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Regular Research Articles| Volume 14, ISSUE 2, P121-129, February 2006

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Daytime Sleeping, Sleep Disturbance, and Circadian Rhythms in the Nursing Home

  • Jennifer L. Martin
    Affiliations
    University of California, Los Angeles School of Medicine, Multicampus Program in Geriatric Medicine and Gerontology, Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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  • Adam P. Webber
    Affiliations
    University of California, Los Angeles School of Medicine, Multicampus Program in Geriatric Medicine and Gerontology, Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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  • Tarannum Alam
    Affiliations
    University of California, Los Angeles School of Medicine, Multicampus Program in Geriatric Medicine and Gerontology, Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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  • Judith O. Harker
    Affiliations
    University of California, Los Angeles School of Medicine, Multicampus Program in Geriatric Medicine and Gerontology, Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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  • Karen R. Josephson
    Affiliations
    University of California, Los Angeles School of Medicine, Multicampus Program in Geriatric Medicine and Gerontology, Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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  • Cathy A. Alessi
    Correspondence
    Send correspondence and reprint requests to Cathy A. Alessi, M.D., VA Medical Center GRECC (11E), 16111 Plummer St., North Hills, CA 91343
    Affiliations
    University of California, Los Angeles School of Medicine, Multicampus Program in Geriatric Medicine and Gerontology, Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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      Objective

      This study reports the frequency of abnormal daytime sleeping and identifies factors related to daytime sleeping, nighttime sleep disturbance, and circadian rhythm abnormalities among nursing home residents.

      Methods

      The authors conducted secondary analysis of data collected under usual care conditions within a nonpharmacologic sleep intervention trial. All residents from four Los Angeles nursing homes were screened for daytime sleeping (asleep ≥15% of observations, 9:00 am–5:00 pm). Consenting residents with daytime sleeping had two nights of wrist actigraphy to assess nighttime sleep disturbance (asleep <80%, 10:00 pm–6:00 am). Residents with nighttime sleep disturbance completed an additional 72-hour wrist actigraphy recording to assess circadian activity rhythms and light exposure.

      Results

      Sixty-nine percent of 492 observed residents had daytime sleeping, of whom 60% also had disturbed nighttime sleep. Sleep disturbance and daytime sleeping were rarely documented in medical records. Residents spent one-third of the day in their rooms, typically in bed, and were seldom outdoors or exposed to bright light. More time in bed and less social activity were significant predictors of daytime sleepiness. Ninety-seven percent of residents assessed had abnormal circadian rhythms. More daytime sleeping and less nighttime sleep were associated with weaker circadian activity rhythms. Later circadian rhythm acrophase (peak) was associated with more bright light exposure.

      Conclusion

      Daytime sleepiness, nighttime sleep disturbance, and abnormal circadian rhythms were common in nursing home residents. Modifiable factors (e.g., time in bed) are associated with sleep/wake abnormalities. Mental health specialists should consider the complexity of factors causing sleep problems in nursing home residents.

      Key Words

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