Incidence and remission of insomnia among elderly adults: An epidemiologicstudy of 6,800 persons over three years

To determine incidence and remission rates of insomnia in older adults and associated risk factors. Three-year longitudinal study, 1982-198-East Bosto n, MA; New Haven, CT; Iowa and Washington counties, IA. Participants were 6 ,899 men and women aged 65 years and older. Self reported difficulty fallin g asleep or early morning arousal (insomnia), along with physician diagnosi s of heart disease, stroke, cancer, diabetes, or hip-fracture, self-report of physical disability, depressive symptomatology, perceived health status, and use of medications ascertained at both baseline and three-year follow- up. Nearly 15% of the 4,956 participants without symptoms of insomnia at ba seline reported chronic difficulty falling asleep or early morning arousal at follow-up, suggesting an annual incidence rate of approximately 5%. Inci dent insomnia was associated with depressed mood, respiratory symptoms, fai r to poor perceived health, and physical disability. In multivariate analys es, these risk factors explained the higher incidence of insomnia among tho se with medical conditions such as heart disease, stroke, and diabetes. Oth er factors associated with an increased risk of insomnia included use of pr escribed sedatives, and widowhood. Only 7% of the incident cases of insomni a occurred in the absence of associated risk factors. Of the nearly 2,000 s urvivors with chronic insomnia at baseline, almost half no longer reported symptoms upon follow-up and were more likely to report improved self-peceiv ed health compared to those who continued to report symptoms. Chronic disea se, depressed mood, physical disability, poor perceived health, widowhood, and use of sedatives are associated with development and remission of insom nia symptoms. Because the vast majority of incident cases of insomnia were among persons with one or more of these risk factors, these data do not sup port a model of incident insomnia caused by the aging process per se.