Self-reported insomnia symptom, sleep duration and the risk of recurrent falls among older men and women

  • Yohannes EndeshawEmail author
Research Paper

Key Summary Points


To examine the risk of recurrent falls among older adults with insomnia symptoms and abnormal sleep duration.


The risk of falls was significantly higher among older women who reported insomnia symptoms along with short sleep duration.


Insomnia symptoms along with a measure of sleep duration may be a more accurate indicator of risk for falls among older women than insomnia symptoms or sleep duration alone.



Previous studies have reported conflicting results on the association between sleep disturbance and recurrent falls. The objective of the current study was to examine the risk of recurrent falls among community-dwelling older adults who reported one or more insomnia symptoms along with normal, short and long sleep durations in comparison with those who reported no insomnia symptom and normal sleep duration.


Secondary data analysis of a prospective cohort study.




2198 community-dwelling older adults who participated in the National Health and Aging Trends Study at round 3 and round 4 follow-up visits.


Data on self-reported sleep characteristics, demographic characteristics, health and memory status, and depression symptom collected at round 3 and round 4 follow-up visits, and corresponding data on falls that was collected at round 4 and round 5 follow-up visits.


Risk of recurrent falls significantly increased among women who reported insomnia symptom with short sleep duration. No significant association was observed among men.


One or more insomnia symptoms with a measure of sleep duration may be a more accurate indicator of adverse outcomes associated with sleep disturbance than either insomnia symptom or sleep duration alone. The mechanism underlying gender-specific association reported in the current study merits further investigation.


Insomnia symptom Sleep duration Recurrent falls 



The author gratefully acknowledges the support provided by the Department of Medicine at Morehouse School of Medicine. The National Health and Aging Trends Study (NHATS) is sponsored by the National Institute of Aging (Grant NIA U01AG032947) through a cooperative agreement with the Johns Hopkins Bloomberg School of Public Health.

Compliance with ethical standards

Conflict of interest

No conflicts of interest declared by the author.

Ethical approval

This is a secondary data analysis of de-identified data and the study was approved by Institutional Review Board of Morehouse School of Medicine.

Informed consent

This is a secondary data analysis of de-identified data and no contact was made with the study participants.


