Web Exclusives

Social Involvement and Sleep

By Jamie Santa Cruz

Researchers have found that older adults who are more socially engaged experience better sleep quality and duration.

A growing body of evidence suggests that sleep is critical for maintaining cognitive function, preventing chronic disease, and reducing the risk of mortality.1-4 Now, a new study from researchers at the University of Missouri and the University of Chicago has found that sleep and social participation are connected: specifically, older adults who are more socially engaged—especially in a religious community—experience better sleep on a variety of objective measures.5

The research, published in January 2016 in Social Science and Medicine, looked at three types of social involvement: volunteer work, attendance at religious services, and attendance at meetings of organized groups. The researchers assessed the association of each form of social involvement with self-reports of sleep quality as well as with objective measures of sleep duration and fragmentation. (Objective measurements were collected via a wrist actigraph that recorded participants' activity levels and sleep patterns over a three-day period.)

Though no statistical association was evident with attendance at community meetings, both volunteer work and religious attendance predicted better sleep, with the association being strongest for religious attendance. Specifically, participants who were socially engaged had lower levels of wake after sleep onset, fewer bouts of wakefulness, and less sleep fragmentation. (As for the heightened effect with respect to religious participation over other types of social involvement, Diane Lauderdale, PhD, a professor of epidemiology at the University of Chicago and coauthor of the study, notes that religious participation was more common among study participants than volunteer work or attendance at meetings of organized groups, making it easier to evaluate the impact of religious activity and identify an association with sleep.)

Not only did social involvement predict better sleep but the study results also suggest that there is a dose effect at work, according to Jen-Hao Chen, PhD, an assistant professor of health sciences at the University of Missouri and the lead author of the study. Participants who were more heavily involved socially experienced better sleep than those who were involved to a lesser degree.

Social Factors' Influence
The findings are "intriguing," Lauderdale says, "because social participation is something people can actually do. Religious organizations in particular are very welcoming to people who are losing social connections of other kinds."

The study builds on a large body of previous research that has demonstrated significant health benefits associated with social involvement among older adults. Older adults who are socially engaged report less disability, for example, and are known to have lower rates of morality.6-9 Though little is known about the exact mechanisms involved, one theory is that social involvement confers benefits by promoting healthy behaviors.10,11 The current study, which is based on data from the National Social Life, Health, and Aging Project, a population-based longitudinal study of older Americans, sought to examine the connection between social involvement and sleep to explore whether sleep might be one of the ways in which social connectedness may impact health and morbidity.

"This [research] adds to mounting evidence that sleep quality is related to both social factors and also health outcomes," Lauderdale says. Though there is no proof at present, "it is possible that this could be one of the mechanisms by which social integration predicts better mental health outcomes and lower mortality."

Though the study demonstrates an association between social engagement and sleep, Lauderdale cautions that it is unclear which direction the causal relationship works. "We don't really know what's coming first," she says. "We don't know whether people who have worse quality sleep don't have the motivation or energy to go to religious services and to do volunteer work, or whether it's going the other way, and that people with more socially connected lives get better sleep quality."

The study examined changes in the participants' social participation over a span of five years to determine what impact such changes would have on sleep quality; however, there was little evidence that increased social engagement resulted in improved sleep. Lauderdale cautions, though, that the study design was not ideal for such longitudinal analysis, and that any beneficial impact of social involvement on sleep would likely be observed over a much shorter period than five years.

Significantly, the association in the current study between sleep quality and social participation was evident only on objective measures of sleep, and not on self-reports. In other words, participants who were socially engaged did not perceive themselves as sleeping better than their socially uninvolved peers, even if they were objectively experiencing fewer bouts of wakefulness and less sleep fragmentation.

The lack of association between social engagement and self-reported sleep was an unexpected finding, according to Chen; however, it is consistent with prior research showing that patient self-reports regarding sleep often do not align with direct assessments of their sleep quality and duration.12,13 According to Chen, self-reports of sleep quality tend to align well with individuals' overall experience of well-being and general health, which suggests that when participants answer subjective questions regarding their sleep quality, their answers may be (perhaps unwittingly) influenced by factors other than mere sleep.

Regardless, Lauderdale says, the finding of an association with objective measurements of sleep quality but not subjective reports in some ways strengthens the findings. "It suggests there is something really there, and it's not just that people who reported insomnia symptoms are just unhappy or depressed," she says.

The clinical relevance of the findings is limited given that participants who experienced better actigraphic-estimated sleep did not feel the impact subjectively. Specifically, Lauderdale says, there is no indication that a prescription of increased social involvement would improve symptoms in older adults who complain of poor sleep.

Chen suggests physicians should consider talking with patients about the connection between social involvement and sleep. Even if the causal relationship between the social engagement and improved sleep is not yet established, social engagement is significant for a wide variety of health factors, and thus physicians may wish to encourage older adults to remain socially active. "We do find that older adults who participate more sleep better, and there is no harmful effect [in recommending social involvement]," Chen says.

— Jamie Santa Cruz is a freelance writer based in Englewood, Colorado.

1. Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010;33(5):585-592.

2. Cricco M, Simonsick EM, Foley DJ. The impact of insomnia on cognitive functioning in older adults. J Am Geriatr Soc. 2001;49(9):1185-1189.

3. Gangwisch JE, Heymsfield SB, Boden-Albala B, et al. Sleep duration associated with mortality in elderly, but not middle-aged, adults in a large US sample. Sleep. 2008;31(8):1087-1096.

4. Phillips B, Mannino DM. Do insomnia complaints cause hypertension or cardiovascular disease? J Clin Sleep Med. 2007;3(5):489-494.

5. Chen JH, Lauderdale DS, Waite LJ. Social participation and older adults' sleep. Soc Sci Med. 2016;149:164-173.

6. Mendes de Leon CF, Glass TA, Berkman LF. Social engagement and disability in a community population of older adults: the New Haven EPESE. Am J Epidemiol. 2003;157(7):633-642.

7. Folland S. Does "community social capital" contribute to population health? Soc Sci Med. 2007;64(11):2342-2354.

8. Hill TD, Angel JL, Ellison CG, Angel RJ. Religious attendance and mortality: an 8-year follow-up of older Mexican Americans. J Gerontol B Psychol Sci Soc Sci. 2005;60(2):S102-S109.

9. Hummer RA, Rogers RG, Nam CB, Ellison CG. Religious involvement and U.S. adult mortality. Demography. 1999;36(2):273-285.

10. Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000;51(6):843-857.

11. Kawachi I, Berkman L. Social cohesion, social capital, and health. In: Berkman L, Kawachi I, eds. Social Epidemiology. New York, NY: Oxford University Press;  2000:174-190.

12. Chen JH, Waite L, Kurina LM, Thisted RA, McClintock M, Lauderdale DS. Insomnia symptoms and actigraph-estimated sleep characteristics in a nationally representative sample of older adults. J Gerontol A Biol Sci Med Sci. 2015;70(2):185-192.

13. Chen JH, Waite LJ, Lauderdale DS. Marriage, relationship quality, and sleep among U.S. older adults. J Health Soc Behav. 2015;56(3):356-377.