Introduction

Sleep is central to health and wellbeing, yet sleep is likely to deteriorate with advancing age. Health promotion over the last two decades has emphasised the importance for health and wellbeing of the ‘big four’ – a good diet, physical exercise, not smoking, and restricting alcohol consumption. A fifth health promotion message is also essential for good health and wellbeing, namely, sleep. Sleep of a sufficient duration and quality is important for older people's wellbeing and ability to engage fully in daytime activities, whether living in their own homes or in a care home.

While many sleep researchers view sleep purely as a physiological process, social scientists have increasingly shown how a range of societal factors associated with individuals’ roles, relationships, family circumstances, daytime activities and environmental factors have an impact on sleep quality and duration (Hislop and Arber, 2006; Williams et al, 2010; Arber et al, 2012). While not denying that sleep has some physiological basis, this chapter examines some of the social aspects of sleep that are critical in influencing the autonomy and independence of older adults. As Williams (2005) reminds us, how, when and where we sleep are all societally, historically and culturally contingent.

Prospective epidemiological studies show a link between short sleep duration (under 6 hours) and elevated mortality, especially from cardiovascular disease (Ferrie et al, 2010; Grandner et al, 2012). Sleep is also important for cognitive functioning and memory consolidation (Busto et al, 2001), and sleep problems have an impact on quality of life, on daytime functioning and on recovery from illness (Haimov and Vadas, 2009).

It is well known that depression is associated with sleep problems, although recent research has shown that sleep problems often predate depression, and may therefore be a causal factor in the development of depression (Ferrie et al, 2011). During sleep, various physiological mechanisms take place associated with repair of the immune and other biological systems. Thus, sleep problems have detrimental effects on health in later life, with those who suffer from poor sleep being more likely to be at risk of heart attacks, falls, stroke, obesity and depression (Ancoli-Israel, 2005; Harrington and Lee-Chiong, 2007).