title: The problems of sleep for older women: changes in health outcomes.
abstract: OBJECTIVE
  to identify the continuance of sleeping difficulty and medication use in a cohort of older Australian women from baseline to 3-year follow-up and to explore the relationship between these factors and health-related quality of life scores, falls and other health care use.
  
  
  METHODS
  a 3-year longitudinal survey of 10,430 Australian women aged 70-75 years at baseline. These women were participants in the Australian Longitudinal Study on Women's Health randomly selected from the Australian Medicare database.
  
  
  RESULTS
  a majority of women (63%) endorsed one or more items related to sleeping difficulty at 3-year follow-up: 33% reported one item only, 16% reported two or three items, and 14% reported more than three items; 4,194 (42.4%) reporting "waking in the early hours", 2,592 (26.0%) "taking a long time to get to sleep", 2,078 (21.0%) "sleeping badly at night", 1,072 (10.8%) "lying awake most of the night" and 1,087 (11.0%) "worry keeping you awake". Total scores on the Nottingham Health Profile sleep sub-scale ranged from 0-100 and were skewed to the right. The median score was 12.57. There was a strong statistical association between reporting sleeping difficulty at baseline and at follow-up. A total of 1,532 (15%) women reported use of sleeping medication at follow-up and women were 6.5 times more likely to report use if they also reported any item of sleep difficulty. There was a moderate level of agreement (88%, kappa=0.56) between taking sleeping medication within 4 weeks before the baseline survey and within 4 weeks before follow-up. On multivariate analysis, sleeping difficulty at baseline was negatively associated with general health perceptions, emotional role limitations and general mental health sub-scales of the Short-Form-36 Health Survey at follow-up; the use of sleep medication at baseline was negatively associated with physical functioning, bodily pain, vitality, social functioning and general mental health Short-Form-36 sub-scale scores. The use of sleep medication was also significantly associated with falls, accidents, and health care utilisation.
  
  
  CONCLUSIONS
  sleeping difficulty is a common and persistent complaint among older women and is strongly associated with use of sleeping medications. Both behaviours are negatively associated with health status.
authors.affiliation: Faculty of Health, School of Medical Practice and Population Health, The University of Newcastle, David Maddison Building, Level 3, Royal Newcastle Hospital NSW 2300, Australia.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Byles
authors.forename: Gita D
authors.initials: GD
authors.lastname: Mishra
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Harris
authors.forename: Kichu
authors.initials: K
authors.lastname: Nair
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011788:Quality of Life; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000453:epidemiology; D011795:Surveys and Questionnaires