Login to Download
PDF version

Sleep-disordered breathing, periodic limb movements in sleep, restless legs syndrome, morning headaches, circadian rhythm disorders, excessive daytime sleepiness, obstructive sleep apnea syndrome, and insomnia, are age-related factors that may also be associated with poor sleep.^16,25–28

  The study population was predominantly (59%) older adults (age > 60 years). Many older adults have sleep issues associated with age-related physiological changes or secondary to medical illness.^26–28 Studies have shown that older adults spend more time in bed and wake up during the night more often than younger adults, and that they experience insomnia and hyposomnia more frequently, which are often secondary to other conditions.²⁹ Unsatisfactory sleep quality or insufficient sleep are very unpleasant experiences and may affect performance, behavior, and sense of well-being during daily activities.³⁰

  It was also observed that 45 (45%) patients were married and reported poor sleep quality, indicating that the marital status of patients may interfere with their sleep quality.³⁰ Sleep disturbances may be related to the presence or absence of a partner. Patients without a partner may have feelings of fear, which may influence the sleep pattern.³¹

  Twenty-nine patients (29%) had diabetes and 61 (61%) had hypertension. In patients with diabetes, sleep may be interrupted by nocturia, which compromises sleep quality. Daytime sleepiness may be one sign of changes in sleep quality.³² Bad dreams and nightmares were reported by 88% of the patients, which may be related to psychological factors, such as stress and anxiety. In stressful situations, there is a hypersecretion of cortisol, which is associated with insulin resistance.^16,17,26,30

  Regarding PSQI item 10, 60 (60%) patients took intentional daytime naps, and 40 (40%) patients reported daytime naps as a necessity, and not a pleasure (Table 6). Daytime naps may be associated with sleep interruptions at night, which contribute to poor sleep quality. Currently, nap episodes and sleep interruptions at night are considered to be part of the natural sleep/wake cycle, but remains a controversial issue. An experimental study showed that sleep deprivation could trigger insulin resistance.²⁶

  Most of the patients went to sleep between 9:00 pm and 11:00 pm (n = 53), took between 31 and 60 minutes to fall asleep (n = 63), woke up between 4:00 am and 5:00 am (n = 53), and slept 4 to 5 hours per night (n = 41). These results are similar to the Luyster et al¹⁶ study in which patients with rheumatoid arthritis reported symptoms of depression, fatigue, functional impairment, and sleeping for 6.6 hours per night on average; one-third of the participants reported having pain that disturbed their sleep 3 or more times per week. An adult needs about 7 hours of sleep per night, but the amount of sleep needed decreases with age. It is important to note that the number of hours of sleep needed varies among individuals, and an individual can feel rested even after a short period of sleep.³¹

  When PSQI component scores are evaluated with the global PSQI score, it is possible to understand the relationship between them, because a person who had slept for less than 5 hours, and taken more than 30 minutes to fall asleep, is considered to have poor sleep quality, and consequently, might be sleepy during the day and feel the need for daytime naps. In order to assess sleep quality, the sleep pattern of patients should be determined.