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12190 PSYCHOGERIATRICS 2016; 17: 43–51


Prevalence and correlates of sleep problems among elderly
Rajeswari SAMBASIVAM, Yunjue ZHANG, Louisa PICCO, Janhavi VAINGANKAR, Siow A. CHONG and

Research Division, Institute of Mental Health, Sin- Abstract
gapore, Singapore
Background: The current study examined the prevalence and correlates of
Correspondence: Miss Vathsala Sagayadevan, Institute
of Mental Health, 10 Buangkok View, Singapore sleep problems among elderly Singaporeans.
539747, Singapore. Email: vathsala_sagayadevan@ Methods: Data were taken from the Well-being of Singapore Elderly study, a cross-sectional, epidemiological survey conducted among Singapore resi-
Received 4 November 2015; revision received 9 December dents aged 60 years and above (n = 2565). Respondents were screened for
2015; accepted 21 December 2015. sleep problems through a series of questions in the Geriatric Mental State
Disclosure statement: The authors have no potential examination. Details on sociodemographic characteristics, physical activity,
conflicts of interest to disclose. cognition, disability, chronic physical conditions, and depression were also
collected. Logistic regression analysis was used to explore significant asso-
ciations between sleep problems, sociodemographic characteristics, physi-
cal activity, cognition, disability, chronic physical conditions, and
Results: Overall, 13.7% (n = 341) of older adults reported at least one sleep
problem. Of those who reported sleep problems, 69.4% experienced sleep
interruption at night, 48.9% reported having difficulty falling asleep, 22.3%
reported early morning awakening, and 11.4% had all three problems. Eld-
erly with sleep problems were significantly more likely to have a range of
chronic physical conditions and depression and were also significantly less
likely to be physically active. Older adults with at least one sleep problem
reported significantly greater disability compared to those with no sleep
Conclusion: The high probability of comorbid chronic conditions as well as
Key words: Asia, elderly, mental health, physical higher disability among those with sleep problems makes this an important
health, sleep difficulties. area of research.

Although evident among young and middle-aged
Sleep-related problems have become pervasive in adults, sleep problems are particularly common
modern society given the increasing work-related among the elderly,4 with a large majority reporting
demands and lifestyle changes.1 Leger et al. found sleep to be shallow and fragmented.5,6 In a review by
prevalence rates of sleep problems among indivi- Ohayon,7 difficulties initiating sleep were reported in
duals aged 15 years and above across the USA, 15–45% of non-institutionalized elderly, disrupted
Western Europe, and Japan to be 56%, 31%, and sleep in 20–65%, early morning awakening in
23%, respectively,2 while epidemiological surveys 15–54%, and non-restorative sleep in about 10%. As
have shown that approximately 13–33% of Australian opposed to being an inevitable part of ageing, sleep
adults have reported frequent difficulties in initiating problems among the elderly are often attributed to
or maintaining sleep.3 underlying physical and mental health conditions,

© 2016 The Authors 43
Psychogeriatrics © 2016 Japanese Psychogeriatric Society

Sagayadevan et al.19 Data for the cur- separated.e.6 Sample Past studies have examined an array of factors in Singapore is a 712. found the sleep interruption (i. and circadian rhythm changes.6 Furthermore. status. Disproportionate stra- Sleep problems pose significant economic and tified sampling was used to obtain equivalent propor- social burden on society.12 Board and the Centralised Institutional Review Board increased likelihood of accidents. The study was dollars in 2004. approved by the relevant ethics committees: the bances to several negative outcomes including day.6.1. sleep?’). fatigue.4% are Malay. 