Loneliness and Marital Quality as Predictors of Older Adults’ Insomnia Symptoms

Abstract

The current study examined associations between marital quality, loneliness, and sleep within a nationally representative sample of older adults who participated in Wave 2 of the National Social Life, Health, and Aging Project (NSHAP). Participants (N = 559) had a spouse or partner and completed a novel sleep module that included subjective (i.e., insomnia symptoms) and objective (i.e., wake after sleep onset;WASO) markers of sleep. Upon controlling for demographics and markers of mental and physical health, a distinct pattern of findings emerged for subjective versus objective markers of sleep. Regarding subjective sleep, older adults who experienced greater loneliness reported more insomnia symptoms, but only when spousal emotional support was low–moderate. Regarding objective sleep, older adults who reported more affectionate touch from their spouse experienced less WASO. Collectively, these findings identify specific aspects of marital quality that may have unique implications for partnered older adults’ subjective and objective sleep quality.

Keywords

sleep insomnia symptoms marital quality aging loneliness

Sleep problems and loneliness both increase with age and undercut older adults’ health and well-being (Patel et al., 2018). Although being married (or partnered) acts as a protective factor that mitigates loneliness (Dahlberg et al., 2022), even partnered older adults experience loneliness, especially in the context of low marital quality (Hsieh & Hawkley, 2018). Approximately one in six married older adults report feelings of loneliness in the moderate to severe range (De Jong Gierveld et al., 2009). Those who report greater loneliness also endorse lower levels of spousal emotional support, thus indicating that marital quality plays a crucial role in predicting loneliness among partnered older adults (Chen & Feeley, 2014; Marini et al., 2020). This is relevant as loneliness heightens feelings of alertness that make it difficult to fall and stay asleep (Hawkley & Cacioppo, 2010). Difficulty falling and staying asleep are particularly problematic symptoms for older adults as they—and other symptoms of insomnia—have been shown to increase susceptibility to chronic disease and all-cause mortality rates (Dew et al., 2003; Jaussent et al., 2011).

Loneliness and Insomnia Symptoms

There is a well-established body of literature linking loneliness and insomnia symptoms, especially among older adults (McHugh & Lawlor, 2013). Loneliness acts as a type of threat signal that stokes alertness, which in turn makes it difficult to fall and stay asleep (Hawkley & Cacioppo, 2010). Effects of loneliness on insomnia symptoms have been shown to persist over prolonged periods of time. As such, a longitudinal study found that those who reported higher (as opposed to lower) loneliness at baseline were more likely to report difficulty falling asleep 4 years later (Shankar, 2020). Such findings are not limited to subjective evaluations of one's sleep, however. Kurina et al. (2011) found that lonelier individuals experienced more restlessness during the night (i.e., sleep fragmentation) when sleep was measured via wrist actigraphy. Likewise, Benson et al. (2021) recently found that loneliness was associated with more wake after sleep onset (WASO) (measured via wrist actigraphy) within a sample of older adults. Although valuable, such studies are limited in that they do not consider marital quality in concert with loneliness in order to examine their unique (and potentially interactive) implications for older adults’ insomnia symptoms.

Marital Quality and Insomnia Symptoms: Emotional Support and Affectionate Touch

Several studies have now shown that married (or partnered) older adults who report higher levels of emotional support from their spouses benefit from better objective (e.g., fewer awakenings after sleep) and subjective (e.g., fewer self-reported sleep problems) sleep quality (Chen et al., 2015; Steptoe et al., 2008). This may be because spousal emotional support encompasses behaviors (e.g., actively listening to one's partner) that communicate a sense of companionship, understanding, and safety that promote one's ability to fall and stay asleep (Chen et al., 2015; Cohen, 2004; Thoits, 2011). As such, research has shown that changes in spousal support and insomnia symptoms are coordinated over prolonged periods of time; decreases in insomnia symptoms coincide with increases in spousal emotional support (Lee et al., 2017).

Forms of physical touch that demonstrate affection with one's partner (e.g., hugs, cuddles, and light caresses on the arm) throughout the day—collectively referred to as affectionate touch (Floyd, 2006)—also have been shown to be a source of support that benefits partnered individuals (Debrot et al., 2013). For this form of touch to be classified as affectionate, the touch recipient must interpret this gesture as an act of their partner's care (Floyd, 2006). Affectionate touch has been linked to improved psychological well-being, physical health (e.g., reduced systolic blood pressure), and reductions in experimentally induced pain (Debrot et al., 2013; Goldstein et al., 2016; Holt-Lunstad et al., 2008).

To our knowledge, links between spousal affectionate touch throughout the day and sleep outcomes (subjective or objective) have yet to be explored. However, Jakubiak and Feeney's (2017) Model of Affectionate Touch in Adulthood posits that affectionate touch leads to positive relational outcomes by means of increased feelings of social inclusion and security. As such, their prior experimental research has demonstrated that affectionate touch from a partner increases felt security (Jakubiak & Feeney, 2016). Feelings of social inclusion and security are also key predictors of improved sleep quality (Troxel et al., 2007). Felt security allows individuals to down-regulate their physiological responses and promotes a sense of relaxation thereby creating an optimal psychological and physical state that is conducive to falling and staying asleep (Troxel et al., 2007). Thus, affectionate touch throughout the day may represent an additional facet of marital quality that mitigates older adults’ insomnia symptoms.

