Sleep Complaints, Subjective and Objective
Sleep Patterns, Health, Psychological Adjustment,
and Daytime Functioning in Community-Dwelling
Christina S. McCrae,1Meredeth A. Rowe,2Candece G. Tierney,3Natalie D. Dautovich,3
Allison L. DeFinis,3and Joseph P. H. McNamara3
1Center for Gerontological Studies and Department of Psychology,
2College of Nursing, and3Department of Psychology, University of Florida, Gainesville.
We examined sleep complaints, subjective and objective sleep patterns, health, psychological adjustment, and
daytime functioning in 103 community-dwelling older adults to identify factors associated with sleep complaints.
We collected 2 weeks of sleep diaries and actigraphy. Only health distinguished complaining from noncomplaining
sleepers. Noncomplaining good sleepers had poorer objective sleep quantity than complaining poor sleepers.
Actigraphy distinguished noncomplaining good and complaining poor sleepers only. Subjective and objective sleep
quantities were related for noncomplainers only; this relationship was stronger for women. Implications include
a need for research exploring: 1. sleep complaints, sleep perceptions, and health; 2. interventions focusing on older
individuals with insomnia secondary to/comorbid with poor health; 3. gender differences in subjective sleep
estimates and in ``single-shot'' versus longitudinal sleep measures.
(Ohayon, 2002). Although quantitative sleep variables (e.g.,
total sleep time, sleep onset latency or the time required to fall
asleep) can be measured subjectively (e.g., sleep diaries,
retrospective questionnaires) or objectively (e.g, polysomnog-
raphy [PSG], or sleep EEG, actigraphy), insomnia diagnosis is
based on subjective estimates of poor sleep quantity and
complaints of poor sleep quality. Interestingly, subjective
estimates of poor sleep quantity are not always predictive of
sleep complaints (McCrae et al., 2003; Fichten et al., 1995).
duration and slow wave sleep (stages 3–4) and increases
in awakenings and light sleep (stages 1–2; Buysse et al., 1992;
1991; Vitiello, Moe, & Prinz, 2002).
Recently, however, Vitiello, Larsen, and Moe (2004) found
men compared to a considerably weaker one for older women,
suggesting that gender influences individuals’ perceptions of
their sleep quantity. This is particularly interesting given that
men (Foley et al., 1995). Sleep complaints have also been linked
to age-related risk factors, including poor health, medication,
anxiety (Fichten et al., 1995), and depression (Foley et al., 1995;
Foley et al., 1999; McCrae et al., 2003; Ohayon, 2002; Vitiello,
Moe, & Prinz, 2002). Epidemiological evidence linking daytime
sleepiness to nocturnal disturbances, depression, and medication
usage in older adults (Whitney et al., 1997) suggests daytime
functioning factors, such as sleepiness and fatigue, may also
NSOMNIA is the most common sleep disturbance in older
adults with prevalence estimates ranging from 15–65%
contribute to sleep complaints. Research exploring the complex
relationships between subjective and objective sleep quantity,
complaints, and the factors related to complaints is crucial for
understanding and treating late-life insomnia.
Numerous researchers have studied late-life insomnia by
comparing complaining poor sleepers to good sleepers (e.g.,
Morin & Gramling, 1989). Recently, researchers have become
interested in a third group—noncomplaining poor sleepers
(Fichten et al., 1995; McCrae et al., 2003). Because sleep
complaints prompt treatment seeking, researchers hope to
identify factors that distinguish individuals likely to seek
treatment for insomnia from those unlikely to seek treatment by
comparing noncomplaining and complaining poor sleepers.
Research to date has produced interesting but equivocal results
and warrants additional follow-up. For example, McCrae and
colleagues (2003) found complaining poor sleepers generally
depressive symptoms than noncomplaining poor sleepers, while
Fichten and colleagues (1995) found complaining poor sleepers
reported more anxiety but small to no differences in subjective
sleep quantity compared to noncomplaining poor sleepers.
In our research, we have found that a substantial number of
older adults fall into a fourth sleep group—complaining good
sleepers. The diagnostic label for this group is sleep state
misperception (American Sleep Disorders Association, 1997).
We believeinclusion of this groupis essentialfor future research
because it allows for comparisons of all possible sleep
complaint—subjective sleep quantity combinations (noncom-
plaining good, complaining good, noncomplaining poor, com-
plaining poor). Thus, the main goal of the present study is to
factors that differentiate these 4 groups and to examine whether
Journal of Gerontology: PSYCHOLOGICAL SCIENCES
2005, Vol. 60B, No. 4, P182–P189
Copyright 2005 by The Gerontological Society of America
by guest on October 20, 2015
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Received June 24, 2004
Accepted January 28, 2005
Decision Editor: Thomas M. Hess, PhD
SLEEP PATTERNS IN OLDER ADULTS
by guest on October 20, 2015