Yoga for improving sleep quality and quality of life of older adults in a western cultural setting

Little research has been published (by early 2007) on yoga as an intervention for improving sleep quality and quality of life of older people in a western cultural setting. The aim of the present study was to fill a gap in existing research and evaluate whether a yoga intervention could improve sleep quality and quality of life of elderly people living in a western cultural setting. A mixed ‘waiting list control’ (WLC) study design (n =74) was used, with participants’ ages ranging from 60 to 87 (M = 74.4, SD = 7.1). The yoga intervention included two weekly classes incorporating physical and meditative yoga, and daily home practice of meditative yoga for 12 weeks. Subjective measures included the Pittsburgh Sleep Quality index (PSQI), Karolinska Sleepiness Scale (KSS), Epworth Sleepiness Scale (ESS), Multivariate Apnea Prediction Index (MAP), Profile of Mood States (POMS), Depression Anxiety and Stress Scale (DASS), Short Form Health Survey (SF36) and daily sleep and practice logs. Objective measures were derived from sleep studies conducted using portable monitoring in the participants’ home environments. Overall, the results indicate that yoga appears to be a safe, easy to implement, and well accepted, non-drug intervention for insomnia in the elderly in a western cultural setting. Practicing yoga for at least 25 minutes a day for twelve weeks improved most aspects of subjective sleep status and many aspects of psychological and emotional well being. Practice compliance was found to be an essential factor in the outcomes of the yoga intervention with high practice compliance being related to improvements in sleep quality measures and some quality of life measures. In comparison to the control group the treatment group showed significant improvements in a range of subjective factors including overall sleep quality (p=.011), sleep efficiency (p=.045), sleep latency (p=.004), sleep duration (p=.042), self assessed sleep quality (p=.002) and fatigue (p=.010). Improvements were also seen in general well being (p=.008), overall mental health (p=.009), depression (p=.019), anxiety (p=.011), stress (p=.022), tension (p=.044) anger (p=.005), vitality (p=.053) and daily function in physical (p=.035), emotional (p=.043), and social (p=.030) roles. Improvements were also seen in the duration of the deep sleep (SWS) stage (p=.042). However, no significant change was found in the use of sedative-hypnotic medications in the study population. It was also found that obstructive sleep apnea (OSA) appears to be present to varying degrees in the majority of elderly people presenting with insomnia symptoms. While the results suggest that yoga practice did not result in a significant change in OSA status, the presence of co-morbid OSA reduced the efficacy of yoga in improving overall sleep quality and sleep efficiency and some aspects of quality of life including carrying out daily roles and social function, but did not affect most other measures. Currently, recommended diagnostic procedures for patients presenting with insomnia symptoms appear inadequate to diagnose OSA reliably in elderly patients presenting with insomnia symptoms, suggesting they should be screened for OSA using objective sleep studies prior to prescribing sedative-hypnotics