Although affectionate touch during the day has yet to be examined as a predictor of insomnia symptoms, a few recent studies have examined associations between touch during the night (while co-sleeping) and sleep outcomes. In fact, the marital (or intimate partner) relationship is often thought to have a primary social influence on sleep because of the likelihood that partners sleep in the same bed (Troxel et al., 2007). There is mixed evidence, however, as to whether touch while co-sleeping has a positive or negative impact on sleep quality. Some research suggests that spousal touch while co-sleeping is associated with increased sleep quality (Shahid, 2017) and related outcomes, such as improved mood (Roberts et al., 2022). However, other research has found negative associations between touch while co-sleeping and sleep quality (Dueren et al., 2022). This may be because one partner's snoring and unexpected sudden movements have been shown to disrupt the other partner's sleep (Troxel et al., 2007). Specifically with regard to affectionate touch, Dueren et al. (2022) found that although most adults in their sample perceived that affectionate touch during co-sleeping would benefit their sleep, it was actually related to lower levels of subjective sleep quality, including increased reports of WASO. While evidence regarding associations between co-sleeping and health and well-being are mixed, we do know that people are actually less likely to report sleeping in the same bed as their partners as they get older (Lauderdale et al., 2014). This may represent an adaptive choice for older couples if one (or both) partner have problems sleeping as research has shown that, in such instances, co-sleeping is associated with decreased physical and mental health (Strawbridge et al., 2004).

In part, because older adults are less likely to co-sleep with their partners, we therefore chose to focus on affectionate touch throughout the day (rather than at night) as a marker of physical support from one's spouse that may—like emotional support—have implications for insomnia symptoms. Doing so enabled us to (a) more closely align our examination of affectionate touch and emotional support and (b) examine associations between affectionate touch and insomnia symptoms regardless of whether older adults co-slept with their partner.

In addition to examining unique associations between older adults’ insomnia symptoms and both loneliness and marital quality, we drew from the stress-buffering hypothesis (Cohen & Wills, 1985) to explore whether marital quality may act as a source of support that buffers negative effects of loneliness (a form of social stress) on insomnia symptoms. As previously discussed, even partnered older adults experience loneliness if their relationships are of low quality (De Jong Gierveld et al., 2009; Marini et al., 2020). Older adults report higher levels of loneliness in the context of low spousal support (Chen & Feeley, 2014; Marini et al., 2020). Loneliness has even been identified as a mechanism through which marital quality predicts increases in older adults’ depressive symptoms over time (Marini et al., 2020). Thus, among partnered older adults, loneliness acts as a form of social stress that is associated with negative health outcomes. Benefits of spousal emotional support (e.g., companionship) and affectionate touch (e.g., felt security) may therefore be particularly salient for older adults who report higher levels of loneliness, which often encompasses feelings of hypervigilance and insecurity which, in turn, disrupt sleep quality (Hawkley & Cacioppo, 2010).

The Current Study

The purpose of the current study was to examine links between loneliness, marital quality, and insomnia symptoms within a nationally representative sample of older adults who were married (or cohabitating with a partner). We examined the degree to which different facets of marital quality, namely, emotional support and affectionate touch, were predictive of insomnia symptoms above and beyond loneliness and whether they buffered negative effects of loneliness on insomnia symptoms. We utilized both subjective (i.e., self-reported symptoms of insomnia) and objective (i.e., actigraphy-measured WASO) measures of insomnia symptoms. We focused specifically on WASO because, relative to other symptoms of insomnia (e.g., sleep onset latency), WASO has been shown to be the strongest predictor of daytime functioning (Edinger et al., 2008). Although correlated with each other, subjective and objective measures of sleep tap into fundamentally different processes (Benson et al., 2021) that have been shown to be differentially associated with psychosocial factors, including spousal emotional support (Chen et al., 2016).

We hypothesized that loneliness would be associated with higher subjective insomnia symptoms and objective WASO (Hypothesis 1), whereas spousal emotional support (Hypothesis 2) and affectionate touch (Hypothesis 3) would each be associated with lower subjective insomnia symptoms and objective WASO. Drawing from the stress-buffering hypothesis (Cohen & Wills, 1985), we then explored whether marital quality moderated associations between loneliness and insomnia symptoms. We hypothesized that marital quality (i.e., spousal emotional support and/or affectionate touch) would buffer/weaken the degree to which loneliness was associated with higher self-reported insomnia symptoms and/or higher WASO (Hypothesis 4).

Method

Participants and Procedure

The current study utilized data from the second wave (2010–2011) of the National Social Life, Health, and Aging Project (NSHAP). NSHAP is a large population-based study of older adults that investigates social factors related to physical health and correlates of healthy aging (Waite et al., 2019). The current study utilized data from a sub-sample of participants from Wave 2 who were partnered (i.e., married or cohabitating) and also participated in an additional sleep module that assessed objective and subjective measures of sleep (N = 559). We were restricted to using Wave 2 because it was the only one that included the sleep outcomes of interest.

