Sleep fragmentation in patients from a nursing home
Abstract
Institutionalized elderly persons are said to have very disturbed sleep, yet few studies have collected empirical data on the sleep of these patients. We recorded sleep in 200 patients (131 females and 69 males; mean age = 81.9 years, SD = 8.6) in a skilled nursing facility. A modified Respitrace-Medilog portable recording system was used. In recordings averaging 15.4 hours, the patients were asleep for 7 hours, 58 minutes and awake for 7 hours, 28 minutes. To obtain that amount of sleep, the patients spent an extended time in bed during the day, for they averaged no more than 39.5 minutes of sleep per hour in any hour of the night, and 50% woke up at least 2 to 3 times per hour. In summary, although nursing home patients slept on average only one hour longer than independently living elderly, they had to spend substantially more time in bed to obtain the same amount of sleep.
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Non-cognitive neuropsychological symptoms associated with AD include activity disturbances, affective disturbances, aggression, stereotypic behavior, circadian rhythm disturbances, and anxiety.
“Non-cognitive neuropsychological symptoms associated with AD include activity disturbances, affective disturbances, aggression, stereotypic behavior, circadian rhythm disturbances, and anxiety (Ancoli-Israel et al., 1989; Okawa et al., 1991; Vitiello et al., 1992; Bliwise, 1994; Satlin et al., 1995; Van Someren et al., 1996; Hope et al., 1998; Harper et al., 2004; Shin et al., 2005; Tan et al., 2”
From Using mice to model Alzheimer's dementia: an overview of the clinical disease and the preclinical behavioral changes in 10 mouse models (2014) · cites this paper as Ancoli-Israel et al., 1989
Circadian rhythm disturbances have been well described in human AD patients.
“Circadian rhythm disturbances have also been well described in human AD patients”
From Using mice to model Alzheimer's dementia: an overview of the clinical disease and the preclinical behavioral changes in 10 mouse models (2014) · cites this paper as Ancoli-Israel et al., 1989
Human AD circadian rhythm disturbances are characterized by frequent awakenings during the nighttime and increased time slept during the day.
“These disturbances are characterized by the AD patient's propensity to frequently awaken during the nighttime and to increase the amount of time slept during the day”
From Using mice to model Alzheimer's dementia: an overview of the clinical disease and the preclinical behavioral changes in 10 mouse models (2014) · cites this paper as Ancoli-Israel et al., 1989
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van Hilten, J. J., Middelkoop, H. A. M., Braat, E. A. M., van der Velde, E. A., KERKHOF, G. A., Ligthart, G. J., Wauquier, A., & KAMPHUISEN, H. A. C. (1993) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1993.tb06180.x · Cited by 24 · see citing works
“480 483 480 476 485 512 492 508 (13) (3) (18) (20) (46) (8) (18) (16)”
Lok, R., Ancoli‐Israel, S., Ensrud, K. E., Redline, S. S., Stone, K. L., & Zeitzer, J. M. (2023) · Frontiers in Sleep · doi:10.3389/frsle.2023.1268379 · Cited by 23 · see citing works
Self-citationAssessment and Managment of SLEEP DISORDERS IN THE ELDERLY
Beck-Little, R., & Weinrich, S. (1998) · Journal of Gerontological Nursing · doi:10.3928/0098-9134-19980401-08 · Cited by 22 · see citing works
Developing Architectural Lighting Designs to Improve Sleep in Older Adults
Figueiro, M. G., Saldo, E., Rea, M. S., Kubarek, K., Cunningham, J. M., & Rea, M. S. (2008) · The Open Sleep Journal · doi:10.2174/1874620900801010040 · Cited by 22 · see citing works
“Moreover, adults in nursing homes see as little as 2 minutes a day [29].”
BackgroundPatterns of Sleep Disorders and Sedative Hypnotic Use in Seniors
Mullan, E., Katona, C., & Bellew, M. (1994) · Drugs & Aging · doi:10.2165/00002512-199405010-00005 · Cited by 21 · see citing works
Fong, K. N., Ge, X., Ting, K., Wei, M., & Cheung, H. (2023) · American Journal of Alzheimer's Disease & Other Dementias® · doi:10.1177/15333175231160682 · Cited by 20 · see citing works
“9 10-12 The reasons suggested for sleep disturbance in PwD are not unitary.”
