Toward Better Nights: Sleep Hygiene, Depression, Pain, and Insomnia in Geriatric Palliative Veterans

Insomnia is common among older adults receiving palliative care, yet the role of sleep hygiene in insomnia severity remains unclear. We conducted a cross-sectional study of 76 older veterans receiving outpatient palliative care (mean age, 75 years; 85.5% male). Participants completed the Sleep Hygiene Index, Insomnia Severity Index, Epworth Sleepiness Scale, and Geriatric Depression Scale. Nighttime pain was assessed using a 0-10 numeric rating scale. Multivariable linear regression examined the association between sleep hygiene and insomnia severity after adjusting for age, depressive symptoms, and nighttime pain. Poorer sleep hygiene was independently associated with greater insomnia severity (B = 0.382, 95% CI, 0.198-0.566; p < 0.001). Higher depressive symptoms (B = 1.063, 95% CI, 0.684-1.442; p < 0.001) and nighttime pain (B = 0.725, 95% CI, 0.331-1.119; p < 0.001) were also independently associated with greater insomnia severity. These findings support the potential value of addressing sleep hygiene alongside depressive symptoms and nighttime pain in palliative care. Prospective and interventional studies are needed to determine whether such approaches improve sleep outcomes.