Gender was operationalized as a binary variable, and 49.4% of the sample identified as female. Participants were, on average, 69.91 years old (SD = 7.91). The majority (82.3%) of participants identified as White, whereas 8.8% identified as Black, 0.7% identified as American Indian or Alaskan Native, 2.7% identified as Asian or Pacific Islander, and the remaining 5.4% identified as other. Most of the sample was married (95.5%), while a small percentage reported that they cohabitated with their partner but were not legally married (4.5%). The majority (83%) of participants had received a high school diploma or had passed an equivalency test. Further, 23.3% of the sample also had received a bachelor's degree or higher level of education (i.e., master's degree, J.D., M.D., Ph.D.).

Measures

Loneliness

Loneliness was assessed by the UCLA Loneliness (3-item) Scale (Russell et al., 1978). Participants were asked: (a) How often do you feel that you lack companionship? (b) How often do you feel left out? and (c) How often do you feel isolated from others? The response options included 0 (never), 1 (hardly ever), 2 (some of the time), and 3 (often). Following Russell (1996), we combined all three items to create a single sum scale where higher scores indicated higher endorsements of loneliness (ω = 0.83).

Emotional Support

Emotional support was operationalized by two items: (a) How often can you open up to your spouse/partner if you need to talk about your worries? and (b) How often can you rely on your spouse/partner if you have a problem? Responses ranged from 0 (never), 1 (hardly ever), 2 (some of the time), and 3 (often). These items originated from Schuster et al.'s (1990) scale of supportive and negative interactions. These two items were summed and averaged to create a mean scale as has been done in previous research (ω = 0.58) (Hsieh & Hawkley, 2018; Marini et al., 2020).

Affectionate Touch

The frequency of affectionate touch was assessed by a single-item developed for NSHAP that asked participants how many times, reflecting upon the past 12 months, they shared a caring touch with a romantic partner (Thomas & Kim, 2021). Affectionate touch included a hug, sitting or lying cuddled up, a neck rub, or holding hands. The response scale ranged from (0) never, (1) about once a month or less, (2) about once a week, (3) several times a week, (4) about once a day, (5) a few times a day, and (6) many times a day. Higher scores on this item indicated more affectionate touch.

Insomnia Symptoms

Insomnia symptoms were measured via self-reported items that asked participants how often they had trouble: (a) falling asleep, (b) waking up during the night, and (c) waking up too early and not being able to fall asleep again. Response options included (0) rarely or never, (1) sometimes, and (2) most of the time. Consistent with existing research (e.g., Chen et al., 2016), we summed all of these items together to create a scale in which higher values reflected more insomnia symptoms (ω = 0.53).

WASO

WASO (or the total number of minutes awake during a period of sleep) was captured via wrist actigraphy. Participants were asked to wear wrist actigraphy devices (Actiwatch Spectrum model from Phillips Respironics) for three consecutive nights. The actigraphy device measures sleep disturbances based on wrist movements (indicating wakefulness) that the participants engage in throughout the night. Participants were also mailed a sleep diary to complete while wearing the device to ensure that the correct sleep intervals were recorded via the Actiwatch. As suggested by Lauderdale et al. (2014), the WASO variable was calculated by averaging each participant's WASO across nights into a single variable (ω = 0.77). The majority (94.5%) of participants had valid actigraphy data for all 3 days (whereas 4.5% had valid data for 2 days, and 1.1% had valid data for 1 day).

Covariates

The following covariates were included in the analyses: gender, age, education, depressive symptoms, comorbidity, consuming sleep medications in the past 2 weeks (yes vs. no), and the frequency at which participants slept in the same bed as their partner. Gender, older age, depressed mood, and chronic illness are all risk factors associated with lower sleep quality and were therefore controlled for in the analyses (Smagula et al., 2016). Depressive symptoms were assessed by an 11-item version of the Center for Epidemiological Studies Depression Scale (CESD; Radloff, 1977). In this questionnaire, participants were asked to report whether—and how often—they experienced symptoms of depression (i.e., “My appetite was poor”) in the past week. Response options included (a) rarely or none of the time, (b) some of the time, (c) occasionally, and (d) most of the time. Positively worded items (e.g., “felt happy”) were reversed coded prior to summing all the items to create a sum scale (M = 3.36, SD = 3.83). Importantly, we left out the two items about loneliness and restless sleep from the sum scale to avoid conceptual redundancy with our key study variables of interest. The measure used in the current study had high reliability (ω = 0.77). However, we also estimated all of our models with the full 11-item scale as a sensitivity analysis, and the pattern of findings was virtually identical. Comorbidity was operationalized as the NSHAP Comorbidity Index (NCI; Vasilopoulos et al., 2014), which is a weighted sum of 15 different chronic conditions (e.g., diabetes) with a possible range of 0–21. The mean in our sample was 2.55 (SD = 1.98).

The majority (80.5%) of the sample reported that they did not take sleep medications in the past 2 weeks (whereas 19.5% did take sleep medications in the past 2 weeks). Finally, because co-sleeping may have both positive and negative implications for older adults’ sleep (Andre et al., 2021), we controlled for the frequency at which older adults slept with their partner in the current study. Participants were asked how often in the last month they slept in the same bed with their spouse or romantic partner. Response options included: (0) never, (1) rarely, (2) some of the time, (3) most of the time, and (4) all of the time. About half (51.7%) of participants reported that they slept in the same bed as their partner all of the time.

