Older women who have trouble falling asleep and who spend little time in bed actually sleeping are three times more likely of being placed in a nursing home compared to those who have restful uninterrupted sleep.

Researchers at the Johns Hopkins Bloomberg School of Public Health followed 1,664 women with an average age of 83 for five years.

At the beginning of the study, participants were asked to wear actigraphs on their non-dominant wrists for at least three days. An actigraph records sleep movement and is used to determine a person's sleep and wake cycles.

Researchers noted that while previous studies also found a link between sleep disturbance and nursing home placement, researchers in those studies had asked participants questions about their sleep rather than using actigraphs which collects objective data based on movements.

The study, published in the Journal of the American Geriatrics Society, found that women who spent the most time awake after first falling asleep had more than twice the odds of being placed into a nursing home or personal care home and those with the lowest sleep efficiency or spend the smallest portion of their time in bed actually sleep were about three times more likely to be placed in a nursing home.

While the authors found similar results between disturbed sleep and nursing home placement, they found no associations between the amount of time spent sleeping and the likelihood of being placed in an assisted living facility.

"Sleep disturbances are common in older people," lead author Adam Spira, an assistant professor with the Bloomberg School's Department of Mental Health, said in a statement. "Our results show that in community-dwelling older women, more fragmented sleep is associated with a greater risk of being placed in a nursing home or in a personal care home."

Insufficient sleep is associated with a host of chronic diseases and conditions like diabetes, cardiovascular disease, obesity and depression. Not getting enough sleep has also been linked to disability in older adults and the inability to perform basic daily activities.

"Despite the growing literature on sleep disturbance and disability, prior to our research very little was known about the association between sleep disturbance in older adults and risk of placement in long-term care facilities. Greater sleep fragmentation is associated with greater risk of placement in a nursing home or personal care home 5 years later after accounting for a number of potential confounders," Dr. Kristine Yaffe, senior author of the study and professor at the University of California, San Francisco, said in a statement.

"It's important to remember that this is an observational study, so our findings cannot demonstrate a conclusive causal link between sleep disturbance and placement in long-term care facilities. We need more research to explain how sleep disturbance might lead to this outcome, and whether interventions to improve sleep might prevent it," she added.

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