Sleep characteristics and self-rated health in older persons

  • Mariana Simoes Maria
  • Christophe Büla
  • Brigitte Santos-Eggimann
  • Hélène Krief
  • Raphaël Heinzer
  • Laurence Seematter-BagnoudEmail author
Research Paper

Key summary points


To examine the association between older persons’ sleep characteristics and subjective health.


Older persons with good self-rated health are more likely to report a good sleep quality and less likely to take naps or sleep medication, even when accounting for comorbidity, depressive symptoms and cognitive difficulties.


While sleep efficiency is positively associated with subjective health, napping and use of sleep medication are negatively associated to rating one’s health as good. These associations need to be further investigated in longitudinal analyses to better understand causality.



It remains unclear, how much older persons’ sleep problems are due to age-related changes in sleep architecture and pattern, or whether they are a consequence of health problems. This work aimed to examine the association between sleep characteristics and self-rated health, taking into account potential confounders.


Data about sleep, including sleep efficiency (ratio of sleep duration to the amount of time spent in bed, considered as good if > 85%), as well as health-rated characteristics were self-reported by community-dwelling persons enrolled in the Lausanne cohort 65+ study (n = 2712, age 66–75 years). Participants’ subjective health was categorized as good versus poor. The cross-sectional association between good self-rated health and sleep characteristics was examined in bivariate and multivariate analysis.


The majority of participants (68.4%) rated their health as good. Compared to the participants with poor-rated health, they more often reported a good sleep efficiency (59.5% vs 45.0%, p < 0.001) and less often reported napping (41.6% vs 54.0%, p < 0.001) as well as using sleep medication (12.7% vs 31.8%, p < 0.001). After adjustment for comorbidity, depressive symptoms and cognitive difficulties, a positive association persisted between good sleep efficiency and good self-rated health (adjOR: 1.35, 95% CI 1.10–1.66). Regular napping remained negatively associated to feel healthy (adjOR: 0.65, 95% CI 0.53–0.79).


Sleep efficiency is positively associated with subjective health, whereas napping and use of sleep medication are negatively associated to rating own health as good. These associations need to be further investigated in longitudinal analyses to better understand causality.


Sleep Older persons Subjective health 



The authors want to thank all participants to the Lausanne Cohort 65 + study.


None of the authors received specific funding for this analysis.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The Lc65+ study initial protocol and follow-up amendments received approval from the Cantonal Human Research Ethical Committee [Protocol (19/04); 2009 amendment approved January 9, 2009]. All procedures performed in studies involving human participants were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Participants were informed about the nature of the study and confidentiality of data management, and gave written consent to participate.