Data Analysis

We conducted our analyses using multiple regression models with complex survey and sampling designs in Mplus V8.4 (Muthén & Muthén, 2017). Full information maximum likelihood (FIML) estimation was used to handle missing data (Santini et al., 2020). Importantly, WASO data were missing for 31 participants because they did not participate in the sleep module. Likewise, loneliness and affectionate touch data were missing for 93 participants because these constructs were measured via a separate leave-behind questionnaire. All other variables had fewer than five cases of missing data. To assess whether there were significant differences among key study variables for participants with valid versus missing data on WASO and loneliness/affectionate touch, we conducted a series of independent samples t-tests. As shown in Supplemental Table 1, there were no significant differences by missing data status for any key variable of interest in the current study. In addition to using FIML to handle missing data, all analyses further took into account the clustering and stratification of NSHAP's sample design utilizing NSHAP-supplied sampling weights from Wave 2 to account for differential probabilities of selection.

To test our hypotheses, we estimated two sets of models, one where subjective insomnia symptoms served as the outcome and one where objective WASO served as the outcome. For each outcome, we estimated three models: (a) main effects of loneliness (H1) and spousal emotional support (H2) and affectionate touch (H3) + covariates (i.e., age, gender, sleep with partner, sleep medications, and depressive symptoms); (b) all effects estimated in model 1 plus the interaction between loneliness and spousal emotional support (H4); and (c) all effects estimated in model 1 plus the interaction between loneliness and affectionate touch (H4). The added interactions in models 2 and 3 enabled us to test our hypothesis that spousal emotional support and/or affectionate touch would buffer the negative association between loneliness and insomnia symptoms (either subjective insomnia symptoms or objective WASO). For each significant interaction effect (p < .05), additional analyses were conducted to test the region of significance within Mplus.

Results

Bivariate correlations among all study variables are reported in Table 1. As illustrated, there were significant correlations in hypothesized directions. Loneliness was significantly positively associated with subjective insomnia symptoms (but not objective WASO). Spousal emotional support was significantly negatively associated with subjective insomnia symptoms (but not objective WASO). Finally, affectionate touch was significantly negatively associated with both insomnia symptoms and WASO (see Table 1).

Table 1.
Descriptive Statistics and Correlations.

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

1. Age –

2. Gender (female) −0.22*** –

3. Education −0.09* −.01 –

4. Sleep with partner −0.04 0.01 0.08 –

5. Sleep medications (yes) −0.01 0.12** 0.09* −0.001 –

6. Depressive symptoms 0.02 0.09* −0.14** −0.07 0.10* –

7. Comorbidity 0.18 −0.05 −0.04 0.001 0.08 0.18 –

8. Loneliness −0.04 0.01 0.11* −0.11* 0.07 0.36** 0.04 –

9. Emotional support −0.06 −0.10* 0.07 0.11* −0.03 −0.20** −0.09* −0.26 –

10. Affectionate touch 0.02 −0.04 0.04 0.28 0.05 −0.09* −0.01 −0.22 0.29 –

11. Insomnia symptoms −0.001 0.05 −0.03 −0.02 0.18 0.24 0.16 0.19 −0.06 −0.01 –

12. WASO 0.06 −0.08 −0.16** −0.10* 0.02 0.12** 0.07 0.06 −0.04 −0.11* 0.14** –

M/% 69.91 49.4 2.71 2.93 19.5 3.36 2.55 2.88 2.72 3.53 2.27 38.07

SD 7.91 – 1.01 1.58 – 3.83 1.98 2.24 .47 1.77 1.76 22.25

N 559 559 559 458 559 556 559 466 557 468 558 528

Observed range 36–91 – 1–4 0–4 – 0–19 0–12 0–9 0–3 0–6 0–8 3.17–198.50

p < .05; p < .01; p < .001.

Subjective Insomnia Symptoms

With subjective insomnia symptoms as the outcome, we found support for H1; loneliness was significantly positively associated with insomnia symptoms even after accounting for covariates (estimate = 0.129, p = .002, 95% confidence interval [CI] = 0.048–0.211; see model 1, Table 2). Contrary to H2 and H3, neither spousal emotional support (estimate = 0.241, p = .210, 95% CI = −0.136–0.618) nor affectionate touch (estimate = −0.001, p = .986, 95% CI = −0.142–0.139) was significantly associated with insomnia symptoms. Together, covariates and main effects of loneliness and marital quality accounted for 13.6% of the variance in insomnia symptoms (see model 1, Table 2).

Table 2.
Loneliness and Marital Quality Predicting Self-Reported Insomnia Symptoms.

