Sleep problems affect men and women differently in muscle strength loss during ageing, study shows
Sleeping nine hours or more per night may accelerate the decline in neuromuscular strength in women aged 50 and over. Among men, however, insomnia symptoms are associated with a faster loss of strength during ageing.
These are the findings of a study conducted by researchers from the Federal University of São Carlos (UFSCar), in partnership with University College London (UCL), and published in the journal Age and Ageing.
The results show that men and women respond differently to sleep-related problems, indicating that strategies for preventing and monitoring muscle strength loss should take these differences into account. Neuromuscular strength is one of the main indicators of musculoskeletal health and functional capacity during ageing, and is directly related to autonomy, independence and quality of life.
The study analysed data from 6,429 participants in the English Longitudinal Study of Ageing (ELSA), a population-based study representative of the English population. All participants were aged 50 or older, had preserved handgrip strength at the beginning of the study, and were followed for eight years. ELSA is part of the International Collaboration of Longitudinal Studies of Ageing (InterCoLAgeing), an international consortium coordinated by Professor Tiago da Silva Alexandre, Associate Professor in the Department of Gerontology at UFSCar.
The research was conducted by Leticia Coelho Silveira as part of her Master's degree in the Graduate Programme in Physiotherapy at UFSCar, under Alexandre's supervision. It also involved Professor Patricia Silva Tofani, from the Federal University of Sergipe (UFS), and researchers from University College London (UCL).
To investigate the relationship between sleep and neuromuscular strength, the researchers assessed insomnia symptoms using the Jenkins Sleep Questionnaire, which examines difficulties falling asleep and staying asleep, as well as feelings of fatigue or sleepiness upon waking during the month preceding the interview. Questionnaire scores ranged from 3 to 12, with higher scores indicating more severe insomnia symptoms. Sleep duration was classified as short (≤ 6 hours), optimal (> 6 and < 9 hours), or long (≥ 9 hours). Neuromuscular strength was measured through handgrip strength at the beginning of the study and again after four and eight years of follow-up.
Although men and women had similar neuromuscular strength at the beginning of the study when compared with their counterparts who had optimal sleep duration or no insomnia symptoms, important differences emerged over the follow-up period. Among women, sleeping nine hours or more per night was associated with a greater rate of decline in neuromuscular strength compared with the optimal sleep duration category. Among men, by contrast, an increase in insomnia symptoms was associated with a faster loss of strength over time.
According to the researchers, the findings suggest that sleep should be considered an important component of muscle health assessments during ageing. "Our findings show that both sleep quality and sleep duration are associated with the maintenance of neuromuscular strength, but their effects differ between men and women. This reinforces the need for prevention and monitoring strategies that take these specific characteristics into account," the author’s state.
The biological mechanisms underlying these differences are not yet fully understood. Evidence from the literature suggests that inflammatory, metabolic and hormonal changes, as well as alterations in sleep architecture, may influence muscle health during ageing. However, these hypotheses were not directly investigated in this study.
In clinical practice, the researchers highlight that simple questions about insomnia symptoms and sleep duration may help identify individuals at greater risk of neuromuscular strength decline before functional limitations develop. This information may support early interventions, such as physical activity programmes, muscle strength monitoring and strategies to promote healthy sleep, helping to preserve autonomy and quality of life among older adults.
The study was funded by the São Paulo Research Foundation (FAPESP – grant numbers 24/01918-6 and 23/02140-6).
Silveira, L.C., Máximo, R.O., Luiz, M.M., Lima, S.S., Tofani, P.S., Borges, M.M., Cochar-Soares, N., Souza, T.B., Steptoe, A., de Oliveira, C. and Alexandre, T.S., 2026. Are there sex differences in the influence of insomnia symptoms and sleep duration on the trajectory of neuromuscular strength decline?. Age and Ageing, 55(7), p.afag201
Image by Ron Lach
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