BackgroundMeadows, R. P., Luff, R., Eyers, I., Venn, S., Cope, E., & Arber, S. (2010) · Chronobiology International · doi:10.3109/07420521003797732 · Cited by 20 · see citing works
“Studies have shown that this population experiences prolonged sleep latency (Fetveit & Bjorvatn, 2002), increased fragmentation and wake after sleep onset (Ancoli-Israel et al., 1989), more disturbed circadian rhythms (Ancoli-Israel et al., 1997), and night-day reversal (Ancoli-Israel et al., 2002).”
BackgroundInfluentialSleep Problems in a Racially Diverse Chronic Pain Population
Green, C. R., Ndao-Brumblay, S. K., & Hart-Johnson, T. (2009) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e3181a087aa · Cited by 19 · see citing works
Jean‐Louis, G., Ayappa, I. A., Rapoport, D. M., et al. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.09.010 · Cited by 18 · see citing works
Figueiro, M. G., Bierman, A., Bullough, J. D., & Rea, M. S. (2009) · Chronobiology International · doi:10.1080/07420520902927809 · Cited by 17 · see citing works
“It is estimated that in the late years of the disease, AD patients spend approximately 40% of their time at night awake and a significant amount of their daytime hours asleep (Ancoli-Israel et al., 1989; McCurry et al., 2000; Vitiello et al., 1991).”
BackgroundDiagnosis and Treatment of Sleep Disorders in Older Adults
Ancoli‐Israel, S., & Ayalon, L. (2009) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/foc.7.1.foc98 · Cited by 16 · see citing works
Self-citationSymptoms of obstructive sleep apnea in a Caribbean sample
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When is nighttime? A description of bedtime in persons with dementia in the nursing home
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Nursing home residents’ self-perceived resources for good sleep
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“Nevertheless, actigraphy studies have clearly evidenced the often fragmented sleep of nursing home residents [7,8,9].”
BackgroundDíaz, J. Á. R., Gamundı́, A., Akaârir, M., Cañellas, F., Rial, R. V., Roig, M. N. B., & Nicolau, M. C. (2017) · Chronobiology International · doi:10.1080/07420528.2017.1356840 · Cited by 14 · see citing works
“Another source of problems lies in the poor nursing practices during nighttime (Ancoli-Israel et al., 1989; Ouslander et al., 1988; Schnelle et al., 1999) and shows the need of developing specific training programs both for residents and caregivers (Midorikawa et al.”
BackgroundInfluentialClassification of Sleep Disorders
Thorpy, M. J. (2005) · Elsevier eBooks · doi:10.1016/b0-72-160797-7/50058-6 · Cited by 15 · see citing works
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Self-citationEffectiveness of strategies to manage sleep in residents of aged care facilities
Haesler, E. (2004) · JBI Reports · doi:10.1111/j.1479-6988.2004.00010.x · Cited by 13 · see citing works
- Authors
- Ancoli-Israel, S., Parker, L., Sinaee, R., Fell, R. L., & Kripke, D. F.
- Affiliations
- Veterans Health Administration (US)
- ORCID
- Kripke, D. F.
- Venue
- Journal of Gerontology
- Publisher
- Oxford University Press (OUP)
- Published
- 1989-01-01
- Volume
- 44
- Issue
- 1
- Pages
- M18-M21
- ISSN
- 0022-1422 (ISSN-L)
- OpenAlex
- W2329419803
- Cited by
- 157
- References
- 0
- Citations by year
- 2025: 2 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 1 · 2018: 2 · 2017: 4 · 2016: 2 · 2015: 7 · 2014: 2 · 2013: 3 · 2012: 4
- FWCI
- 6.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Gerontology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research
- National Institutes of Health
- National Institute on Aging (AG-02711, AG03990)
- National Institute of Mental Health (MH 00117)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- sleep fragmentation, institutionalized elderly, nursing home residents, sleep duration, nocturnal awakenings, daytime napping, sleep-wake patterns, older adults
- MeSH terms
- Activity Cycles, Aged, Aged, 80 and over, Bed Rest, Female, Humans, Male, Skilled Nursing Facilities, Sleep, Sleep Wake Disorders, Wakefulness
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