  1. 1.
    Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Agein 35(Suppl 2):ii37–ii41CrossRefGoogle Scholar
  2. 2.
    Hartholt KA, Stevens JA, Polinder S, van der Cammen TJ, Patka P (2011) Increase in fall-related hospitalizations in the United States, 2001–2008. J Trauma 71:255CrossRefGoogle Scholar
  3. 3.
    Panel on Prevention of Falls in Older Persons (2011) Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 59:148–157CrossRefGoogle Scholar
  4. 4.
    Stevens JA, Rudd RA (2014) Circumstances and contributing causes of fall deaths among persons aged 65 and older: United States, 2010. J Am Geriatrics Soc 62:470–475CrossRefGoogle Scholar
  5. 5.
    Brassington GS, King AC, Bliwise DL (2000) Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64–99 years. J Am Geriatrics Soc 10:1234–1240CrossRefGoogle Scholar
  6. 6.
    Helbig AK, Doring A, Heier M, Emeny RT, Zimmerman AK, Autenrieth CS et al (2013) Association between sleep disturbances and falls among the elderly: results from the German Cooperative Health Research in the Region of Augsburg-Age study. Sleep Med 12:1356–1363CrossRefGoogle Scholar
  7. 7.
    StoneL KL, BlackwellL TL, Ancoli-Israel S, Cauley JA, Redline S, Marshall LM et al (2014) Sleep disturbances and risk of falls in older community-dwelling men: the outcomes of sleep disorders in older men (MrOS Sleep) Study. J Am Geriatr Soc 62:299–305CrossRefGoogle Scholar
  8. 8.
    Min Y, Slattum PW (2018) Poor sleep and risk of falls in community-dwelling older adults. J Appl Gerontol 37:1059–1084CrossRefGoogle Scholar
  9. 9.
    Kuo HK, Yang CC, Yu YH, Tsai KT, Chen CY (2010) Gender-specific association between self-reported sleep duration and falls in high-functioning older adults. J Gerontol Ser A Biol Sci Med Sci 65:190–196CrossRefGoogle Scholar
  10. 10.
    Mesas AE, Lopez-Garcia E, Rodriguez-Artalejo F (2011) Self-reported sleep duration and falls in older adults. J Sleep Res 20:21–27CrossRefGoogle Scholar
  11. 11.
    Stone KL, Ewing SK, Lui LY, Ensrud KE, Ancoli-Israel S, Bauer DC et al (2006) Self-reported sleep and nap habits and risk of falls and fractures in older women: the study of osteoporotic fractures. J Am Geriatr Soc 54:1177–1183CrossRefGoogle Scholar
  12. 12.
    Kim SY, Kim SG, Sim S, Park B, Choi HG (2016) Excessive Sleep and lack of sleep are associated with slips and falls in the adult korean population: a population-based cross-sectional study. Medicine 95:e2397CrossRefGoogle Scholar
  13. 13.
    Wu L, Sun D (2017) Sleep duration and falls: a systemic review and meta-analysis of observational studies. J Sleep Res 26:293–301CrossRefGoogle Scholar
  14. 14.
    Fernandez-Mendoza J, Vgontzas AN, Liao D, Shaffer ML, Vela-Bueno A, Basta M, Bixler EO (2012) Insomnia with objective short sleep duration and incident hypertension: the Penn State Cohort. Hypertension 60:929–935CrossRefGoogle Scholar
  15. 15.
    NakazakiC C, Noda A, Koike Y, Yamada S, Murohara T, Ozaki N (2011) Association of insomnia and short sleep duration with atherosclerosis risk in the elderly. Am J Hypertens 11:1149–1155Google Scholar
  16. 16.
    Vgontzas AN, Liao D, Pejovic S, Calhoun S, Karataraki M, Bixler EO (2009) Insomnia with objective short sleep duration is associated with type 2 diabetes: a population-based study. Diabetes care 32:1980–1985CrossRefGoogle Scholar
  17. 17.
    Vgontzas AN, Liao D, Pejovic S, Calhoun S, Karataraki M, Basta M et al (2010) Insomnia with short sleep duration and mortality: the Penn State cohort. Sleep 33:1159–1164CrossRefGoogle Scholar
  18. 18.
    J Montaquila, VA Freedman, B Edwards, JD Kasper National Health and Aging Trends Study Round 1 sample design and selection NHATS technical paper#1 (2012) Baltimore: Johns Hopkins University School of Public Health. Available at Accessed 5 Dec 2018
  19. 19.
    J D Kasper, VA Freedman. National Health and Aging Trends Study User Guide: Rounds 1-7 Beta Release (2018) Baltimore: Johns Hopkins University School of Public Health. Available at Accessed 5 Dec 2018
  20. 20.
    Goldman SE, Stone KL, Ancoli-Israel S, Blackwell T, Ewing SK, Boudreau R et al (2007) Poor sleep is associated with poorer physical performance and greater functional limitations in older women. Sleep 30:1317–1324CrossRefGoogle Scholar
  21. 21.
    Van Cauter E, Spiegel K, Tasali E, Leproult R (2008) Metabolic consequences of sleep and sleep loss. Sleep Med 9(Suppl 1):S23–28CrossRefGoogle Scholar
  22. 22.
    Schmid SM, Hallschmid M, Schultes B (2015) The metabolic burden of sleep loss. Lancet Diabetes Endocrinol 3:52–62CrossRefGoogle Scholar
  23. 23.
    Irwin MR, Carrillo C, Olmstead R (2010) Sleep loss activates cellular markers of inflammation: sex differences. Brain Behav Immun 24:54–57CrossRefGoogle Scholar
  24. 24.
    Newman AB, Spiekerman CF, Enright P, Lefkowitz D, Manolil T, Reynolds CF, Robbins J (2000) Daytime sleepiness predicts mortality and cardiovascular disease in older adults the cardiovascular health study research group. J Am Geriatr Soc 48:115–123CrossRefGoogle Scholar
  25. 25.
    Barsky AJ, Peekna HM, Borus JF (2001) Somatic symptom reporting in women and men. J Gen Intern Med 16:266–275CrossRefGoogle Scholar
  26. 26.
    Spira AP, Kaufmann CN, Kasper JD, Ohayon MM, Rebok GW, Skidmore E et al (2014) Association between insomnia symptoms and functional status in US older adults. J Gerontol Ser B Psychol Sci Soc Sci 69(Suppl 1):S35–41CrossRefGoogle Scholar
  27. 27.
    Silva GE, Goodwin JL, Sherrill DL, Arnold JL, Bootzin RR, Smith R et al (2007) Relationship between reported and measured sleep times: the sleep heart health study (SHHS). J Clin Sleep Med 3:622–630Google Scholar
  28. 28.
    Van Den Berg JF, Van Rooij FJ, Vos H, Tulen JJ, Hofman A, Miedema HM et al (2008) Disagreement between subjective and actigraphic measures of sleep duration in a population-based study of elderly persons. J Sleep Res 17:295–302CrossRefGoogle Scholar
  29. 29.
    Cappuccio FP, D’Elia L, Strazzullo P, Miller MA (2010) Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep 33:585–592CrossRefGoogle Scholar
  30. 30.
    Leipzig RM, Cumming RG, Tinetti ME (1999) Drugs and falls in older people: a systematic review and meta-analysis: I psychotropic drugs. J Am Geriatr Soc 47:30–39CrossRefGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  1. 1.Geriatric Section, Department of MedicineMorehouse School of MedicineAtlantaUSA

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