Who Cares about Sleep in Older Adults?

The idea voiced by Thomas Dekker that “Sleep is that golden chain that ties health and our bodies together” may ring especially true for older adults. At its most basic level, sleep helps to maintain cognitive functioning by serving as the brain’s “housekeeper” and facilitating the daily removal of metabolic waste (Xie et al., 2013). Accordingly, the consequences of sleep impairments for brain health are many-fold, including short-term cognitive impairment and longitudinal cognitive-decline (Dzierzewski, Dautovich, & Ravyts, 2017). Beyond the impact on cognitive functioning, healthy sleep is a critical factor predicting better mental well-being, increased ability to perform activities of daily living, reduced fall risk, better self-reported health status, and reduced risk of hospitalization, among many, many, other outcomes (Brassington, King, & Bliwise, 2000; Kaufmann et al., 2013; Mccrae et al., 2008; Newman, Enright, Manolio, Haponik, & Wahl, 1997). In fact, it is hard to find a domain of mental or physical functioning that is not dependent on sleep for older adults. Nonetheless, sleep disorders are prevalent in older adults, with epidemiological evidence suggesting that over 50% of older adults suffer from one of several sleep disorders (Dzierzewski, Rodriguez Tapia, & Alessi, 2017). As such, sleep disorders are among the most common disorders of aging; however, they are often overlooked by both clinicians and researchers as mere symptoms of other ‘primary’ disorders. The good news is that psychological treatments for late-life sleep disorders have achieved the distinction of being evidence-based (McCurry, Logsdon, Teri, & Vitiello, 2007), and have even been acknowledged by the American College of Physicians as the first-line treatments for insomnia (Qaseem, Kansagara, Forciea, Cooke, & Denberg, 2016). Unfortunately, there still remains much to be done in terms of increasing our basic understanding of, and applied skills in working with, sleep in older adults. The overarching goal of this special issue is to shed much needed light on the important issues related to sleep in older adults. Our issue opens with a topic that is an emerging area of focus in sleep research—intraindividual variability or fluctuations that occur within individuals (Dillon et al., 2015). Variability is an important but often overlooked factor to consider when behaviors vary significantly day-to-day. In their original research article, Paterson and colleagues ask whether sleep schedule regularity, the extent that older adults are consistent with their bed and wake times, is associated with greater sleep sufficiency (greater than 7 hours per night; Paterson, Reynolds, & Dawson, 2017). Using a sample of Australian community-dwelling adults (N = 312) and a single time point telephone survey, the authors found that bedtimes and/or waketimes that varied greater than 60 mintues on average were associated with at least a twofold increased risk for obtaining insufficient sleep. These results are fascinating because even after controlling for relevant covariates, the authors identified a behavioral factor that is salient to older adults and amenable to change—maintaining consistent bed and wake times. Given the elusive target of sufficient sleep, the identification of a sleep health behavior that shows potential to address sleep insufficiency has significant implications. Next, an original research article by Ravyts and colleagues also used an observational design but with the added strength of a microlongitudinal approach (across 7 days) to assess the association