Sex Differences, Sleep Problems, and Psychological Well-Being in Older Adults

CONFERENCE REPORTER

CLINICAL CONVERSATIONS

New research presented at the SLEEP 2026 annual meeting found that sleep problems in middle-aged and older adults are linked to lower psychological well-being 9 years later. Interestingly, the link was stronger in women than in men. This suggests that sleep may play an important role in how women feel later in life.

Investigators followed 574 middle aged and older adults over 9 years, and found that those who reported trouble sleeping in midlife scored lower on in terms of psychological well-being years later. This pattern continued even after investigators accounted for other factors like age, sex, education, employment status, partner status, number of illnesses, and baseline psychological well-being. Further analyses showed that the association between sleep problems and psychological well-being differed significantly by sex.¹

Psychiatric Times spoke with Fumiko Hamada, a researcher and PhD student at the University of South Florida in Tampa, to learn more.

Psychiatric Times: Talk to us about the data you're presenting here at SLEEP 2026 concerning sex differences in sleep problems and psychological well-being.

Fumiko Hamada: My research is focused on older adults. I do not want to say stereotype, but many people think sleep change is age-related and tend to let it go. They say, “I am getting old, sleep like this is normal.” Being a sleep researcher, I wanted to see if there are any sex differences, because as we age, hormones change, lifestyles change, occupations change—everything can change! I wanted to see if there is any difference for specifically biological women.

PT: Can you speak to why it is important to develop early sleep interventions that account for sex differences?

Hamada: That is very hard, because if you talk about lifespan—child to young adult to older adult—their bodies are so different, their social expectancy is so different. I think all interventions have to tailor sex difference and age differences, as well as social demographic differences. We must always individualize beyond just sex differences.

PT: What is one thing you want attendees to take away from your presented research today?

Hamada: I am really interested in sex differences, specifically women's health. The most important changes are when menstruation starts and when menstruation ends. I think that's really key for female patients when they are getting older, because hormones suddenly drop and this impacts their mental heatlh. Beyond just hormones, maybe loneliness affects psychological well-being, or maybe the perception of being old makes a patient hesitate to participate actively. “I am old, I am not doing that,” they say.

Sleep is definitely modifiable. We sleep every day, so if we can get patients to focus on the sleep, that helps for over time for longevity and a healthy lifestyle. That is not just for older people either, that is throughout the lifespan.

PT: Do you think menopause and things like night sweats have some sort of impact on sleep quality for older women specifically?

Hamada: Yes, thank you so much for mentioning that! I did not include environmental differences, especially temperature change, in our work, but it plays an important role. Some people like to sleep in a cold room; some people cannot sleep when they are cold. Some people have to wear socks when they sleep. Everybody is different.

But we know, based on the research, women are more susceptible to heat. Heat makes women’s sleep a little bit difficult. When they wake up in the middle of the night, because they need to use bathroom or frequency, and then on top of it, that's a warm room or warm night, and they can't go back to sleep, so that's going to be a spiral, so that's also interesting about sex differences, probably men less likely experience that, yeah. Thank you so much for bringing that up.

especially if anyone has a partner who likes to sleep cold or warm, like a different temperature can be very hard, yeah.

PT: In your opinion, what can psychiatrists and mental health clinicians be doing to help address this issue, especially for women?

Hamada: In my opinion, when older women say, “I'm having a sleep issue lately,” even if it is minor, I think it is important to pay attention at that point. Don’t dismiss it as age-related. Dig into what is really causing that sleep issue.

It is very important to note that the power of sleep is not just in physical illness; it also regulates emotion. It helps them to understand what is going on the next day and to feel good. Emotional dysregulation does not have to be an anxiety disorder or depression. General depression symptoms may not immediately mean major depressive disorder when women mention their psychological well-being. If they say, “I am not happy lately,” ask them: but how is your sleep? That is my hope for any psychiatrist and mental health clinician: if a patient comes in, especially women, ask them about their sleep.

PT: I know you also have an interest in cognitive impairment. What role does sleep play in cognition as we age, and do you see any differences in the genders?

Hamada: I do not want to draw linear conclusions, but we see a connection between when you are unhappy—emotionally dysregulated, and more stressed out—cognitive impairment, and hormone change.

When women become 60 or 70, studies suggest that psychological well-being and mental health are related to Alzheimer disease. That is a worst-case scenario. Before that, we have cognitive decline. We need to catch this problem way before that worst possible outcome. Happiness, social isolation, and loneliness are all very important, outside of as depressive symptoms. I am a sleep researcher, so of course, I must again ask, how is the patient sleeping?

PT: What behavioral interventions do you suggest to improve sleep?

Hamada: There are multiple behavioral interventions that are researched and implemented, but unfortunately are not covered by health insurance. It is very hard to recommend treatments when the patient may respond and say, "I can’t afford that.” Available does not mean affordable. Virtual therapies are available, but older people tend to avoid virtual therapy.

Before thinking about interventions, consider lifestyle change, something small they can change, or try to change. For example, have them try to sleep more regularly, or find a better room temperature for optimal sleep. Set a time: “Okay, it is 8PM, I am going to put my phone away and try to sleep.” Those are really the most important interventions an individual can do without any cost or insurance coverage.

PT: Finally, is there anything else you would like our audience to know?

Hamada: It is easy to tell people, “Please get better sleep,” but we live in a 24/7 society. Everyone has different work schedules, lifestyles, demands, pressures, and even different ways of enjoying life.

Because of that, I think it is important not only to communicate the importance of sleep, but also to provide practical and achievable strategies. Small changes can make a difference, such as avoiding caffeine in the afternoon, limiting fluid intake close to bedtime, maintaining a consistent sleep and wake schedule, putting phones away at a certain time each evening, or keeping the bedroom dark and comfortable.

For many people, making all of these changes at once may not be realistic. However, we can encourage small, manageable steps at the individual and household level, while also promoting broader community and societal efforts over time to support healthy sleep habits.

We know we have to eat well. We know we have to do exercise. But we cannot forget sleep.

Ms Hamada is a PhD student at the University of South Florida.

Reference

1. Hamada F, Walters M. 0852 Sex differences in the association between sleep problems and psychological well-being nine years later among middle-aged and older adults. Sleep. 2026;49(Suppl 1):A381.