Vitamin D supplementation can improve sleep disorders in the elderly

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Author: Zhu Feng, Guan Rui

Unit: Beijing Rehabilitation Hospital, Capital Medical University

Sleep disorders refer to disturbances in sleep duration, sleep quality or sleep rhythm.

As they age, the elderly have more chronic diseases, such as coughing, sputum, frequent toileting, body pain, and limited turning over at night, which affects their sleep quality. Their sleep becomes shallow, they have difficulty falling asleep again, and their sleep rhythm is disrupted, resulting in poor spirits, decreased appetite, and reduced daily activities the next day. This leads to negative emotions and a decline in the nutritional status and life satisfaction of the elderly.

Comprehensive nutritional intervention plays an important role in improving sleep disorders. The "Expert Consensus on Nutrition for Sleep Disorders in the Elderly" points out that appropriate supplementation of vitamin D is very important for sleep disorders in the elderly.

Vitamin D is generally deficient in the elderly. A 2021 systematic review of vitamin D levels in the Chinese mainland population showed that the rates of vitamin D deficiency and insufficiency were 20.7% and 63.2%, respectively, and the incidence of vitamin D deficiency and insufficiency was 95.3% and 11.3% respectively among the elderly aged ≤18 years.

The proportion further increases in people aged 60 and above. Risk factors for vitamin D deficiency in the elderly include poor living environment, low income, smoking, lack of physical activity, obesity, and comorbidities with other diseases. Meta-analysis found that adults with vitamin D deficiency have a significantly increased risk of sleep disorders, which can be manifested as poor sleep quality and shortened sleep time.

It is currently believed that the level of 25-hydroxyvitamin D, one of the vitamin D metabolites, is the most reasonable indicator to reflect the body's vitamin D level.

Serum 25-hydroxyvitamin D < 20 μg/L can significantly increase the risk of unhealthy sleep, indicating that vitamin D deficiency can significantly increase the risk of sleep disorders. It has been found that vitamin D deficiency may be associated with a variety of sleep disorders, such as sleep apnea syndrome and restless legs syndrome. Persistent vitamin D deficiency may also increase the risk of obstructive sleep apnea by promoting tonsil hypertrophy, airway muscle myopathy and/or chronic rhinitis. Currently, limited evidence shows that vitamin D supplementation can improve insomnia and other related symptoms; and more and more studies show that vitamin D supplementation is not only beneficial to bone health,

It has positive significance in preventing muscle attenuation, improving sugar metabolism, and nervous system function.

The Consensus on the Clinical Application of Vitamin D and Its Analogues recommends the use of ordinary vitamin D₂ or D₃ preparations, and does not recommend the use of active vitamin D or its analogues to correct vitamin D deficiency. The recommended supplementation dose for elderly people at high risk of vitamin D deficiency is 1600~2000IU/d, and a single large dose is not recommended. Elderly people who take vitamin D supplements for a long time should monitor their serum 25-hydroxyvitamin D levels. Increasing sunlight is an economical and effective way to supplement vitamin D, and it is recommended to take 3~4 times a week, 20~30 minutes each time.