Study Evaluates Link Between Chronic Stress and Insomnia in Aging Population

Research on the sleep health and associations of chronic stressors and symptoms of insomnia in older adults has yielded conflicting results. And while the overall prevalence of stress increased during the COVID-19 pandemic, not much is understood about chronic stressors in this population or how these stressors have impacted sleep health.

This study aimed to expand the understanding by assessing any associations between chronic stress and insomnia symptoms during the first year of the pandemic. Wan-Chin Kuo, PhD, RN, School of Nursing, University of Wisconsin-Madison, and investigators performed an analysis focused on the sleep health of aging adults.

Investigators noted the substantial economic impact that insomnia has had on the US healthcare system with estimates placing the yearly cost of direct and indirect treatment expenditures at $100 billion. This includes healthcare utilization, medications, and risk of accidents due to insomnia, which is the most prevalent sleep disorder.

Looking for Links Between Insomnia and Stress

The cross-sectional analysis implemented early-release COVID-19 data collected from the Health and Retirement Study which included more than 37,000 older individuals. Investigators isolated and examined information regarding chronic stressors and insomnia symptoms in 2021 adults over the age of 55.

Insomnia Symptoms

Insomnia was defined as difficulty initiating or maintaining sleep in the context of adequate opportunities to sleep that led to daytime consequences. The Jenkins Sleep Questionnaire (JSQ) rated symptom frequency with a 3-point Likert-type scale (0 = rarely or never, 1 = sometimes, and 2 = most of the time) and consisted of 4 screening questions:

1. How often do you have trouble falling asleep?
2. How often do you have trouble with waking up during the night?
3. How often do you have trouble with waking up too early and not being able to fall asleep again?
4. How often do you feel really rested when you wake up in the morning?

If a symptom was reported as "sometimes" or "most of the time" it was considered a current experience of insomnia.

Chronic Stressors

Individuals used a similar numeric scale (0 = did not occur; 1 = not upsetting; 2 = somewhat upsetting; and 3 = very upsetting) to report the occurences of stressors present within the previous 12 months which aligned with the first year of the pandemic for this study. The 8-item chronic stressors scale (CSS-8) was used to measure individuals' subjective experience of chronic stressors across 8 areas of life:

1. Self-health problems
2. Family health problems
3. Alcohol or drug use in a family member
4. Difficulties at work
5. Financial strain
6. Housing problems
7. Problems in a close relationship
8. Caregiving stress

Health and Money Stress Inhibit Sleep

Findings revealed that self-health issues, family-health issues, and financial stress were the leading co-occurences in older adults during the beginning of the pandemic.

Those with frequent experiences of co-occuring stressors were much more likely (91%) to have difficulty falling asleep. This group was also more likely to have issues staying asleep (40%), but investigators noted that the association wasn't as strong after adjusting for health risk factors and COVID-19 concerns.

"Frequent stress co-occurrence plays an important role linking chronic stress to insomnia symptoms in an aging population," investigators concluded. "Ongoing research is needed to examine the lingering effects of frequent stress co-occurrence on older adults' sleep health in the post COVID-19 era."

The study "Linking chronic stress to insomnia symptoms in older adults: The role of stress co-occurrence during the pandemic" was published in Research in Nursing and & Health.