Sleep disturbances represent a significant and often overlooked health issue within long-term care facilities, affecting over 20% of elderly residents. An extensive study led by University of Waterloo researchers has shed new light on the prevalence, evolution, and contributing factors of sleep problems in older adults living in institutional care settings. These findings emphasize both the complexity of sleep disturbances in this vulnerable population and the critical need for comprehensive strategies to improve their sleep health, thereby enhancing overall well-being.
The research team conducted a longitudinal analysis involving more than 21,000 residents aged 65 and above, living in 228 long-term care homes across the Canadian provinces of New Brunswick and Saskatchewan. Utilizing data collected through the standardized interRAI assessment system between 2016 and 2021, the study uniquely tracked sleep quality changes over time among this large cohort. Initial assessments revealed that nearly 22% of residents experienced difficulties with sleep, though this prevalence fluctuated widely between facilities, ranging from as little as 3% to as much as 56%, highlighting heterogeneity in environmental or management factors across homes.
Tracking sleep trajectories within the population, the study observed that approximately 10% of residents initially reported as good sleepers developed new sleep disturbances within a year. Conversely, half of those with existing sleep problems experienced improvement or resolution of symptoms over the same period. This dynamic pattern underscores sleep disturbance not merely as a static chronic condition, but as a potentially modifiable state influenced by multiple intrinsic and extrinsic factors.
Critically, the research identified several key predictors associated with the onset or persistence of sleep issues among long-term care residents. Pain emerged as a prominent factor, consistent with existing literature linking nociceptive discomfort to impaired sleep architecture and frequent nocturnal awakenings. Additionally, chronic comorbidities such as cardiovascular and pulmonary diseases were implicated, likely reflecting the combined physiological burden and symptomatology that disrupt restful periods.
Cognitive impairment also featured prominently in the risk profile for altered sleep patterns, with moderate deficits correlating with higher rates of sleep disturbances. This association may relate to neurodegenerative changes affecting central sleep regulatory mechanisms or the increased prevalence of psychiatric and behavioral symptoms disturbing nocturnal rest. Daytime napping was another significant factor, supporting the hypothesis that excessive daytime sleep can impair circadian rhythms and reduce homeostatic sleep drive.
Medication use further complicated the clinical picture, with sedatives and antipsychotics identified as contributors to persistent sleep problems. While these drugs may initially be prescribed to manage behavioral or psychiatric symptoms, their potential side effects include altered sleep architecture, increased risk of falls, daytime sedation, and paradoxical insomnia, thereby perpetuating a vicious cycle of sleep disruption and pharmacological intervention.
Sleep disturbances in this demographic have far-reaching implications beyond mere fatigue or poor subjective sleep quality. According to Dr. John Hirdes, a professor in Waterloo’s School of Public Health Sciences and senior author of the study, insufficient or fragmented sleep is strongly linked to adverse health outcomes, including elevated risks for cardiovascular disease, cognitive decline, and depression. Furthermore, poor sleep often precipitates increased reliance on medications that may further elevate rates of delirium, fall incidents, and other iatrogenic complications, complicating care in already medically complex residents.
Importantly, these findings point to numerous actionable strategies that could mitigate sleep disturbances in long-term care settings. As many identified risk factors are modifiable, tailored approaches such as optimized pain management protocols, meticulous medication reviews to reduce inappropriate sedative and antipsychotic use, and the promotion of structured sleep hygiene routines could collectively improve resident sleep outcomes and overall health.
Dr. Sophiya Benjamin, a geriatric psychiatrist affiliated with McMaster University and adjunct professor at Waterloo, emphasized the systemic impact of resident sleep problems. She noted that poor sleep quality not only adversely affects the individuals but also contributes to heightened stress and burnout rates among caregivers. This, in turn, can compromise quality of care, staff retention, and facility operations, underlining the importance of integrating sleep quality as a key parameter within routine health monitoring frameworks.
Benjamin also highlighted the necessity of considering environmental factors such as ambient noise levels, lighting conditions, and the establishment of consistent night-time routines — variables known to influence circadian entrainment and sleep continuity. These elements, although not directly analyzed in the present study, represent promising domains for intervention. Non-pharmacological modalities like cognitive-behavioral therapies, relaxation techniques, and environmental modifications are increasingly advocated to optimize sleep without exposing residents to medication-associated risks.
The implications of this rigorous analysis extend beyond Canadian borders and resonate globally, given the similar challenges faced by long-term care facilities worldwide. By harnessing standardized assessment tools such as interRAI, healthcare providers and administrators can better identify at-risk individuals and tailor interventions effectively. This evidence-based approach fosters a culture prioritizing resident-centered care, emphasizing quality of life alongside traditional biomedical outcomes.
In conclusion, the study represents a significant advancement in understanding the multifactorial nature of sleep disturbances among elderly residents in long-term care. By illuminating the predictors and longitudinal patterns of sleep problems, the research provides a scientific foundation for targeted strategies to enhance sleep health. Implementing such approaches holds promise not only for improving the well-being and safety of residents but also for mitigating caregiver burden and optimizing the functioning of healthcare systems serving aging populations.
Subject of Research: Sleep disturbances and their predictors among elderly residents in long-term care facilities
Article Title: Predictors of change in sleep disturbance in Canadian long-term care facilities: a longitudinal analysis based on interRAI assessments
News Publication Date: Not specified
Web References:
https://doi.org/10.1007/s41999-025-01302-z
References:
Published in European Geriatric Medicine
Keywords:
Geriatrics, Home care, Sleep, Human health, Health care
