Association of Healthy Lifestyle with Insomnia Among Chinese Older Adults: A Cross-Sectional Study

Insomnia is common among older adults and is associated with adverse health outcomes, yet evidence on its relationship with healthy lifestyle in Chinese older adults is limited. This study included 4929 participants from the Hubei Memory and Aging Cohort Study (HMACS). A healthy lifestyle score (range 0-6) was constructed based on body weight, drinking alcohol, smoking, regular exercise, diet, and cognitive activity. Participants were categorized into unfavorable (0-2), average (3), and favorable (4-6) lifestyle groups. Insomnia was defined using the Athens Insomnia Scale (AIS ≥ 6), or the Pittsburgh Sleep Quality Index (PSQI > 5). Multivariable logistic regression models were applied to assess the associations of overall and individual healthy behaviors with insomnia risk. Stratified analyses by smoking status and substitution analyses were conducted. Healthier lifestyle was associated with lower risk of insomnia. Compared with the unfavorable group, participants with favorable lifestyle had a 17.5% lower risk of insomnia. Among individual lifestyle behaviors, healthy diet and active cognitive activity were associated with reduced insomnia risk. Stratified analyses showed these associations were only evident among non-current smokers. Substitution analyses suggested that replacing unhealthy behaviors with healthy ones was associated with a lower insomnia risk. Favorable lifestyle, particularly healthy diet and active cognitive activity, is associated with lower insomnia risk among older adults, with stronger associations observed among non-current smokers.