Skip to main content
SpringerLink
Log in

The Relationship Between Sleep and Anxiety in Older Adults

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Anxiety and sleep problems are major barriers to healthy aging and are frequently comorbid conditions in older adults. In the current review, we present recent advances in understanding the extensive overlap among older adults between anxiety and one specific related sleep problem, insomnia. These proposals suggest that anxiety and insomnia may share a common vulnerability to negative emotionality and at times may act as risk factors for each other in older adults. We also highlight developmental shifts in motivation that are likely to impact cognitive-behavioral mechanisms of anxiety and insomnia. Finally, we characterize the current state of treatment for comorbid anxiety and insomnia among older adults and identify future directions for research and clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •Of importance

  1. Rice DP, Miller LS: Health economics and cost implications of anxiety and other mental disorders in the United States. Br J Psychiatry Suppl 1998, 34:4–9.

    PubMed  Google Scholar 

  2. Walsh JK, Engelhardt CL: The direct economic costs of insomnia in the United States for 1995. Sleep 1999, 22(Suppl 2):S386–S393.

    PubMed  Google Scholar 

  3. Beekman AT, Bremmer MA, Deeg DJ, et al.: Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam. Int J Geriatr Psychiatry 1998, 13:717–726.

    Article  CAS  PubMed  Google Scholar 

  4. Schaub RT, Linden M: Anxiety and anxiety disorders in the old and very old—results from the Berlin Aging Study (BASE). Compr Psychiatry 2000, 41(2 Suppl 1):48–54.

    Article  CAS  PubMed  Google Scholar 

  5. Ancoli-Israel S, Cooke JR: Prevalence and comorbidity of insomnia and effect on functioning in elderly populations. J Am Geriatr Soc 2005, 53(7 Suppl):S264–S271.

    Article  PubMed  Google Scholar 

  6. • Koffel E, Watson D: The two-factor structure of sleep complaints and its relation to depression and anxiety. J Abnorm Psychol 2009, 118:183–194. This article characterizes the overlapping structure of sleep, depression, and anxiety symptoms among younger adults, older adults, and psychiatric patients.

    Article  PubMed  Google Scholar 

  7. Mallon L, Broman JE, Hetta J: Sleeping difficulties in relation to depression and anxiety in elderly adults. Nord J Psychiatry 2000, 54:355–360.

    Article  Google Scholar 

  8. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4 (text revision). Washington, DC: American Psychiatric Association; 2000.

    Book  Google Scholar 

  9. Harvey AG: Insomnia: symptom or diagnosis? Clin Psychol Rev 2001, 21:1037–1059.

    Article  CAS  PubMed  Google Scholar 

  10. Ohayon MM, Caulet M, Lemoine P: Comorbidity of mental and insomnia disorders in the general population. Compr Psychiatry 1998, 39:185–197.

    Article  CAS  PubMed  Google Scholar 

  11. Ohayon MM: Interactions between sleep normative data and sociocultural characteristics in the elderly. J Psychosom Res 2004, 56:479–486.

    Article  PubMed  Google Scholar 

  12. McCrae CS, McNamara JP, Rowe MA, et al.: Sleep and affect in older adults: using multilevel modeling to examine daily associations. J Sleep Res 2008, 17:42–53.

    Article  PubMed  Google Scholar 

  13. Lichstein KL: Secondary insomnia. In Treatment of Late-Life Insomnia. Edited by Lichstein KL, Morin CM. Oakland, CA: Sage Publications; 2000:297–319.

  14. Uhde TW, Cortese BM, Vedeniapin A: Anxiety and sleep problems: emerging concepts and theoretical treatment implications. Curr Psychiatry Rep 2009, 11:269–276.

    Article  PubMed  Google Scholar 

  15. Johnson EO, Roth T, Breslau N: The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. J Psychiatr Res 2006, 40:700–708.

    Article  PubMed  Google Scholar 

  16. Jansson M, Linton SJ: The role of anxiety and depression in the development of insomnia: cross-sectional and prospective analyses. Psychol Health 2006, 21:383–397.