74. who provided a positive answer were assessed to marily focused on specific sleep disorders and less determine if they faced difficulty falling asleep so on the prevalence and correlates of general sleep (i.6 bil. Those Previous studies conducted in Singapore have pri.12 and low physical 2012 and November 2013 among a nationally repre- activity have also been identified as potential risk sentative sample of Singapore residents aged factors for sleep problems. ‘Have you had trouble sleeping recently?’).20 decreased productivity. ‘Is your sleep interrupted dur- prevalence rate of snoring and sleep breathing. These three questions were chosen to tive sleep apnoea among Singaporean patients seek.16 (i. being higher among women. which was chronic physical and mental illnesses with age and the part of the 10/66 Dementia Research Group’s ques- pre-existing evidence linking sleep problems with tionnaires.11 60 years and above (n = 2565).11 reduced (SingHealth).12 therefore aimed to address this gap in knowledge by examining the prevalence and correlates of sleep Cognitive functioning problems among elderly Singaporeans aged 60 years Cognitive functioning was measured by the Commu- and above. 13. ‘Have you had any difficulty falling asleep?’).13 In Australia. National Healthcare Group Domain Specific Review time drowsiness.2% are of Chinese descent.9 and study was described in a previous article. duals.43%.10. those who are widowed.1.3 billion Australian sent prior to study participation. ‘Have you recently been waking up early in the Singapore (aged 20–74 years) to be 0.17 morning and found it impossible to get back to whereas.11.5.11 depression. trained lay interviewers aged 18 years and above to be approximately $6. found the total tions of the three main ethnic groups in Singapore. with these problems Asia with a population of 5 million.6 which threatens their mobility and independ. Participants or their legally accepta- accounted for 1.e. Of its residents. and 9. with ble representatives provided written informed con- an associated economic cost of $10.5. The detailed methodology of the WiSE physical and mental health.5. the increasing incidence of the Geriatric Mental State examination. sleep disorders the participants. sleep METHODS disorders.11 Daley et al. as many disregard Measures them as a problem and consider them to be a part of normal ageing.V. conducted face-to-face household interviews with lion Canadian dollars. assess sleep problems based on past studies that ing bariatric surgery to be 72%.9. Ng et al.21 a 32-item 44 © 2016 The Authors Psychogeriatrics © 2016 Japanese Psychogeriatric Society . through a series of questions in the sleep module of ence. those of older age.14 The literature has linked sleep distur. problems among the elderly.1. cognitive deficits. nity Screening Instrument for Dementia. divorced. Lee et al. experienced any sleep problems over the past month erly an important area of research.2. ing the night?’).8 Sleep problems often go unrecognized among the elderly. those with a low level rent study were extracted from the Well-being of Sin- of education.15 However. and those of low socioeconomic gapore Elderly (WiSE) study. or single. sleep deprivation has been Sleep problems associated with an increased risk of falls among the The respondents were screened for sleep problems elderly.7–11 The use of medication. and/or early morning awakening related disorders among the general population in (i. annual cost of insomnia among Canadian individuals As part of the WiSE study. medications used to treat these conditions.18 The current study have used similar criteria.e. unemployed indivi. mortality.2% are of Indian descent. a cross-sectional.4% of the total burden of disease.4-km2 city-state in South-East relation to sleep problems.6 chronic physical epidemiological survey conducted between August conditions. noted the prevalence of obstruc.e.21 Individuals were first asked if they had chronic illnesses warrant sleep problems among eld. lower quality of life.