  1. 1.
    Gulia KK, Kumar VM (2018) Sleep disorders in the elderly: a growing challenge. Psychogeriatrics 18(3):155–165CrossRefGoogle Scholar
  2. 2.
    Reid KJ, Martinovich Z, Finkel S, Statsinger J, Golden R, Harter K et al (2006) Sleep: a marker of physical and mental health in the elderly. Am J Geriatr Psychiatry 14(10):860–866CrossRefGoogle Scholar
  3. 3.
    Grossman ES (2017) Enduring sleep complaints predict health problems: a six-year follow-up of the survey of health and retirement in Europe. Aging Ment Health 21(11):1155–1163CrossRefGoogle Scholar
  4. 4.
    Basta M, Simos P, Bertsias A, Duijker G, Zaganas I, Koutentaki E et al (2018) Association between insomnia symptoms and cognitive impairment in the Cretan Aging Cohort. Eur Geriatr Med 9(5):697–706CrossRefGoogle Scholar
  5. 5.
    Foley D, Ancoli-Israel S, Britz P, Walsh J (2004) Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res 56(5):497–502CrossRefGoogle Scholar
  6. 6.
    Smagula SF, Stone KL, Fabio A, Cauley JA (2016) Risk factors for sleep disturbances in older adults: evidence from prospective studies. Sleep Med Rev 25:21–30CrossRefGoogle Scholar
  7. 7.
    Yoon HS, Yang JJ, Song M, Lee HW, Han S, Lee SA et al (2015) Correlates of self-reported sleep duration in middle-aged and elderly Koreans: from the Health Examinees Study. PLoS One 10(5):e0123510CrossRefGoogle Scholar
  8. 8.
    Ancoli-Israel S, Ayalon L, Salzman C (2008) Sleep in the elderly: normal variations and common sleep disorders. Harv Rev Psychiatry 16(5):279–286CrossRefGoogle Scholar
  9. 9.
    Martin MS, Sforza E, Barthelemy JC, Thomas-Anterion C, Roche F (2014) Sleep perception in non-insomniac healthy elderly: a 3-year longitudinal study. Rejuvenation Res 17(1):11–18CrossRefGoogle Scholar
  10. 10.
    Dalmases M, Benitez ID, Mas A, Garcia-Codina O, Medina-Bustos A, Escarrabill J et al (2018) Assessing sleep health in a European population: results of the Catalan Health Survey 2015. PLoS One 13(4):e0194495CrossRefGoogle Scholar
  11. 11.
    Endeshaw Y (2019) Self-reported insomnia symptom, sleep duration and the risk of recurrent falls among older men and women. Eur Geriatr Med 10(2):303–312CrossRefGoogle Scholar
  12. 12.
    Leng Y, Stone K, Ancoli-Israel S, Covinsky K, Yaffe K (2018) Who take naps? Self-reported and objectively measured napping in very old women. J Gerontol A Biol Sci Med Sci 73(3):374–379CrossRefGoogle Scholar
  13. 13.
    Li J, Chang YP, Riegel B, Keenan BT, Varrasse M, Pack AI et al (2018) Intermediate, but not extended, afternoon naps may preserve cognition in Chinese older adults. J Gerontol A Biol Sci Med Sci 73(3):360–366CrossRefGoogle Scholar
  14. 14.
    Owusu JT, Wennberg AMV, Holingue CB, Tzuang M, Abeson KD, Spira AP (2019) Napping characteristics and cognitive performance in older adults. Int J Geriatr Psychiatry 34(1):87–96CrossRefGoogle Scholar
  15. 15.
    Keage HA, Banks S, Yang KL, Morgan K, Brayne C, Matthews FE (2012) What sleep characteristics predict cognitive decline in the elderly? Sleep Med 13(7):886–892CrossRefGoogle Scholar
  16. 16.
    Santos-Eggimann B, Karmaniola A, Seematter-Bagnoud L, Spagnoli J, Bula C, Cornuz J et al (2008) The Lausanne cohort Lc65+: a population-based prospective study of the manifestations, determinants and outcomes of frailty. BMC Geriatr 8:20CrossRefGoogle Scholar
  17. 17.
    Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213CrossRefGoogle Scholar
  18. 18.
    Magee CA, Caputi P, Iverson DC (2011) Relationships between self-rated health, quality of life and sleep duration in middle aged and elderly Australians. Sleep Med 12(4):346–350CrossRefGoogle Scholar
  19. 19.
    Lubetkin EI, Jia H (2018) Burden of disease due to sleep duration and sleep problems in the elderly. Sleep Health 4(2):182–187CrossRefGoogle Scholar
  20. 20.
    Sasai T, Inoue Y, Komada Y, Nomura T, Matsuura M, Matsushima E (2010) Effects of insomnia and sleep medication on health-related quality of life. Sleep Med 11(5):452–457CrossRefGoogle Scholar
  21. 21.
    Hornby-Turner YC, Peel NM, Hubbard RE (2017) Health assets in older age: a systematic review. BMJ Open 7(5):e013226CrossRefGoogle Scholar
  22. 22.
    Seematter-Bagnoud L, Spagnoli J, Bula C, Santos-Eggimann B (2014) Alcohol use and frailty in community-dwelling older persons aged 65 to 70 years. J Frailty Aging 3(1):9–14PubMedGoogle Scholar
  23. 23.
    Goldman SE, Hall M, Boudreau R, Matthews KA, Cauley JA, Ancoli-Israel S et al (2008) Association between nighttime sleep and napping in older adults. Sleep 31(5):733–740CrossRefGoogle Scholar
  24. 24.
    Mesas AE, Lopez-Garcia E, Leon-Munoz LM, Graciani A, Guallar-Castillon P, Rodriguez-Artalejo F (2011) The association between habitual sleep duration and sleep quality in older adults according to health status. Age Ageing 40(3):318–323CrossRefGoogle Scholar
  25. 25.
    Leblanc MF, Desjardins S, Desgagne A (2015) The relationship between sleep habits, anxiety, and depression in the elderly. Nat Sci Sleep 7:33–42PubMedPubMedCentralGoogle Scholar
  26. 26.
    Jacobs JM, Cohen A, Hammerman-Rozenberg R, Stessman J (2006) Global sleep satisfaction of older people: the Jerusalem Cohort Study. J Am Geriatr Soc 54(2):325–329CrossRefGoogle Scholar
  27. 27.
    DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P (2006) Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med 21(3):267–275CrossRefGoogle Scholar
  28. 28.
    McCrae CS, Rowe MA, Tierney CG, Dautovich ND, Definis AL, McNamara JP (2005) Sleep complaints, subjective and objective sleep patterns, health, psychological adjustment, and daytime functioning in community-dwelling older adults. J Gerontol B Psychol Sci Soc Sci 60(4):P182–P189CrossRefGoogle Scholar
  29. 29.
    Zhong G, Wang Y, Tao T, Ying J, Zhao Y (2015) Daytime napping and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis of prospective cohort studies. Sleep Med 16(7):811–819CrossRefGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  1. 1.Service of Geriatric Medicine and Geriatric RehabilitationUniversity of Lausanne Hospital CentreLausanneSwitzerland
  2. 2.Faculty of Biology and MedicineLausanne UniversityLausanneSwitzerland
  3. 3.Health Services Unit, Center for Primary Care and Public Health (Unisanté)University of LausanneLausanneSwitzerland
  4. 4.Center for Investigation and Research in Sleep (CIRS)University of Lausanne Hospital CentreLausanneSwitzerland

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