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

Abstract

There is an inconsistent conclusion regarding the relationship of social isolation and loneliness with poor sleep. We investigated the associations of social isolation and loneliness with new-onset insomnia symptoms in a nationally-representative sample of 9,430 adults aged ≥50 who were free of any insomnia symptoms/sleep disorders at baseline (wave 12/13) and followed up to 4 years from the Health and Retirement Study. Social isolation was measured by Steptoe's Social Isolation Index. Loneliness was measured by the revised 3-item UCLA-Loneliness Scale. Insomnia symptoms were quantified using the modified Jenkins Sleep Questionnaire. During a mean follow-up of 3.52 years, 1,522 (16.1%) participants developed at least one insomnia symptom. Cox models showed that loneliness was associated with the onset of difficulties initiating or maintaining sleep, early-morning awakening, nonrestorative sleep, and at least one of these symptoms after adjusting for potential covariates; while social isolation was not associated with the onset of difficulties maintaining sleep, early-morning awakening, or at least one insomnia symptom after adjusting for health indicators. These results are consistent in sensitivity analyses and stratified analyses by age, sex, race/ethnicity, and obesity. Public health interventions aimed at fostering close emotional relationships may reduce the burden of poor sleep among middle-aged and older adults.

Keywords: Sleep disorders; Sleep disturbance; Social connection; Social relationship; Survival analysis.