A four-year-long study of middle-aged and older adults has found that that lonely individuals tend to develop sleep problems over time. These problems include difficulty falling asleep and maintaining sleep, early-morning awakenings, and feeling tired and unrefreshed after sleeping. The study was published in Psychiatry Research.
Insomnia is a common sleep disorder characterized by difficulty falling asleep, staying asleep, or experiencing nonrestorative sleep (feeling tired and unrefreshed after sleeping). It can lead to daytime fatigue, irritability, and impaired functioning in daily activities. Insomnia can be caused by various factors, including stress, anxiety, medical conditions, and lifestyle habits.
Insomnia has also been linked to aging. Nearly half of adults aged 65 years or older experience insomnia symptoms. Insomnia symptoms, on the other hand, are associated with higher risks of cardiovascular diseases, dementia, increased hospitalization and nursing home admission, and risk of death. As the world population ages, insomnia is expected to become a more common problem, bringing with it all the associated adverse health consequences.
Scientists have tried to explain the link between insomnia and aging in the hope of developing ways to prevent the development of insomnia. They have identified various factors that develop as people age that might be responsible for the onset of insomnia. The authors of the new study proposed that loneliness and social isolation might be two of the factors associated with insomnia in older adults.
“I’ve always been intrigued by the intricate connections between our social lives and our health. The topic of social isolation and loneliness, particularly among middle-aged and older adults, is a pressing issue in our society. I was interested in exploring how these factors might influence sleep patterns, as sleep is a crucial aspect of overall health and well-being,” explained study co-author Bei Wu, Dean’s Professor in Global Health and Vice Dean for Research at the NYU Rory Meyers College of Nursing.
The researchers used data from the Health and Retirement Study (HRS), a nationally-representative longitudinal survey of middle-aged and older adults in the United States, conducted since 1992. The Health and Retirement Study has been specifically designed to investigate the health, economic, and social factors that impact the well-being of individuals as they age.
The researchers analyzed data of 9,430 participants who were over 50 years of age and who completed assessments of sleep, social isolation, and loneliness in the scope of this survey. These individuals had no insomnia symptoms at the start of the study. These researchers analyzed data from a 4-year period starting with waves 12 and 13 of the Health and Retirement Study. The mean age of participants was 68 years and 58.3% were women.
The participants completed assessments of social isolation (the Steptoe’s Social Isolation Index), loneliness (revised UCLA Loneliness Scale), and insomnia symptoms (the Jenkins Sleep Questionnaire). The researchers also analyzed data on participants’ age, sex, race/ethnicity, education, income, smoking, alcohol consumption, physical exercise, obesity, depressive symptoms, daily living activities, cognitive function, and chronic conditions.
The results showed that 1,522 participants (16.1%) developed at least one insomnia symptom during the study period. Roughly 15% of participants reported difficulties falling asleep, 11.7% reported difficulties staying asleep, 14.1% reported early-morning awakening, and 13.0% reported nonrestorative sleep i.e., feeling tired and unrefreshed after sleeping.
Participants who reported being more socially isolated or lonely tended to belong to ethnic/racial minority groups more often, to be less educated, with lower income, less physically active, current or former smokers, having impairments related to daily living activities, having more depressive symptoms, lower levels of cognitive function, and more chronic medical conditions.
Analysis of trends of change over time showed that lonely participants were almost twice more likely to develop at least one insomnia symptom over the study period compared to participants who were not lonely. When socio-demographic, economic and medical factors were controlled for, this risk was still more than 50% higher among lonely participants.
“Our study underscores the significant impact that social factors can have on health,” Wu told PsyPost. “Specifically, we found that loneliness was associated with difficulties in initiating or maintaining sleep among middle-aged and older adults. This suggests that fostering social connections and addressing feelings of loneliness could potentially help improve sleep quality in this population.”
The risk of developing at least one insomnia symptom was also higher in the group of participants who reported being socially isolated compared to those who were not socially isolated. However, this increased risk practically disappeared when socio-demographic, economic and medical factors were taken into account.
“One surprising finding was that social isolation was not associated with the onset of insomnia symptoms after adjusting for health indicators. This indicates that the quality of social connections may be more important than the quantity when it comes to sleep health,” said study co-author Xiang Qi, a research scientist at Rory Meyers College of Nursing.
The study makes an important contribution to understanding the link between age and insomnia. However, it also has limitations that need to be considered. Notably, insomnia and all other assessments were done solely using self-reports. This may have introduced bias. Additionally, researchers did not have data on the duration of insomnia symptoms nor were they able to control for the major depressive disorder, a condition known to be associated with insomnia.
“As with any study, there are caveats,” Qi said. “Our study was observational, so we can’t establish causality. There may also be other unmeasured factors that could influence the results. Further research is needed to understand the mechanisms behind these associations and to explore potential interventions.”
“I would like to add that our findings highlight the importance of public health interventions aimed at fostering close emotional relationships,” Wu explained. “Such interventions could potentially reduce the burden of poor sleep among middle-aged and older adults.”
The paper “Associations of social isolation and loneliness with the onset of insomnia symptoms among middle-aged and older adults in the United States: A population-based cohort study” was authored by Xiang Qi, Susan K. Malone, Yaolin Pei, Zheng Zhu, and Bei Wu.