chronic physical conditions. pain. educational level (primary and blems. divorced or sepa. Of those who had trouble sleeping.4% had all three sleep problems. heart problem. retired. married/cohabiting. physical below. physically active. those who completed secondary education © 2016 The Authors 45 Psychogeriatrics © 2016 Japanese Psychogeriatric Society . and (v) life this study. chronic physical condi- (employed.1–2. or other). and other things which word list learning task with delayed recall. tions. depressed. or ≥85 years). 95% confidence interval (CI): depression was assessed via the following question: 1.3% reported early morning awakening.05 level with two-sided tests. Disability Disability was assessed with the World Health Organ. Malay. not very physically active.e. (ii) self-care. 48. fainting/ report any one of the sleep problems. or unemployed). Indians (versus Chinese). and depression. Overall. and retirees (versus those with full. Cary. ruption at night. arthritis or rheumatism. Descriptive analyses were at interview (60–74. A break- the following question: ‘Taking into account both down of prevalence of sleep problems by sociode- work and leisure.or betes. things like work. hobbies. or early morning awakening). A cog. high blood pressure. eth. Prevalence of sleep problems fied World Health Organization Disability Assessment Of the 2565 respondents who were interviewed for Schedule II evaluates five domains of functioning: the WiSE study. NC. Statistical analyses nitive score based on an item-weighted total score of Statistical analyses were carried out with SAS version each participant was obtained based on the number 9. (iv) getting along with people. 75–84. education). 22. Details (versus men). explore significant associations between sleep pro- rated. blackouts. questions on sleep problems and were included in (iii) mobility. Logistic regression analysis was used to (never married. homemaker.22 ruption. paralysis.2 (SAS Institute. P = 0. Statistical significance was evaluated at the 0. adults in the current sample reported at least one cating the extent of difficulty individuals faced in per. or not at all physically active?’ Sociodemographic correlates of sleep Those who reported being very/fairly physically active problems were grouped as being ‘physically active’. stroke. sleep problem (i. the data were weighted to adjust for oversampling and post-stratified by age and ethnicity Sociodemographic information between the survey sample and the Singapore resi- Sociodemographic information obtained included age dent population in 2010. or tertiary) and employment status activity. sleep inter- forming these activities. whereas Logistic regression was used to determine the socio- those who were not very/not at all physically active demographic correlates of sleep problems. USA). persistent cough. In particular. Each of the items yield severity ratings indi.7 times more likely than men obtained via self-report. cognition. sociodemographic characteristics. those who regarding the presence of chronic medical conditions had completed secondary education (versus tertiary (i. The modi.7% (n = 341) of the older activities. 69. Indian. The presence or absence of (odds ratio (OR): 1. or widowed). The level of physical activity was assessed through and 11. stomach or intestine problems.21 pore population. gender. Sleep problems among the elderly questionnaire incorporating the modified Consortium felt sad. 2382 individuals responded to the (i) understanding and communicating. empty. 13. part-time paid work) were significantly more likely to asthma. performed to establish the prevalence of sleep pro- nicity (Chinese. 32 = no the survey findings were representative of the Singa- cognitive impairment).4% experienced sleep inter- Physical activity. To ensure that of correct answers (0 = cognitively impaired.7.02) to report any one of the sleep pro- ‘Has there been a time or times in your life when you blems. dia. fairly physically active. secondary. disability. and the lasted at least two weeks?’ Consortium to Establish a Registry of Alzheimer’s Disease’s animal naming verbal fluency task. marital status blems.9% reported having difficulty fall- and depression ing asleep. RESULTS ization Disability Assessment Schedule II. or lost interest in most to Establish a Registry of Alzheimer’s Disease’s 10. Women were grouped as ‘not physically active’.7. would you say that you are very mographic correlates are presented in Table 1.e. difficulty falling asleep. and cancer) were also elderly women were 1.

