Adverse Childhood Experiences and Sleep in Adult Women: A Dimensional Approach

Women are disproportionately affected by poor sleep, both in terms of how much sleep they get (quantity) and how disturbed that sleep is (quality). One relatively unexplored association with poor sleep is adverse childhood experiences, which also disproportionately affect women. How childhood adversity affects sleep in adult women is not well understood, partly because of opacity in the way prior research considers different types of adversity. Prior research has emphasized cumulative approaches, treating all adverse experiences as equivalent and overlooking how different adversities may manifest in adult health problems. We investigated how adversity differentially contributed to sleep issues in a sample of treatment-seeking women (N=329), utilizing both cumulative and person-centered, dimensional analytic approaches. Latent class analysis revealed four distinct adversity profiles: ‘emotional/physical abuse’, ‘household dysfunction’, ‘high ACEs’, and ‘low ACEs’. Sleep symptom analysis identified two subgroups: high and low sleep issues. Women classified within the abuse-related and high-ACE subgroups reported worse sleep, while those in the abuse profile did so even when their total cumulative adversity scores did not reach conventional clinical thresholds. These findings suggest that specific patterns of childhood adversity—particularly abuse—uniquely contribute to adult sleep issues among women and can be missed using only cumulative scoring methods. This study underscores the importance of dimensional, subtype-focused approaches to ACE research and highlights the enduring impact of childhood adversity on women’s lifelong sleep health.