Jacob Coleman

Kitano N, Tsunoda K, Tsuji T, et al. Association between difficulty initiating sleep in

older adults and the combination of leisure-time physical activity and consumption
of milk and milk products: a cross-sectional study. BMC Geriatr. 2014;14:118.
One of the chief determinants of a persons quality of life is sleep. In Japan, the
location of this study, one in three adults suffer from insomnia-type symptoms.
These symptoms include difficulty falling asleep, difficulty remaining asleep, early
morning awakening, and lack of satisfying sleep. Changes in sleep quality often
occur in the later years of life and sometimes different approaches are needed to
achieve optimum sleep quality and quantity in the elderly. This study takes an
especially novel approach to identifying ways to overcome insomnia in the elderly
and looks at the combination of two different non-pharmacological treatments:
leisure-time physical activity (LTPA) and milk consumption. The idea behind using
milk-products to induce sleep is based on the nutrient tryptophana precursor to
melatonin and serotonin found in dairy. Studies have been done on this topic before
and have shown benefit; however, these studies have been primarily in the Western
population. Additionally, there is limited data on the sleep effects of LTPA and dairy
on the elderly population.
The study was cross-sectional and combined data from 421 people aged 65 and
older who were recruited using local advertisements and flyersdata may have
been skewed because of this sample collection method. LTPA was measured using
the Physical Activity Scale for the Elderly and sleep latency was measured using the
Pittsburgh Sleep Quality Index. Based on internationally-known reliability and welldefined measurement, these two scales were appropriate for this study. Difficulty
initiating sleep (DIS) was defined as a participants inability to fall asleep for at least
30 minutes. Dairy consumption was based on intake of milk, cheese, and yogurt and
was measured using a self-reported questionnaire. The estimated dairy
consumption was calculated from this questionnairethis is the reported gold
standard for assessing diet. Differences in age, gender, BMI, and hypnotic use each
had the potential to skew results in this study. As a cross-sectional study, hypnotic
use could not be controlled and was not adequately discussed in the results.
Data for the results was reported primarily using odds-ratio tables. High-level LTPA
was associated with decreased prevalence of DIS compared to no LTPA. Results for
diet were divided to show specific data for milk, yogurt, cheese, and total dairy
consumption, respectively. Interestingly, high-level milk intake was the only data set
that showed significant reduction in DISyogurt, cheese, and total dairy
consumption had no significant effect on insomnia-symptoms. Combined data
revealed that the combination of LTPA and milk intake reduced DIS. The study
power, however, was not great enough to determine which aspectmilk intake or
LTPAcontributed more to improved sleep quality.
Based on this study, both exercise and milk intake can decrease the time it takes to
fall asleep for elderly patients. This study demonstrated that milk, specifically,
contributes to this effect and not simply any dairy product. The study was
appropriately structured and methods were well-suited for the cross-sectional
design. Further cohort-type research could be done to determine the comparative
value of exercise and milk intake. However, this study adequately demonstrates

Jacob Coleman
that exercise and milk consumption can be added to help improve the sleep quality
of elderly patients suffering from insomnia.