ACEs are associated with shorter sleep duration and poorer sleep quality in middle-aged and older adults, with each additional ACE increasing the risk of incident inadequate sleep and sleep disturbance, and the associations varied across ACEs exposure patterns.
Each additional adverse childhood experience was associated with a higher risk of incident inadequate sleep over a 9-year follow-up.
Each additional adverse childhood experience was associated with a higher risk of incident sleep disturbance over a 9-year follow-up.
ACEs were associated with poorer sleep quality in middle-aged and older adults.
ACEs were associated with shorter sleep duration in middle-aged and older adults.
Exposure to 4 or more ACEs was associated with substantially higher odds of belonging to the 'Severely Restless Short Sleep' trajectory.
Restricted cubic spline regression supported a linear dose-response relationship between ACEs and adverse sleep outcomes.
Certain ACE clusters showed stronger associations with adverse sleep outcomes than others.
The study sample comprised 12,363 Chinese middle-aged and older adults drawn from five waves of the China Health and Retirement Longitudinal Study (CHARLS).
This research suggests that difficult or traumatic experiences during childhood — such as abuse, neglect, or household dysfunction — are linked to worse sleep health decades later in middle age and older adulthood. Using data from over 12,000 Chinese adults followed for nine years, the study found that each additional adverse childhood experience (ACE) meaningfully increased the chances of developing problems like insufficient sleep duration and sleep disturbances. People who experienced four or more ACEs were more than twice as likely to fall into a 'severely restless short sleep' pattern compared to those with fewer ACEs, and this relationship followed a straight-line dose-response pattern — meaning more ACEs consistently meant worse sleep, with no apparent cutoff below which ACEs had no effect. The study also found that not all ACEs are equal in their impact on sleep. Certain combinations or clusters of childhood adversities were more strongly linked to poor sleep than others, suggesting the nature and co-occurrence of early-life stressors matter, not just how many occurred. These associations held up across multiple ways of measuring sleep — including sleep quality scores, sleep duration, and trajectory patterns tracked over nearly a decade — and were observed even after accounting for other factors that could influence sleep. This research suggests that a person's childhood history may be a relevant factor when healthcare providers are evaluating or treating sleep problems in middle-aged and older adults. Early prevention of adverse childhood experiences could have long-term protective effects on sleep health, and screening for ACE history might help identify adults who are at higher risk for chronic sleep difficulties.
Chen Q, Zhao J, Zhang X, Hu L. (2026). Associations of adverse childhood experiences and sleep in adulthood and older age: A nationwide cohort study.. Archives of gerontology and geriatrics. https://doi.org/10.1016/j.archger.2026.106195