Sleep Typology and Mental Distress Among Older Asian Immigrants

Background and Purpose:
Poor sleep quality and sleep-related experiences (e.g., sleep disturbance) are frequently associated with adverse mental health outcomes among middle-aged and older adults. Asian immigrants are particularly known to experience disparities in sleep health. Because sleep is a multidimensional construct, individuals may experience distinct patterns of sleep characteristics. Applying the Stress Process Model (SPM), sleep disturbances are hypothesized to function as chronic stressors that contribute to psychological distress, with the impact varying across social and cultural contexts. However, little research has examined how patterns of sleep associate with mental distress among diverse groups of older Asian immigrants. Using a person-centered approach, this study aimed to: (1) identify latent sleep profiles among older Asian immigrants, and (2) examine whether the association between sleep typology and mental distress varies across ethnic groups.

Methods:
Data were drawn from a community-based survey of 505 Chinese, Korean, and Vietnamese Americans aged 50 and older in Central Florida. Sleep characteristics were assessed using seven indicators derived from the Pittsburgh Sleep Quality Index: perceived sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, sleep medication use, and daytime dysfunction. Latent profile analysis was used to identify sleep profiles. Differences in sociodemographic characteristics and mental distress across profiles were examined using ANOVA and chi-square tests. Mental distress was measured using the Kessler-6 scale. Multiple regression analyses assessed the association between sleep profiles and mental distress while adjusting for age, gender, marital status, education, perceived financial status, years of residence in the U.S., and chronic conditions. Then interaction terms were included to examine ethnic differences in the sleep–distress relationship.

Results:
Three sleep profiles were identified: healthy sleep (20%), moderate sleep disturbance (62%), and poor sleep (18%). The poor sleep group demonstrated shorter sleep duration, greater sleep disturbance, more frequent medication use, and higher daytime dysfunction than the other groups. Mental distress differed significantly across sleep profiles, with the highest distress observed in the poor sleep group (M±SD = 6.67±4.62), followed by the moderate disturbance (M±SD = 3.56±3.42) and healthy sleep groups (M±SD = 2.18±3.32). Regression models indicated that the moderate sleep disturbance (b = 1.20, SE = .40, p < .01) and poor sleep (b = 4.14, SE = .51, p < .001) profiles were associated with higher levels of mental distress compared with the healthy sleep profile. Ethnicity was independently associated with distress, with Korean and Vietnamese participants reporting higher distress than Chinese participants. The association between poor sleep and mental distress was significantly stronger among Vietnamese older adults (b = 3.98, SE = 1.19, p < .001).

Conclusions and Implications:
Findings reveal heterogeneity in sleep experiences among older Asian immigrants and show that sleep typology is strongly associated with mental distress. Consistent with SPM, sleep disturbances may operate as chronic stressors that increase vulnerability to psychological distress, and this process may differ across ethnic groups. Person-centered approaches to sleep assessment may help identify high-risk groups and inform culturally responsive interventions addressing sleep and mental health among older immigrant populations.