8) Indian 124 (16.8) 22 (27.V.03–0.4) 47 (70.1.6) 139 (54.e. and retirees dents.6) Divorced/separated 19 (14. 95%CI: sleep problems were also significantly less likely to 1. P = 0.5–30.9) – – Marital status Never married 21 (19.7) 23 (13.3) 34 (11.8) 118 (67.4) 39 (58.7.7) 185 (48.1) 4 (7.01) were significantly less likely to asthma.7) 11 (55.6) 95 (44.4) 46 (39.8) 36 (40.5. Table 1 Prevalence of sleep problems by sociodemographic characteristics At least one Difficulty sleep problem falling asleep Sleep interruption Early morning All three sleep (n = 341) (n = 185) (n = 225) awakening (n = 97) problems (n = 59) n (%) n (%) n (%) n (%) n (%) Overall 341 (13.9) 6 (22.4) Widowed 117 (14.6) 23 (15. both difficulty falling After adjustment for sociodemographic variables.01) to sleeping (Table 2).6) 42 (43.0) Completed tertiary 23 (8. difficulty falling asleep.4) Women 232 (16. stomach or intestine problems.7) 72 (62.03) report early morning awakening than Chinese respon- to report any one of the sleep problems.1.5) 68 (47. P = 0. whereas Indians (OR: 3.0) Completed primary 85 (11. to sociodemographic correlates.9.2–3.6.8) 20 (8.9) 20 (14.9) 60 (46. and early Relationship between sleep problems and morning awakening) were further examined in relation physical activity. The individual subtypes of sleep problems (i.1) Retired 141 (15.5) 12 (48.2) 60 (68.3) 4 (22.7) 3 (100) 2 (66. and mental conditions including pain.5) 20 (18.6) Others 3 (8.01) and Malays (OR: 11.2) 45 (48.1) 77 (57.6) 56 (22. In comparisons of the and depression three subtypes of sleep problems. CI: 0.7) 66 (25.4) 4 (18.8) 12 (4.6) 31 (13.4) 29 (25.2) 153 (72. Marital status and ethnicity were found to be cantly more likely to have a range of chronic physical significantly associated with early morning awakening.2) were 2.1–4.3) 47 (56.3) 12 (8.2 times more likely than those who completed 4.5.6) 32 (56. arthritis/rheumatism.8) – Homemaker 125 (16.1–2.01) were significantly more likely to tertiary education (OR: 2. P = 0.2) ≥85 48 (15.8) 130 (67.4) Age group 60–74 204 (13. P < 0.5) 9 (53. sleep interruption at night.7) 5 (100) 2 (10.0) 59 (66.8.9) Ethnicity Chinese 129 (13.9) 17 (8.7) 75–84 89 (12.9) 54 (77. Sagayadevan et al.3) 11 (9.0) 46 (37.5) Malay 85 (11.01) were were 1.0) 41 (59. P < 0.1) 78 (69.6) Married/cohabiting 184 (12.5) 39 (22. 95%CI: 1. P = 0.8) 12 (9.3) 78 (71.5) 38 (42. 95%CI: 1. 95%CI: 1.0) 27 (53.0) 15 (16. 95%CI: be physically active compared to those who did not 46 © 2016 The Authors Psychogeriatrics © 2016 Japanese Psychogeriatric Society .8 times more likely than those employed in also more likely than the Chinese to report difficulty paid work (OR: 1.6) 90 (70.1) Employment Paid work (part time and full time) 66 (9.8) 70 (55. and depression.4) 29 (24.8) 8 (4. paralysis.8.3) Completed secondary 73 (17. Indians (OR: 2. fainting/ report early morning awakening than those who were blackouts.5) 75 (61.6) 25 (20.6) 55 (25.2) Education None 74 (17.0) Sex Men 109 (10.7) 73 (58.9.6) 48 (63. chronic physical conditions.9) 116 (49.7) 23 (25.0) 1 (1.2) 11 (11.6–7. asleep and early morning awakening yielded significant individuals who reported sleep problems were signifi- findings.2) 33 (17.6) Some but did not complete primary 86 (13. Those with married/cohabiting.9) 38 (28. persistent cough.9) 2 (46.2.8) 36 (38.4) 63 (81.9) 225 (69. heart pro- Those who were divorced or separated (OR: 0. report any one of the sleep problems.8) 42 (12.1) 12 (10.7) 17 (71.4.4) 12 (54.4) 97 (22.3) 59 (11.9) 16 (14.0) 25 (21.1) 17 (83.4) 5 (25. 95% blems.4) Unemployed 5 (16.1) 15 (12.2) 102 (75.5) 36 (11.2) 44 (61.

