Sleeping difficulties in relation to depression and anxiety in elderly adults

This study examines the prevalence of sleeping difficulties and their relat ionship to depression and anxiety in 1328 subjects aged 57-79 years by mean s of a questionnaire. Difficulties initiating sleep (DIS), difficulties mai ntaining sleep (DMS), early morning awakenings (EMA), and nightmares were a ssessed with The Uppsala Sleep Inventory (USI) and depression and anxiety w ith The Hospital Anxiety and Depression Scale (HAD scale). A total of 20.4% reported severe sleeping difficulties (DIS, DMS, or EMA), with a female pr eponderance. On the basis of the HAD scale we found that 3.4% fulfilled the criteria for "definite depression" and 10.1% fulfilled the criteria for "p ossible depression". The prevalence of "definite" and "possible pure anxiet y" (anxiety without depression) was 2.7% and 8.1%, respectively. There was no sex difference in reports of depression, but women more often reported p ure anxiety. Altogether, 24.3% of the sample had either depression or anxie ty. Nightmares were reported by 2.2% of the sample and associated with both depression and anxiety. We found that 39% of respondents with definite dep ression and 45.2% with definite pure anxiety reported sleeping difficulties . Depression emerged as the variable most consistently associated with slee ping difficulties when depression, pure anxiety, age, and sex were consider ed simultaneously. Habitual sleeping pill use was reported by 31.1% of the subjects with definite depression, whereas only 24.4% received antidepressi ve medication. These findings indicate that sleeping difficulties often are associated with psychiatric symptoms, especially depression.