleep and felt less refreshed during the day than non-users. Contrary to most studies, no general gender differences in perception of sleep was revealed. The only exception was total sleep time where men reported more sleep than women (6.78 vs. 6.15 hours) per day. Conclusion: The results cast doubts about the usefulness of the common criteria (30 minutes sleep onset latency and wake after sleep onset) used in clinical contexts to diagnose insomnia. Unrealistic positive expectations about sleep changes with age can lower the threshold for complaining and thus contribute to dissatisfaction and worry about sleep. Sedative-hypnotic drugs did seem to have limited benefit for the participants in this study.