04 4.31 Retired 1.6 0.0 29.1 2.1 2.1 4.4 0.5 1.1 1.70* 1.4 4.48 Education Completed tertiary† Completed primary 1.2 0.8 0.5 0.90 0.91 0.7 0.1 0.07 1.9 4.9 0.9 0.1 0.2 1.3 0.3 0.9 0.2 0.5 7.7 0.01 0.6 0.3 0.03 1.4 0.9 0.4 2.1 2.1 1.2 0.12 3.46 0.5 0.3 0.76 1.1 0.0 0.5 0. * OR in bold represent those with p-values <.5 <.4 0.13 Sex Male† Female 1.7 5.3 0.3 0.10 1. confidence interval.5 2.01 Never married 1.97 complete primary Ethnicity Chinese† Indian 1.5 1. but did not 1.1 0.4 0.1 0.06 0.1 0.5 0.7 0.37 None 2.01 Others 0.8 3.2 0.52 – – – – 0.4 0.5 30.1 1.3 0.8 0.03 1.1 0.5 0.3 0.5 0.1 0.10 Employment status Paid work (part time and Psychogeriatrics © 2016 Japanese Psychogeriatric Society full time)† Homemaker 1.70 4.5 11.50 1.1 0.2 2.18 1.7 2.02 2.7 0.8 2.9 0.03 0.99 – – – – 0.6 1.57 0.2 0.2 2.1 5.7 0.6 7.21 1.2 3.40 1.01 Malay 0.25 0.2 0.9 0.79 0.4 0.43 1.78 1. Table 2 Sociodemographic correlates of sleep problems Any one of the sleep problems Difficulty falling asleep Sleep interruption Early morning awakening 95%CI 95%CI 95%CI 95%CI Odds Lower Upper Odds Lower Upper Odds Lower Upper Odds Lower Upper ratio limit limit P-value ratio limit limit P-value ratio limit limit P-value ratio limit limit P-value © 2016 The Authors Age group 60–74† 75–84 0.9 0.7 0.8 0.1 2.03 2.9 0.6 0.4 9.1 0.0 0.9 0.6 0.68 Widowed 0.4 0.2 0.4 0.4 0.4 0.3 2.7 0.35 1.1 5.7 0.85 0.40 1.4 2.18 0.17 0.1 1.75 Completed secondary 2.1 7.1 0.9 3.8 12.65 0.46 ≥85 0. 47 Sleep problems among the elderly .9 0.3 0.4 0.06 1.18 0.6 0.4 0.35 0.0 0.2 5.56 1.0 0.73 Some.9 0.06 Marital status Married/cohabiting† Divorced/separated 1.0 0.7 0.6 0.4 0.2 5.5 1.4 0.9 0.0 6.67 1.5 2.1 12.8 <.3 0.9 0.9 9.35 0.5 0. CI.2 1.4 0.61 0.3 1.5 0.5 0.0 0.17 1.0 0.83 11.7 0.4 0.7 0.10 1.8 0.1 2.93 – – – – † Referent group.1 0.9 0.9 3.6 1.5 4.72 1.8 6.7 0.4 0.3 0.10 0.8 0.5 0.5 7.4 0.39 3.92 2.90 1.3 6.1 3.40 0.6 3.11 Unemployed 1.17 3.25 0.9 0.7 0.0 0.05.1 3.4 4.80 1.2 6.3 0.6 0.5 0.1 0.01 1.8 0.3 0.60 2.6 3.1 3.