Model 1 Model 2 Model 3

Est. SE 95% CI Est. SE 95% CI Est. SE 95% CI

Age 0.001 0.012 −0.023–0.026 0.002 0.012 −0.022–0.026 0.001 0.012 −0.023–0.025

Gender (female) 0.032 0.160 −0.281–0.345 0.004 0.157 −0.303–0.311 0.024 0.156 −0.282–0.330

Education −0.025 0.077 −0.176–0.127 −0.021 0.082 −0.182–0.139 −0.021 0.080 −0.177–0.136

Sleep with partner 0.012 0.065 −0.115–0.140 0.028 0.066 −0.102–0.158 0.013 0.064 −0.113–0.139

Sleep medications (yes) 0.672 0.201 0.278–1.065 0.703 0.199* 0.312–1.094 0.677 0.204 0.278–1.077

Depressive symptoms 0.101 0.023* 0.056–0.146 0.103 0.024* 0.056–0.149 0.101 0.023* 0.055–0.146

Comorbidity 0.074 0.034* 0.008–0.141 0.075 0.033* 0.010–0.141 0.074 0.034* 0.008–0.141

Loneliness 0.129 0.042 0.048–0.211 0.121 0.040 0.043–0.199 0.128 0.041** 0.047–0.209

Emotional support 0.241 0.192 −0.136–0.618 0.409 0.193* 0.031–0.787 0.244 0.192 −0.132–0.620

Affectionate touch −0.001 0.072 −0.142–0.139 −0.013 0.074 −0.159–0.132 0.001 0.070 −0.136–0.138

Loneliness X emotional support – – – −0.177 0.091^t −0.355–0.001 – – –

Loneliness X affectionate touch – – – – – – −0.012 0.022 −0.055–0.032

R ² 0.136 0.032* 0.148 0.030* 0.137 0.032***

Note. Unstandardized estimates are shown.

^t
p < .10; p < .05; p < .01; p < .001.

Although there were no main effects of marital quality on insomnia symptoms, we did detect a trend-level interaction between loneliness and spousal emotional support in accordance with H4 (estimate = −0.177, p = .052, 95% CI = −0.355–0.001; see model 2, Table 2). The pattern of the interaction is illustrated in Figure 1, which depicts the magnitude of the slope of the association between loneliness and insomnia symptoms across different levels of spousal emotional support. The positive association between loneliness and insomnia symptoms (positive values on the y-axis) gets weaker as spousal emotional support increases (a downward sloping line). The association between loneliness and insomnia symptoms actually only reached statistical significance at low/moderate—but not high—levels of spousal emotional support (region of significance is indicated by the shaded area of Figure 1, that is where the upper and lower confidence bands did not include 0). Thus, in accordance with H4, high spousal emotional support acted as a buffer that weakened the extent to which higher loneliness was associated with higher insomnia symptoms.

Figure 1.
Moderating role of spousal emotional support on association between loneliness and insomnia symptoms. Note. The center line depicts the magnitude of the association between loneliness and insomnia symptoms across different levels of the mean-centered moderating variable of spousal emotional support (i.e., simple slopes). The shaded area indicates at which levels of spousal emotional support there is a statistically significant association between loneliness and insomnia symptoms (i.e., where the confidence bands—the upper and lower lines—do not include zero). Loneliness is therefore positively associated with insomnia symptoms at low and moderate (but not high) levels of spousal emotional support.

Objective WASO

With WASO as the outcome, we did not find support for H1 or H2; neither loneliness (estimate = −0.069, p = .911, 95% CI = −1.264–1.127) nor spousal emotional support (estimate = 1.333, p = .543, 95% CI = −2.960–5.626) was significantly associated with WASO after accounting for covariates (see model 1, Table 3). However, in support of H3, affectionate touch was significantly negatively associated with WASO (estimate = −1.378, p = .029, 95% CI = −2.615–−0.141). Together, covariates and main effects of loneliness and marital quality accounted for 6.2% of the variance in WASO (see model 1, Table 3). To test H4, we added interactions between loneliness and spousal emotional support (see model 2, Table 3) and between loneliness and affectionate touch (see model 3, Table 3), neither of which reached statistical significance. Spousal affectionate touch did not buffer an association between loneliness and WASO, but rather was directly associated with it.

Table 3.
Loneliness and Marital Quality Predicting Wake After Sleep Onset.

Model 1 Model 2 Model 3

Est. SE 95% CI Est. SE 95% CI Est. SE 95% CI

Age 0.043 0.099 −0.152–0.237 0.042 0.099 −0.153–0.237 0.031 0.100 −.166–0.227

Gender (female) −2.677 1.393^t −5.407–0.054 −2.586 1.370^t −5.271–0.099 −2.924 1.471* −5.808–−0.041

Education −2.521 1.085* −4.647–−0.394 −2.532 1.096* −4.680–−0.384 −2.394 1.044* −4.441–−0.347

Sleep with partner −0.687 0.718 −2.094–0.719 −0.758 0.747 −2.222–0.706 −0.649 0.718 −2.057–0.759

Sleep medications (yes) 1.808 2.547 −3.184–6.800 1.705 2.530 −3.255–6.664 1.989 2.607 −3.121–7.099

Depressive symptoms 0.672 0.275* 0.133–1.210 0.667 0.271* 0.135–1.198 0.653 0.266* 0.131–1.175

Comorbidity 0.410 0.529 −0.626–1.447 0.403 0.524 −0.624–1.431 0.400 0.522 −0.623–1.424

Loneliness −0.069 0.610 −1.264–1.127 −0.036 0.617 −1.246–1.175 −0.125 0.582 −1.265–1.016

Emotional support 1.333 2.190 −2.960–5.626 0.718 2.345 −3.879–5.315 1.401 2.201 −2.913–5.715

Affectionate touch −1.378 0.631* −2.615–−0.141 −1.324 0.638* −2.574–−0.074 −1.335 0.615* −2.541–−0.130

Loneliness X emotional support – – – 0.567 0.845 −1.088–2.223 – – –

Loneliness X affectionate touch – – – – – – −0.379 0.429 −1.129–0.461

R ² 0.062 0.026* – 0.063 0.027* – 0.068 0.033* –

Note. Unstandardized estimates are shown.