    Article  Google Scholar 

  17. Ohayon MM, Roth T: Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatr Res 2003, 37:9–15.

    Article  PubMed  Google Scholar 

  18. Morphy H, Dunn KM, Lewis M, et al.: Epidemiology of insomnia: a longitudinal study in a UK population. Sleep 2007, 30:274–280.

    PubMed  Google Scholar 

  19. Spira AP, Friedman L, Flint A, Sheikh JI: Interaction of sleep disturbances and anxiety in later life: perspectives and recommendations for future research. J Geriatr Psychiatry Neurol 2005, 18:109–115.

    Article  PubMed  Google Scholar 

  20. Clark LA, Watson D: Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnorm Psychol 1991, 100:316–336.

    Article  CAS  PubMed  Google Scholar 

  21. Brown TA, Chorpita BF, Barlow DH: Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. J Abnorm Psychol 1998, 107:179–192.

    Article  CAS  PubMed  Google Scholar 

  22. Teachman BA, Siedlecki KL, Magee JC: Aging and symptoms of anxiety and depression: structural invariance of the tripartite model. Psychol Aging 2007, 22:160–170.

    Article  PubMed  Google Scholar 

  23. Barlow DH, Allen LB, Choate ML: Towards a unified treatment for emotional disorders. Behav Ther 2004, 35:205–230.

    Article  Google Scholar 

  24. Stepanski EJ, Rybarczyk B: Emerging research on the treatment and etiology of secondary or comorbid insomnia. Sleep Med Rev 2006, 10:7–18.

    Article  PubMed  Google Scholar 

  25. Baltes PB, Baltes MM: Psychological perspectives on successful aging: the model of selective optimization with compensation. In Successful Aging: Perspectives From the Behavioral Sciences. Edited by Baltes PB, Baltes MM. New York: Cambridge University Press; 1990:1–34.

  26. Heckhausen J: Developmental regulation across adulthood: primary and secondary control of age-related challenges. Dev Psychol 1997, 33:176–187.

    Article  CAS  PubMed  Google Scholar 

  27. Carstensen LL: Motivation for social contact across the life span: a theory of socioemotional selectivity. In Nebraska Symposium on Motivation: Developmental Perspectives on Motivation, vol 40. Edited by Jacobs J. Lincoln, NE: University of Nebraska Press; 1993:209–254.

  28. Dark-Freudeman A, West AL, Viverito KM: Future selves and aging: older adults’ memory fears. Educ Gerontol 2006, 32:85–109.

    Article  Google Scholar 

  29. Unemori P, Omoregie H, Markus HR: Self-portraits: possible selves in European-American, Chilean, Japanese and Japanese-American cultural contexts. Self Identity 2004, 3:321–338.

    Article  Google Scholar 

  30. Beck AT, Emery GD, Greenberg R: Anxiety Disorders and Phobias. A Cognitive Perspective. New York: Basic Books; 1985.

  31. Harvey AG: A cognitive model of insomnia. Behav Res Ther 2002, 40:869–893.

    Article  CAS  PubMed  Google Scholar 

  32. Calamari JE, Janeck AS, Deer TM: Cognitive processes and obsessive-compulsive disorder in older adults. In Cognitive Approaches to Obsessions and Compulsions: Theory, Assessment, and Treatment. Edited by Frost RO, Steketee G. Oxford: Pergamon; 2002:315–336.

  33. Teachman BA, Gordon T: Age differences in anxious responding: older and calmer, unless the trigger is physical. Psychol Aging 2009, 24:703–714.

    Article  PubMed  Google Scholar 

  34. Morgan K: Daytime activity and risk factors for late-life insomnia. J Sleep Res 2003, 12:231–238.

    Article  PubMed  Google Scholar 

  35. Stepanski E, Rybarczyk B, Lopez M, Stevens S: Assessment and treatment of sleep disorders in older adults: a review for rehabilitation psychologists. Rehabil Psychol 2003, 48:23–36.