for instance. Leger et al. whereas 63.3 0.5 3.2 4. given that the current study was Faints or blackouts 2. The study also found the decrease in DISCUSSION sleep efficiency to be greater among older women Overall.9–11 (7. With regard to the prevalence of individual sleep complaints.5 1. found emerge as significant correlates.11 Leng et al.4.4 3.8 early morning awakening and marital status.3 0.9%). 49. reported a prevalence sleep problems in relation to sociodemographic cor- rate of 60. women.4 <0. Foley et al.2 2. it is possible that individuals Physical activity 0. 95%CI: 0.01 might have associated the presence of sleep symp- Presence of sleep problems was the predictor variable in all regression ana- toms with these disorders and consequently chose lyses reported in this table.5 0.01 cultural reticence and reluctance among Japanese Stomach or intestine 2. 95%CI methodological differences between studies Odds Lower Upper (e.05.11 and retirees were between those with sleep problems (28.24 whereas Eser et al.3 0. and early morning awakening (18%) Older adults who had at least one sleep problem among elderly aged 65 years and above in a multi- (mean  SEM: 14.6 1.2.71 Heart problems 2.4 0.01) (Table 3).56 the UK.1 2.7 1. France.7% of elderly in the current sample than in men. difficulty maintaining sleep (29%) (equivalent to sleep interruption in our study).1 3.8 <0.9 who noted the highest prevalence for P < 0. cognitive scores those with lower education.9 0.1 0. and chronic mental conditions problems is truly low among the elderly in Singapore.9% among Turkish elderly residing in nurs.4%).3–0.10 for instance. The to report sleep problems in this study. attributed the low Arthritis/rheumatism 1.5 4. Italy.0 <0. Spain.3 0. snoring and sleep breathing-related disorders to be and early morning awakening (22.01 Paralysis 2.5.2 1. nificantly more likely than those of Chinese ethnicity lem in the month prior to being interviewed.2 Similarly.7. different instruments.9* 1. followed by difficulty falling asleep (48.9 0. to minimalize or deny these symptoms. cognition. our findings were similar to those of report such problems (OR: 0.2) reported significantly centre study.4  1.24 preclude direct comparison of results.6 <0. we noted a significant association between ing homes.8 1.8. confidence interval.6 1. This finding majority experienced sleep interruption at night concurred with the study by Ng et al.9  0. Chronic conditions Low prevalence of sleep problems in the current pop- Depression 1.23. Those of Indian ethnicity were also sig- reported having experienced at least one sleep prob. Age and marital status did not in past studies.1 1.9 0. chronic physical conditions.7 4.01 people to associate sleep problems with psychiatric problems disorders.4 3. followed by difficulty initiat- ing sleep (19%) (equivalent to difficulty falling asleep Sleep problems. In comparing sleep problems across various Stroke 0.02 ulation could also be due to underreporting of symp- High blood pressure 0. 13.58 lence of dementia and depression among older Pain 3. relates. Germany.6% of women reported never experiencing difficulty falling asleep.4 <0. and disability in our study). P = 0.5 6.3% of men never had difficulty.2 0.6  0.1) and found to be more likely to report any one of the sleep those without sleep problems (28.. The overall more prevalent among Indians (and Malays) than prevalence was generally lower than those reported among Chinese.7 0.7 <0.7. and Japan).24 Li et al. Sagayadevan et al.01 prevalence of sleep problems in Japan to possible Asthma 2.g. However.7. Although it is possible that the prevalence of sleep ity.94 countries (the USA.5 4..0 <0. found that were not statistically different.V. * OR in bold indicate p-values <.635) problems.7% of elderly in China reported poor sleep In further examining the individual subtypes of quality.7  0.01 adults in Singapore.1 <0.5 1. CI.01 part of a larger survey aimed at examining the preva- Cancer 1. greater disability than those without sleep problems Consistent with previous findings. Diabetes 1. Table 3 Relationship between sleep problems* and physical activ.. those 48 © 2016 The Authors Psychogeriatrics © 2016 Japanese Psychogeriatric Society .7.02 Persistent cough 3.01 toms.17 which found (69. only 39. varying definitions of sleep Criterion variable ratio limit limit P-value problems)7.3%).0 1..001). P < 0.4 1.

