New research from Israel found that keeping to a regular daily routine was linked to better quality of sleep and reduced insomnia in older adults living in a retirement community. However, the researchers pointed out that they have only found a link and not strictly established the direction of cause (it could be that better sleep quality somehow enables older people to keep more easily to daily routines, it is not necessarily the other way around) and said more studies should now be done with larger populations of different cultural backgrounds.

You can read about the study by lead author Dr Anna Zisberg, assistant professor at the University of Haifa in Mt. Carmel, and colleagues, in the 1 April online issue of the journal Sleep.

It is not unusual as we age to experience increasing problems with sleep. The authors wrote in their background information that over half of older adults suffer from insomnia, mainly due to age-related changes in patterns of sleep and wakefulness.

Previous studies have suggested that a daily regular routine is linked to sleep quality among healthy adults and people with Parkinson’s disease: Zisberg and colleagues wanted to investigate if this might also be the case for elderly people.

For the study, which ran from August 2007 to September 2008, they recruited 96 Russian-speaking elderly people living in two retirement communities in the northern part of Israel: 82 per cent of them lived alone. Their ages ranged from 58 to 89 years, with an average of 75 years.

72 per cent of the participants were women and 75 per cent of them described their state of health as good or fair. 5 per cent of them used sleep medication less often than once a week, seven per cent used it once or twice a week, and 23 per cent used it three or more times a week.

The participants lived in apartments, each fully equipped for independent living, including a kitchenette.

Trained interviewers assessed the participants’ daily routines three times, at two-week intervals. To do this they used a modified version of the Scale of Older Adults Routine (SOAR). 89 of the 96 participants completed all three interviews and were included in the final analysis.

Participants were also asked to complete self-rated questionnaires every day from which the researchers could evaluate sleep quality and daily function. The questionnaires they used were the Pittsburg Sleep Quality Index (PSQI) and a modified Lawton Scale of Instrumental Activities of Daily Living (IADL).

33 of the participants were also asked to keep a diary for 2 weeks that followed a recognized system (the Social Rhythm Metric, SRM).

From the data the researchers calculated that the mean total sleep time among the participants was 6 hours, the mean sleep efficiency was 77.9 per cent, and the mean sleep latency (time to go from fully awake to asleep) was 37.5 minutes. (Sleep efficiency is the percentage of time in bed that is intended for sleeping that is spent actually asleep).

The researchers also worked out stability in the timing, frequency and duration of daily activities like bathing, eating, watching TV and reading and they assessed weekly patterns like cleaning, exercise, social engagements, keeping appointments.

Then, using regression analysis to look for patterns between stability of routines and sleep variables, the researchers found that:

  • Increased stability in daily routine predicted a shorter time to fall asleep, higher sleep efficiency and better quality of sleep.

  • Stability in daily activities such as bathing, dressing and eating was more strongly linked to sleep quality than activities not necessarily done every day like shopping, use of public transport and attending medical appointments.

  • Poorer sleep quality was linked to less lifestyle regularity and more illness.

The authors concluded that:

“Maintenance of daily routines is associated with a reduced rate of insomnia in the elderly. Further studies should examine these relations in broader populations with regard to health, functional status, and cultural background.”

Zisberg told the media that they had expected to find a link between routine activity patterns and sleep quality.

“However, given the widely accepted view that light is the major synchronizer of the human sleep-wake cycle, we were surprised that our findings were so robust,” she added.

Zisberg and colleagues noted that changes in the circadian system (an approximately 24-hour cycle that is reflected in the biochemistry, physiology and behaviour of plants and animals) are seen as a natural part of the aging process and often regarded as the main reason for impaired sleep quality in older people.

While these results may suggest that keeping to a daily routine could be a way to protect ourselves from loss of sleep quality as we age, the researchers urged caution and said more research with broader populations in different cultures should be done to confirm these findings. Longitudinal studies might also reveal whether keeping to a routine is a cause or a result of sleep quality, they noted.

“Contribution of Routine to Sleep Quality in Community Elderly.”
Anna Zisberg, Nurit Gur-Yaish, Tamar Shochat.
Sleep, 2010, Vol 33, Issue 04, pages 509-514

Source: American Academy of Sleep Medicine.

Written by: Catharine Paddock, PhD