The same effect was not found for anxiety symptoms, as insomnia more often appeared after anxiety symptoms than concurrently or before anxiety symptoms. Ohayon and Roth (2003) found that insomnia more often appeared before mood disorder symptoms compared to concurrently or after mood disorder symptoms. Research on adolescent depression and insomnia suggests that this is not a bidirectional relation, but rather insomnia is a precursor to depression ( Lovato and Gradisar, 2014). Insomnia also may be a perpetuating factor for depression in older adults ( Pigeon et al., 2008). Meta-analytic findings also have shown that individuals with insomnia are twice as likely to develop depression than individuals without insomnia ( Baglioni et al., 2011), and this rate may increase to 4- to 5-time greater likelihood of developing depression in adolescents ( Sivertsen et al., 2014). They also found that maintenance insomnia was significantly associated with later MDD diagnosis compared to onset and terminal insomnia. (2006) found that insomnia was a significant risk factor for the later development of MDD such that participants with insomnia were six times more likely to obtain an MDD diagnosis at follow-up than participants without insomnia. Insomnia often co-occurs with depression and anxiety disorders ( Ohayon and Roth, 2003), and in fact insomnia is a DSM-5 criterion for both major depressive disorder (MDD) and generalized anxiety disorder (GAD American Psychiatric Association, 2013). Insomnia's relation with depression and anxiety It is possible that rates of terminal insomnia are higher for older adults, but they may change what they view as an acceptable and normative wake time, thus reporting similar rates of terminal insomnia as their younger counterparts.ฤก.2. Examining the prevalence of the three insomnia types in later life, Ohayon and Roth (2001) found that participants over age 65 had higher rates of onset and maintenance insomnia than participants younger than 45, whereas rates of terminal insomnia were comparable across the lifespan. Ohayon and Roth (2003) found that 24% of people over the age of 65 reported insomnia symptoms, and people over 65 were more likely to endorse persistent insomnia present for more than five years compared to their younger counterparts. Unsurprisingly given these changes in sleep architecture, the prevalence of insomnia symptoms increases across the lifespan. This is especially problematic as older adults often deal with health conditions such as sleep apnea, nocturia, and chronic pain which, when combined with lighter sleep, can result in more arousals. Additionally, older adults have lighter sleep, as the time spent in Stage 1 and Stage 2 slow wave sleep increases and the time spent in stage 3 slow wave sleep decreases with age ( Li et al., 2018 Ohayon and Roth, 2003). It has also been found that sleep efficiency (i.e., ratio of time asleep to time in bed) decreases with age ( Li et al., 2018a Ohayon and Roth, 2003), and this may be associated with increased sleep latency (i.e., time to initially fall asleep) and waking after sleep onset. To begin, total sleep time (TST) decreases by approximately 10 minutes per decade of age ( Dorffner et al., 2015 Ohayon and Roth, 2003).
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