Environmental stressors and sleep health among low-income older adults: a mixed-methods study

TL;DR

This study shows that environmental stressors like noise and temperature significantly affect sleep health in low-income older adults.

Contribution

The study introduces a mixed-methods approach to identify and analyze environmental sleep stressors in low-income older adults.

Findings

Environmentally impacted sleepers reported significantly worse sleep health compared to those not impacted.

Common stressors included noise, temperature, and lighting, which participants tried to adjust for better sleep.

Both groups experienced poor sleep quality and frequent awakenings, but impacted sleepers struggled more to return to sleep.

Abstract

Environmental factors are increasingly recognized as critical determinants of sleep health, particularly among older adults in low-income communities. This convergent mixed-methods study aimed to: (1) explore sleep environment stressors (SES) reported by community-dwelling, low-income older adults; and (2) compare subjective sleep health between those affected by SES and those who were not. Twenty-four older adults participated. SES were measured with Assessment of Sleep Environment (ASE), a 4-point Likert scale from “Strongly Agree” to “Strongly Disagree”. Participants were classified as Environmentally Impacted Sleepers (EIS, n = 14) if they endorsed any AES items, or as Environmentally Unimpacted Sleepers (EUS, n = 10) if they did not. Sleep health was assessed with the Pittsburgh Sleep Quality Index (PSQI), with group comparisons analyzed using Welch’s t-tests and effect sizes (Cohen’s d with Hedges’ correction). Semi-structured interviews further explored perceived environmental stressors and sleep experiences, which were inductively coded and thematically analyzed. The most frequently self-reported stressors were: “too soft mattress” (n = 7), “uncomfortable smell” (n = 6), “too noisy” (n = 5), “too humid” (n = 5), “too cool” (n = 5), “too much light” (n = 5). Qualitative findings revealed that outdoor noise and thermal conditions as major stressors, and participants noted that adjusting their environment (e.g., lighting, sound, or fans) improved sleep; most participants described a cool, dimly lit room with some background noise as ideal. EIS group had worse sleep health (p<.001, d = 1.87). Both groups perceived poor sleep quality, frequent night awakenings, and medical aid use; yet EIS group more commonly described challenges returning to sleep. Addressing environmental stressors is essential for healthy aging sleep.