    Article  Google Scholar 

  36. Goldman SE, Hall M, Boudreau R, et al.: Association between nighttime sleep and napping in older adults. Sleep 2008, 31:733–740.

    PubMed  Google Scholar 

  37. Frisoni GB, de Leo D, Rozzini R, Trabucchi M: Napping in the elderly and its association with night sleep and psychological status. Int Psychogeriatr 1996, 8:477–487.

    Article  CAS  PubMed  Google Scholar 

  38. Morin CM, Savard J, Blais F: Cognitive therapy of late-life insomnia. In Treatment of Late-Life Insomnia. Edited by Lichstein KL, Morin CM. Oakland, CA: Sage Publications; 2000:207–230.

  39. Otto MW: Stories and metaphors in cognitive-behavior therapy. Cogn Behav Pract 2000, 7:166–172.

    Article  Google Scholar 

  40. Scheibe S, Blanchard-Fields F: Effects of regulating emotions on cognitive performance: what is costly for young adults is not so costly for older adults. Psychol Aging 2009, 24:217–223.

    Article  PubMed  Google Scholar 

  41. Fitchen CS, Libman E, Creti L, et al.: Role of thoughts during nocturnal awake times in the insomnia experience of older adults. Cognit Ther Res 2001, 25:665–692.

    Article  Google Scholar 

  42. • Bloom HG, Ahmed I, Alessi CA, et al.: Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc 2009, 57:761–789. This article provides a summary of current evidence for the assessment and treatment of sleep disorders in older adults. The reader is encouraged to supplement this reading as new clinical trials emerge.

    Article  PubMed  Google Scholar 

  43. • Ayers CR, Sorrell HT, Thorp SR, Wetherell JL: Evidence-based psychological treatments for late-life anxiety. Psychol Aging 2007, 22:8–17. This article provides a summary of current evidence for the treatment of anxiety in older adults. The reader is encouraged to supplement this reading as new clinical trials emerge.

    Article  PubMed  Google Scholar 

  44. Zayfert C, DeViva JC: Residual insomnia following cognitive-behavioral therapy for PTSD. J Trauma Stress 2004, 17:69–73.

    Article  PubMed  Google Scholar 

  45. Rybarczyk B, Lopez M, Benson R, et al.: Efficacy of two behavioral treatment programs for comorbid geriatric insomnia. Psychol Aging 2002, 17:288–298.

    Article  PubMed  Google Scholar 

  46. Kamel N, Gammack J: Insomnia in the elderly: cause, approach, and treatment. Am J Med 2006, 119:463–469.

    Article  PubMed  Google Scholar 

  47. Sheikh JI, Cassidy EL: Treatment of anxiety disorders in the elderly: issues and strategies. J Anxiety Disord 2000, 14:173–190.

    Article  CAS  PubMed  Google Scholar 

  48. Sirey JA, Bruce ML, Alexopoulos GS, et al.: Perceived stigma as a predictor of treatment discontinuation in younger and older outpatients with depression. Am J Psychiatry 2001, 158:479–481.

    Article  CAS  PubMed  Google Scholar 

  49. Teachman B: Aging and negative affect: the rise and fall and rise of anxiety and depression symptoms. Psychol Aging 2006, 21:201–207.

    Article  PubMed  Google Scholar 

  50. McCrae CS, Wilson NM, Lichstein KL, et al.: ‘Young old’ and ‘old old’ poor sleepers with and without insomnia complaints. J Psychosom Res 2003, 54:11–19.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of Illinois at Chicago, 912 South Wood Street, Chicago, IL, 60612, USA

    Joshua C. Magee & Cheryl N. Carmin

Authors
  1. Joshua C. Magee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cheryl N. Carmin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joshua C. Magee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Magee, J.C., Carmin, C.N. The Relationship Between Sleep and Anxiety in Older Adults. Curr Psychiatry Rep 12, 13–19 (2010). https://doi.org/10.1007/s11920-009-0087-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-009-0087-9

Keywords

Search

Navigation