Researchers and policymakers have paid attention in recent years to how everything from housing to racism and pollution affects health and how such social determinants contribute to health inequalities.
But new research found one thing missing from that list: sleep.
People who don’t sleep well appear to be at greater risk of a range of negative health outcomes, including cancer, cardiovascular disease, diabetes, high blood pressure, obesity and even death. And blacks and browns have less access to sleep as a resource than whites, said Prof. Rachel Widome of the University of Minnesota School of Public Health.
“Sleep is absolutely a determinant of health,” she said. “Sleep impacts a whole range of health outcomes, from physical to mental.”
Prof Ivan Wu of the US School of Public Health, who studies the link between sleep, obesity and cancer, said poor sleep perpetuates persistent health inequalities. “Not getting enough sleep ties into all these horrible things,” he said.
Until recently, most research on sleep disparities focused on documenting the problem. But now Wu and others are starting to find solutions.
The picture that has emerged from a decade of research is that black and brown Americans are far more likely to have poor sleep patterns than white Americans. The darker a person’s skin tone, the worse they tend to sleep, said Prof. Dayna A. Johnson, a sleep epidemiologist at Emory University in Atlanta.
“The theory is that racial minorities experience a stress that is unique and chronic, in addition to the common stressors that all humans experience,” said Johnson, one of the first researchers to look at sleep differences. “We all experience stress, but for certain groups there are additional stressors. For certain demographics, racism fits into that category.”
People who experience racism and brood over it at night may have trouble falling asleep, according to a study led by Johnson in Sleep magazine. When people anticipate racism, they might notice disruptions in their sleep-wake cycles, she said, as their bodies may be in a heightened state of arousal with higher blood pressure and different heart rates.
Structural racism is also a major contributor to sleep disparities, Johnson said. For example, people of color are more likely to live in neighborhoods that are not conducive to sleep, areas that experts sometimes refer to as “sleep deserts.”
Air pollution can cause inflammation and contribute to sleep apnea. Places with higher pollution often have fewer trees and sidewalks, facilities that allow people to move around safely. Louder nights, whether from nearby traffic or thin apartment walls, can affect sleep. The lack of a sense of security can also lead to sleepless nights.
The longer a foreign-born person lives in the United States, the worse their sleep gets, Johnson said. She suspects this could be due to the stress of language barriers or deteriorating dietary habits.
The National Institutes of Health has funded more research into sleep differences in recent years, and it’s now considered a priority area, Johnson said. But the development of ways to solve the problem is still in its infancy.
Wu, a clinical psychologist, began researching sleep disorders while working at the University of Texas MD Anderson Cancer Center in Houston. He recognized that the topic of sleep was often missing from research on obesity and cancer risk.
A pilot study Wu started in Houston looked at whether sleep interventions could reduce the risk of cancer and obesity. Through individual counseling sessions over the course of a month, Wu customizes cognitive behavioral therapy for insomnia to a population of black adults. He has found that the practice works as long as neighborhood stressors like loud traffic don’t interfere.
The Houston participants were recruited through connections with black churches. Now Wu is trying to work with local churches to expand this research in Minneapolis.
Wu is also collaborating with Prof. Abdifatah Ali of the US Carlson School of Management on a cancer prevention initiative with the East African community of the Twin Cities funded by the Masonic Cancer Center. The couple hope to train community health workers to spread information about cancer prevention strategies, including healthy sleep.
Individual corrections, like yoga before bed or Wu’s sleep therapy program, can work. But there are often external factors, such as B. Pollution beyond the control of individuals. Both Johnson and Wu believe that sleep justice solutions must be community-driven to bring about significant and lasting change.
“It’s not the individual, it’s the context they live in,” Johnson said.
For example, adjusting school start times could promote better sleep for children. Doctors could talk to patients about sleep health. In the area of public health, healthy sleep campaigns could provide knowledge about sleep and local customs.
Many Somali residents in the Twin Cities believe smoke alarms, which beep 24 hours a day, are working properly, Ali said, or that it’s the landlord’s responsibility to fix them. Such misinformation could be corrected with a community-wide effort.
Widome pointed out that sleep is often viewed as “garbage” or “throw away” time.
“If you get the right amount of sleep, you’ll spend a third of your life sleeping,” she said. “In the other two-thirds of the day, how much time do we spend thinking about our health — what we do in our free time, how physically active we are, what we eat?”