^t
p < .10; p < .05; p < .01; p < .001.

Discussion

The current study utilized a nationally representative sample of older adults to examine links between insomnia symptoms (subjective and objective markers), loneliness, and marital quality later in life. Our pattern of findings differed for subjective versus objective markers of insomnia symptoms. For subjective insomnia symptoms, results supported our moderation hypothesis such that spousal emotional support buffered (or weakened) the degree to which higher loneliness was associated with higher insomnia symptoms. For objective WASO (measured via actigraphy), however, we found only significant main effects. That is, higher affectionate touch (controlling for loneliness and spousal emotional support) was associated with lower WASO. WASO was not associated with loneliness or spousal emotional support.

This different pattern of findings for our different sleep outcomes may be due to the fact that objective and subjective measures of sleep quality tap into different constructs. In fact, objective and subjective markers of sleep are often only modestly correlated within samples of older adults (Benson et al., 2021). While WASO represents the total number of minutes an individual is awake after falling asleep, an individual may wake up multiple times throughout the night and not remember; they may also not experience their awakenings as disruptive (Chen et al., 2015). In such cases, an individual may have a high WASO score but low self-reported insomnia symptoms.

Even though subjective and objective measures of sleep likely tap into different facets of sleep, both are likely important markers of well-being later in life. In fact, Bastien et al. (2003) found that, for some older adult groups, including those with chronic insomnia, perceiving that one slept better was associated with improved next day cognitive performance as opposed to objective measures of their sleep quality. Even among healthy older adults, objective sleep quality declines, as evidenced by increases in sleep fragmentations, as well as WASO, and thus, objective measures may be less variable (Pace-Schott & Spencer, 2011). Therefore, it is important to find interventions that will ameliorate not only older adults’ objective sleep quality but also their negative perceptions of their sleep. Findings from the current study identify different pathways to doing so for both subjective insomnia symptoms and objective WASO.

Loneliness and Insomnia Symptoms: Spousal Emotional Support as a Buffer

Spousal emotional support buffered the degree to which higher loneliness was associated with higher insomnia symptoms. In fact, loneliness was only significantly associated with insomnia symptoms at low and moderate (but not high) spousal emotional support. This finding demonstrates that loneliness is detrimental to partnered older adults’ sleep to the extent that it occurs in concert with low to moderate spousal emotional support. This finding extends those of other studies within partnered samples that have indicated that loneliness is detrimental to older adults’ mental health and well-being when it occurs in the context of low spousal support and/or high spousal strain (e.g., Marini et al., 2020).

It may be that spousal emotional support increases feelings of felt security that attenuate threat detection in the face of loneliness, which in turn promotes the onset and maintenance of sleep (Thoits, 2011). Felt security is one of the main mechanisms that underlie secure adult romantic attachment (Sbarra & Hazan, 2008). It not only helps individuals maintain a sense of physiological homeostasis but also has been shown to have other benefits, such as improved emotional control through co-regulation with a partner (Sbarra & Hazan, 2008). On the other hand, the dissolution of felt security (perhaps through a chronic lack of support) can lead to a state of heightened emotional distress and dysregulation (Sbarra & Hazan, 2008), which may undermine sleep quality.

Spousal emotional support may also bolster other protective factors, such as positive mood, for example, that may also render older adults less susceptible to negative aspects of their sleep, and they may thereby experience—and report—better subjective sleep quality (Mather & Carstensen, 2005). Given that older adults have a heightened susceptibility to experiencing both loneliness and sleep disturbances (Patel et al., 2018), it is especially important to identify psychosocial pathways by which subjective sleep quality can be enhanced—or even maintained—later in life. Our findings suggest that spousal emotional support may be a salient mechanism, particularly for partnered older adults who are experiencing loneliness. Notably, affectionate touch was not significantly associated with insomnia symptoms. Insomnia symptoms, however, were related to depressive symptoms, comorbidity, and sleep mediations in expected directions. It may be that affectionate touch during the night—as opposed to throughout the day—is a more proximal predictor of insomnia symptoms. Further, it may be that affectionate touch throughout the day is indirectly associated with insomnia symptoms via some other mediating mechanism, such as felt security, or emotional arousal before bedtime.

Affectionate Touch and WASO

Greater frequency of affectionate touch was associated with lower levels of WASO. This finding adds a unique contribution to the literature as this study was the first to our knowledge to examine associations between affectionate touch throughout the day (as opposed to while sleeping at night) and objectively measured sleep outcomes. Further, our findings specifically point to affectionate touch—as opposed to emotional support—from a spouse as an important correlate of WASO. This may be, in part, because affectionate touch has been associated with neurobiological benefits that are associated with improved sleep quality (Jakubiak & Feeney, 2017). For instance, affectionate touch has been shown to increase oxytocin and endogenous opioids which are neurochemicals that mitigate stress responses (DeVries et al., 2003; Diamond, 2001) and in turn reduce nighttime awakenings given that stress is a well-known disruptor of sleep (Holt-Lunstad et al., 2008). Future research should therefore examine effects of affectionate touch on sleep via neurobiological pathways in an effort to further identify mechanisms by which affectionate touch may be related to older adults’ objective sleep quality.

