Subjective age — how old a person feels rather than how old they are — may offer clues to sleep health and daytime functioning.

In a cross-sectional survey, adults who reported feeling older than their chronological age consistently reported more insomnia symptoms, less regular sleep, and greater daytime impairment, even after accounting for chronological age, sex, race, depression, and anxiety.

“Our findings suggest subjective age is a meaningful signal of sleep health. If a patient feels significantly older than their chronological age, it may flag underlying sleep problems, stress, or health concerns that deserve attention,” principal investigator Joseph M. Dzierzewski, PhD, senior vice president of research and scientific affairs at the National Sleep Foundation, told Medscape Medical News.

“Clinicians asking ‘How old do you feel?’ is an interesting proposition. It’s a simple, low-burden question that could reveal a lot,” he added.

The study was presented on June 17 at SLEEP 2026.

A Bidirectional Relationship?

In an online survey, researchers asked 3177 adults (mean age, 42.8 years) a simple question: “How old do you feel?” They calculated an age discrepancy score by comparing subjective age with actual age. Positive scores indicated feeling older than one’s chronological age.

Participants also completed validated assessments of insomnia severity, sleep health, sleep regularity, sleep-related impairment, depression, anxiety, and self-reported physical health.

Individuals who felt older than their chronological age reported significantly more insomnia symptoms, poorer overall sleep health, lower sleep regularity, and greater sleep-related impairment. These associations persisted after adjustment for multiple potential confounders.

Feeling older than one’s age was indirectly associated with poorer self-reported physical health through its links with insomnia severity, sleep regularity, and sleep-related impairment.

Dzierzewski cautioned that the study cannot determine causality but said the relationship between subjective age and sleep is likely reciprocal.

“The relationship is almost certainly bidirectional. Feeling older and sleeping poorly reinforce each other; each can make the other worse,” he said.

Feeling older than one’s age may reflect stress, low mood, or underlying health conditions that interfere with sleep. Conversely, poor sleep may contribute to fatigue, aches and pains, and reduced energy, making people feel older than their chronological age, Dzierzewski said.

He suggested several potential mechanisms that warrant further investigation, including psychological pathways such as negative self-perceptions and reduced self-efficacy; physiologic pathways involving inflammation, fatigue, and pain sensitivity; and behavioral pathways related to lower physical activity levels and less consistent daily routines.

Dzierzewski cautioned that subjective age may be a “quick, intuitive snapshot of overall well-being, with sleep being one of the main places it shows up,” but it would not replace validated sleep assessments or clinical evaluation.

An Indicator of Psychological Health

Fumiko Hamada, MA, sleep researcher and doctoral student at the University of South Florida in Tampa, Florida, said the link between subjective age and sleep is likely an indicator of a patient’s underlying psychological health.

“Aging itself is not necessarily a negative thing, but feeling older than one’s chronological age may reflect a less positive self-perception,” said Hamada, who wasn’t involved in the study.

People in midlife who feel younger and maintain a positive outlook may sleep and function better than those who view themselves as old or tired, she noted.

“Based on that, one possible interpretation of the results is that a more negative self-perception is associated with greater insomnia symptoms. Additionally, it could suggest that a negative view of oneself has a detrimental impact on psychological well-being,” she said.

One interesting question, said Hamada, is whether feeling older than one’s actual age is associated with lower social engagement, reduced physical activity, or greater loneliness.

“These factors are also strongly linked to poorer psychological well-being and could potentially contribute to a negative cycle that worsens sleep problems,” she noted.

The study was supported by the National Institute on Aging. Disclosures for study authors are available with the original publication. Hamada and Breus reported having no relevant disclosures.