Natalie D. Dautovich

Association between chronotype and nonrestorative sleep in a college population

ABSTRACT Nonrestorative sleep (NRS), characterized by a lack of refreshment upon awakening, has received little attention in the sleep literature even though it can occur and cause impairment apart from other sleep difficulties associated with insomnia. The Restorative Sleep Questionnaire (RSQ) is one of the first validated self-report instruments for investigating NRS severity, presenting new opportunities to explore what factors predict and perhaps contribute to unrefreshing sleep. The present study sought to determine whether inherent circadian preference for morning or evening activity, known as chronotype, predicted restorative sleep in 164 college undergraduates who completed daily RSQs over 2 weeks. The participants who endorsed greater orientation to evening activity on the morningness–eveningness questionnaire reported significantly less average restorative sleep across their full sampling period, and this association was maintained after accounting for demographic factors, number of sleep-relevant psychiatric and medical diagnoses, sleep diary parameters, self-reported status as an insomniac and ratings of sleep quality. When analyses were conducted separately for weekday and weekend RSQ scores, eveningness predicted NRS independently of extraneous variables only during the workweek, not during Saturday and Sunday. These findings have implications for the developing conceptualization of NRS, and continue the work of elucidating the interconnections between common sleep disturbances and the circadian system.

Sleep and Cognition in Older Adults

Increased age is associated with normative declines in both sleep and cognitive functioning. Although there are some inconsistencies in the literature, negative sleep changes are associated with worse cognitive functioning. This negative relationship holds true across normal-sleeping older adults, older adults with insomnia, older adults with sleep disordered breathing, cognitively healthy older adults, and older adults with dementia. There are mixed results regarding potential benefits of sleep treatments on cognitive functions; however, this line of research deserves added attention because the potential mechanisms of action are likely distinct from other interventions to improve cognition.

Efficacy of brief behavioral treatment for insomnia in older adults: examination of sleep, mood, and cognitive outcomes

OBJECTIVE The aim of the present study was to examine the effects of a brief behavioral intervention for insomnia (BBTi) on sleep parameters, mood, and cognitive functioning in older adults. METHODS Older adults (aged 65 years or more) underwent four weekly sessions of BBTi or self-monitoring control (SMC). Participants completed 14 days of sleep diaries and actigraphy measuring sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE), and sleep quality ratings at baseline, post-treatment, and three month follow-up. Participants also completed mood scales (Geriatric Depression Scale [GDS]; Beck Depression Inventory-II; and State Trait Anxiety Inventory) and neuropsychological testing (measuring global cognition, language, memory, attention and processing speed, and executive function) at the three timepoints. RESULTS Significant condition (BBTi vs. SMC) x time (baseline vs. post-treatment vs. follow-up) interactions revealed that BBTi improved relative to baseline in sleep diary-reported SOL, WASO, SE, and sleep quality, and these improvements were maintained at follow-up. SMC showed no change in these measures. A main effect of time showed that actigraphy-measured WASO improved from baseline for both BBTi and SMC at post-treatment. A main effect of time revealed that both BBTi and SMC patients endorsed fewer GDS symptoms relative to baseline at post-treatment and follow-up. We observed no change in performance on neuropsychological measures. CONCLUSIONS A four-week BBTi is an efficacious intervention for reducing insomnia symptoms in older adults. BBTi does not selectively improve mood or cognitive functioning. Future work should examine effects of BBTi on physiological measures of sleep architecture and day-to-day cognition. CLINICAL TRIAL IDENTIFER NCT02967185.

The Associations Between Dispositional Mindfulness, Sense of Control, and Affect in a National Sample of Adults

Objectives The present study examined factors associated with better affective experiences across the life span, extending existing research to older adults. Specifically, we investigated dispositional mindfulness and sense of control as predictors of affect and sense of control as a potential mediator of the mindfulness-affect associations. Method We hypothesized that dispositional mindfulness mediated by sense of control would predict affective outcomes. An archival analysis of a sample of 4,962 adults, aged 28 to 84 years, was conducted using the Midlife in the U.S. national survey (MIDUS-II). Exploratory analyses were conducted with age as a moderator in all associations. Results Greater dispositional mindfulness predicted more positive and negative affect irrespective of age. Dispositional mindfulness did not predict sense of control. Greater sense of control predicted more positive and less negative affect, and these associations were significantly moderated by age. Sense of control did not mediate the dispositional mindfulness-affect associations. Discussion The present study extends existing research on the dispositional mindfulness-positive affect association to older ages. The sense of control and positive and negative affect associations are enhanced and buffered, respectively, at older ages, indicating that the association between control and affect differs by age.

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

Elder Abuse and Mistreatment

In 2011, the Baby Boom generation began to reach the age of 65 ushering in the beginning of a population aging boom remarkable for both its prevalence and proportion (West, Cole, Goodkind, & He, 2014). This shift in demographics predicts that 20% of US citizens will be over age 65 and 4.5% over the age of 85 by the year 2050 (Ortman, Velkoff, & Hogan, 2014). This aging of the US population has many wide-ranging implications, including changes in policy, community support, and social and family dynamics. As societal needs shift with the growing aging population, economic and perceptual changes are imperative in order to keep individuals safe and quality of life high. One threat to aging-well deserving of special focus is elder mistreatment.

Napping in Older and College‐Aged Adults

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Insomnia: A Review of the Use of eszopiclone

The present paper presents a review of the literature examining the efficacy of eszopiclone for treating insomnia. The purpose of the paper was to evaluate both the statistical and clinical efficacy of eszopiclone for treating insomnia. Both subjective and objective assessments of insomnia were evaluated across various sleep variables. Additionally, the efficacy of eszopiclone for treating insomnia comorbid with other conditions (sleep disordered breathing, psychiatric diagnoses, peri/post-menopause, rheumatoid arthritis), transient insomnia, and across diverse samples (adults, older adults, and samples pooled by race) was reviewed. Finally, the impact of eszopiclone use on daytime functioning was examined.