Limitations and Future Research Directions

As the current study utilized secondary data, the measurements used to operationalize variables were limited. Consequently, several variables within the study (e.g., spousal emotional support) had low–moderate reliabilities. This may in part be a reflection of these variables having few items. In addition, it is important to acknowledge that affectionate touch was measured via a single item, which reduces its validity and reliability (Boyd et al., 2005). Further, the item relied on retrospective self-reports, asking participants to reflect on the frequency of affectionate touch received from their spouse/partner within the past 12 months. Future studies should build upon the current study by measuring affectionate touch (as well as loneliness, emotional support, and sleep) across a more micro-timescale, perhaps utilizing ecological momentary assessment (EMA) data. Doing so would enable researchers to examine the degree to which affectionate touch before bed, for example, is beneficial for objective sleep that night and even if benefits of touch on 1 day have lasting effects on sleep quality across days.

Finally, this study was cross-sectional in nature, and therefore, findings cannot imply causation. It is also possible that older adults who perceive or experience fewer insomnia symptoms also view their relationships in a more positive light. Future studies that utilize micro-timescale data will be better positioned to tease apart the directionality of associations observed in the current study.

Conclusion

Findings from the current study suggest that loneliness that occurs in the context of low—and even moderate—spousal emotional support is damaging for partnered older adults’ perceived insomnia symptoms. However, emotional support from a spouse/partner weakens this association such that loneliness is no longer associated with insomnia symptoms at high levels of spousal emotional support. In contrast, affectionate touch—as opposed to emotional support—from one's spouse/partner was associated with less objective WASO. Taken together, these findings pinpoint specific facets of marital quality that may help to maintain—or even improve—partnered older adults’ sleep quality.

Supplemental Material

sj-docx-1-ahd-10.1177_00914150231208013 - Supplemental material for Loneliness and Marital Quality as Predictors of Older Adults’ Insomnia Symptoms

Supplemental material, sj-docx-1-ahd-10.1177_00914150231208013 for Loneliness and Marital Quality as Predictors of Older Adults’ Insomnia Symptoms by Carly Lawrence and Christina M. Marini in The International Journal of Aging and Human Development

	1.	2.	3.	4.	5.	6.	7.	8.	9.	10.	11.	12.
1. Age	–
2. Gender (female)	−0.22***	–
3. Education	−0.09*	−.01	–
4. Sleep with partner	−0.04	0.01	0.08	–
5. Sleep medications (yes)	−0.01	0.12**	0.09*	−0.001	–
6. Depressive symptoms	0.02	0.09*	−0.14**	−0.07	0.10*	–
7. Comorbidity	0.18**	−0.05	−0.04	0.001	0.08	0.18**	–
8. Loneliness	−0.04	0.01	0.11*	−0.11*	0.07	0.36**	0.04	–
9. Emotional support	−0.06	−0.10*	0.07	0.11*	−0.03	−0.20**	−0.09*	−0.26**	–
10. Affectionate touch	0.02	−0.04	0.04	0.28**	0.05	−0.09*	−0.01	−0.22**	0.29**	–
11. Insomnia symptoms	−0.001	0.05	−0.03	−0.02	0.18**	0.24**	0.16**	0.19**	−0.06	−0.01	–
12. WASO	0.06	−0.08	−0.16**	−0.10*	0.02	0.12**	0.07	0.06	−0.04	−0.11*	0.14**	–
M/%	69.91	49.4	2.71	2.93	19.5	3.36	2.55	2.88	2.72	3.53	2.27	38.07
SD	7.91	–	1.01	1.58	–	3.83	1.98	2.24	.47	1.77	1.76	22.25
N	559	559	559	458	559	556	559	466	557	468	558	528
Observed range	36–91	–	1–4	0–4	–	0–19	0–12	0–9	0–3	0–6	0–8	3.17–198.50

	Model 1		Model 2		Model 3
Age	0.001	0.012	−0.023–0.026	0.002	0.012	−0.022–0.026	0.001	0.012	−0.023–0.025
Gender (female)	0.032	0.160	−0.281–0.345	0.004	0.157	−0.303–0.311	0.024	0.156	−0.282–0.330
Education	−0.025	0.077	−0.176–0.127	−0.021	0.082	−0.182–0.139	−0.021	0.080	−0.177–0.136
Sleep with partner	0.012	0.065	−0.115–0.140	0.028	0.066	−0.102–0.158	0.013	0.064	−0.113–0.139
Sleep medications (yes)	0.672	0.201**	0.278–1.065	0.703	0.199***	0.312–1.094	0.677	0.204**	0.278–1.077
Depressive symptoms	0.101	0.023***	0.056–0.146	0.103	0.024***	0.056–0.149	0.101	0.023***	0.055–0.146
Comorbidity	0.074	0.034*	0.008–0.141	0.075	0.033*	0.010–0.141	0.074	0.034*	0.008–0.141
Loneliness	0.129	0.042**	0.048–0.211	0.121	0.040**	0.043–0.199	0.128	0.041**	0.047–0.209
Emotional support	0.241	0.192	−0.136–0.618	0.409	0.193*	0.031–0.787	0.244	0.192	−0.132–0.620
Affectionate touch	−0.001	0.072	−0.142–0.139	−0.013	0.074	−0.159–0.132	0.001	0.070	−0.136–0.138
Loneliness X emotional support	–	–	–	−0.177	0.091^t	−0.355–0.001	–	–	–
Loneliness X affectionate touch	–	–	–	–	–	–	−0.012	0.022	−0.055–0.032
R ²	0.136	0.032***		0.148	0.030***		0.137	0.032***