have suggested that sleep problems erly aged 65 years and above found baseline insom. such as that by Black- studies is limited.12 While whereas a higher percentage of time spent in stage Foley et al.e. or depression).4 This effect of sleep on cognition between marital status and early morning awakening. found individuals with insomnia to sleep duration and cognition in community-dwelling have a higher median World Health Organization Disa. and Other studies have attributed lower cognition to early morning awakening) among individuals aged both short and long sleep duration.. In Australia. or community-dwelling older men in the USA. particularly executive functioning. This was surprising however. was evident even when comparing individuals with we are unable to fully account for this finding.29 and an increase in reported physical disorders.30 In comparing 16–85 years old. This result par. Therefore. Benito-León et al. a lower proportion of time spent in the heart problems.23 with sleep disruptions being especially associated Those with sleep problems were also significantly with executive functioning including attention. found baseline bility Assessment Schedule score (i. arthritis/rheumatism. faint. failed to support past literature. significant in the current sample.11 Likewise.g. Indians were also more as attention. both groups (with and without sleep problems) inactivity than those without these problems among a may be getting an adequate 6–8-h sleep. found sleep complaints among older 1 sleep was associated with executive functioning. which used an equivalent criteria than specific domains such as memory for assessing sleep problems (indicators of insomnia: (e. given this study might be due to the limited number of cog- that most studies have mainly focused on Western nitive domains that were examined in relation to populations. Sleep problems among the elderly who were divorced or separated were significantly The difference in cognitive scores between those less likely to report early morning awakening than with and without sleep problems was not statistically those who were married/cohabiting.25 However. previous relationship pro. direct comparison of results across sleep problems. In examining divorced. Naismith et al. difficulty falling asleep. well et al. depression. adults aged 65 years and above to be associated attention. household commitments) for this association State Examination. thus US population aged 18 years and above. Past studies. a history of stroke. be associated with poorer cognition. stomach or intestine problems. ing/blackouts. paralysis. pared to the former. separated.11. Amer et al. pared to 52% of poor sleepers on the Mini-Mental blems. found problems. pain. cognitive scores in both short (≤5 h) and long sleepers ity) than those without insomnia.26 accounting for the lack of significant difference in © 2016 The Authors 49 Psychogeriatrics © 2016 Japanese Psychogeriatric Society . asthma. mild cognitive impairment (MCI) with sleep disorders With respect to ethnicity.e. and problem-solving. and a global measure of cognition among with having heart disease. individuals who reported sleep stages to be associated with deficits in various sleep problems were more likely to have a range of cognitive domains. This finding. elderly individuals. difficulty staying asleep. Likewise. con- less likely to be physically active and more likely to cept formation. chronic physical and mental conditions (i.g.28 have found sleep disruptions at different As in past literature.16 a longitudinal study among Korean eld.1. which has given that past studies have found sleep problems to generally found those who are widowed. For instance. Strine and (≥9 h) to be lower than the reference group (6–8 h). or single to be more likely to report sleep sleep quality and cognitive deficits.27 tially supports past studies that have found ethnic One possible reason for the insignificant finding in differences in sleep complaints. may have a greater impact on cognition among those nia to be independently associated with depression who already have existing memory impairments. particularly executive functioning.31 Chapman found those with insufficient sleep to be It is possible that despite the report of sleep pro- more likely to report activity limitation and physical blems. it report disability than those who did not report such might be important to look into a range of cognitive problems.7–11 While there may have been other 24% of good sleepers to have cognitive deficits com- underlying factors (e. Malays and Indians were to MCI patients without sleep disorders. rather Health and Wellbeing. whereby the significantly more likely than the Chinese to report latter had significantly higher scores in domains such early morning awakening. persistent rapid eye movement sleep stage was associated with cough. greater disabil. the National Survey of Mental domains. measures of executive functioning and attention. visuo-spatial/executive function com- likely to report difficulty falling asleep. immediate and delayed recall).

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