	Model 1		Model 2		Model 3
Age	0.043	0.099	−0.152–0.237	0.042	0.099	−0.153–0.237	0.031	0.100	−.166–0.227
Gender (female)	−2.677	1.393^t	−5.407–0.054	−2.586	1.370^t	−5.271–0.099	−2.924	1.471*	−5.808–−0.041
Education	−2.521	1.085*	−4.647–−0.394	−2.532	1.096*	−4.680–−0.384	−2.394	1.044*	−4.441–−0.347
Sleep with partner	−0.687	0.718	−2.094–0.719	−0.758	0.747	−2.222–0.706	−0.649	0.718	−2.057–0.759
Sleep medications (yes)	1.808	2.547	−3.184–6.800	1.705	2.530	−3.255–6.664	1.989	2.607	−3.121–7.099
Depressive symptoms	0.672	0.275*	0.133–1.210	0.667	0.271*	0.135–1.198	0.653	0.266*	0.131–1.175
Comorbidity	0.410	0.529	−0.626–1.447	0.403	0.524	−0.624–1.431	0.400	0.522	−0.623–1.424
Loneliness	−0.069	0.610	−1.264–1.127	−0.036	0.617	−1.246–1.175	−0.125	0.582	−1.265–1.016
Emotional support	1.333	2.190	−2.960–5.626	0.718	2.345	−3.879–5.315	1.401	2.201	−2.913–5.715
Affectionate touch	−1.378	0.631*	−2.615–−0.141	−1.324	0.638*	−2.574–−0.074	−1.335	0.615*	−2.541–−0.130
Loneliness X emotional support	–	–	–	0.567	0.845	−1.088–2.223	–	–	–
Loneliness X affectionate touch	–	–	–	–	–	–	−0.379	0.429	−1.129–0.461
R ²	0.062	0.026*	–	0.063	0.027*	–	0.068	0.033*	–

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported in part by the National Institute on Aging at the National Institutes of Health (R03 AG064360 to C.M.M.).

ORCID iDs

Carly Lawrence

Christina M. Marini

Supplemental Material

Supplemental material for this paper is available online.

Author Biographies

Carly Lawrence is a Clinical Psychology Ph.D. candidate at the Gordon F. Derner School of Psychology, Adelphi University. She earned her MA in Psychology at Adelphi University and her BS in Human Development, Gerontology, and Nutritional Sciences from Cornell University. Carly is broadly interested in how relationships affect health with particular interests in sleep, exercise, and other health behaviors in adulthood.

Christina M. Marini is an assistant professor in the Gordon F. Derner School of Psychology at Adelphi University. Her research focuses on links between social relationships and health across the adult lifespan. She is an affiliated scientist of the Military Family Research Institute at Purdue University and a faculty affiliate of the Center for Healthy Aging at the Pennsylvania State University. She is also an external collaborator of the Stress, Health, and Aging Research Program of the VA Boston Healthcare System.

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	Model 1			Model 2			Model 3
	Est.	SE	95% CI	Est.	SE	95% CI	Est.	SE	95% CI
Age	0.001	0.012	−0.023–0.026	0.002	0.012	−0.022–0.026	0.001	0.012	−0.023–0.025
Gender (female)	0.032	0.160	−0.281–0.345	0.004	0.157	−0.303–0.311	0.024	0.156	−0.282–0.330
Education	−0.025	0.077	−0.176–0.127	−0.021	0.082	−0.182–0.139	−0.021	0.080	−0.177–0.136
Sleep with partner	0.012	0.065	−0.115–0.140	0.028	0.066	−0.102–0.158	0.013	0.064	−0.113–0.139
Sleep medications (yes)	0.672	0.201**	0.278–1.065	0.703	0.199***	0.312–1.094	0.677	0.204**	0.278–1.077
Depressive symptoms	0.101	0.023***	0.056–0.146	0.103	0.024***	0.056–0.149	0.101	0.023***	0.055–0.146
Comorbidity	0.074	0.034*	0.008–0.141	0.075	0.033*	0.010–0.141	0.074	0.034*	0.008–0.141
Loneliness	0.129	0.042**	0.048–0.211	0.121	0.040**	0.043–0.199	0.128	0.041**	0.047–0.209
Emotional support	0.241	0.192	−0.136–0.618	0.409	0.193*	0.031–0.787	0.244	0.192	−0.132–0.620
Affectionate touch	−0.001	0.072	−0.142–0.139	−0.013	0.074	−0.159–0.132	0.001	0.070	−0.136–0.138
Loneliness X emotional support	–	–	–	−0.177	0.091^t	−0.355–0.001	–	–	–
Loneliness X affectionate touch	–	–	–	–	–	–	−0.012	0.022	−0.055–0.032
R ²	0.136	0.032***		0.148	0.030***		0.137	0.032***