New Workshop Highlights the Effects of Sleep Health Disparities on Disadvantaged Populations

By Admin

When it comes to sleep and sleep health, one issue that is often overlooked is the problem of social or cultural disadvantages in achieving and maintaining proper sleep. The results of a recent workshop on sleep health in America found that sleep health disparities (SHDs) based on class or ethnicity can develop due to social and economic challenges. For example, problems associated with finances, discrimination, or access to healthcare can affect sleep quality as well as general health and wellbeing. Not only do these issues contribute to stress in daily life, but can directly affect sleep schedules and routines, which also increases the likelihood of sleep disorders. According to the workshop report, sleep health disparities are defined as a consistent difference in at least one dimension of sleep health (quantity, quality, etc.), which adversely affects disadvantaged populations. These disparities in sleep health appear to have some of the same causes as other health disparities, for example, disparities in disease rates between one economic group and another. In addition to sleep disorders like sleep apnea and insomnia, poor sleep is associated with a wide range of health problems, from heart and metabolic conditions to problems with memory, cognitive functioning, mood disorders, and mental health. As the report concludes, new strategies are needed to address this problem on a wide scale, not only from a public health standpoint, but also in the broader sense of helping individuals of low socio-economic status and those from underrepresented racial and ethnic minority groups achieve the same level of care and support given to other members of society.

Sleep Health and Hygiene: A Global Problem

Problems of insufficient sleep and poor sleep quality are widespread throughout the country and beyond, affecting a diverse range of individuals from nearly every social group, class, and ethnicity, but like many health problems, it tends to affect those of lower socioeconomic status, or those from traditionally underrepresented racial and ethnic minority groups disproportionately. Thus, the problem of sleep health disparities is a somewhat complicated but highly significant part of a larger problem of sleep health deficiency in general. Part of the problem (a large part) is that sleep is undervalued in much of western culture, and this extends to populations that are more prone to sleep loss and sleep disorders. To address the problem of sleep health disparities, we must first stress the importance of sleep for the health and happiness of all individuals, regardless of status or circumstances. In other words, valuing sleep and recognizing its importance should be the starting point on the path to better sleep health equity.

What Causes Sleep Health Disparities

As the research shows, sleep health disparities are caused by many of the same factors that contribute to health disparities in general. Social, environmental, and structural challenges facing lower income families and racial or ethnic minority groups can lead to barriers that prevent optimal sleep and healthy living conditions. Over time, these barriers can lead to a higher prevalence of disease, early mortality, and poorer health behaviors that further contribute to the problem in a cyclical manner. For example, the daily effects of discrimination, social disadvantage, and lower access to healthcare can cause stress and/or anxiety that leads to unhealthy coping behaviors such as self-medication, sleep debt (loss), and in some cases, avoidance of medical institutions due to negative experiences. Currently, African Americans, Latinos, American Indians and Alaska Natives, Asians, Native Hawaiians, and Other Pacific Islanders are classified as socioeconomically disadvantaged populations, but other populations such as those at or near the poverty level, underserved rural populations, and sexual and gender minority populations are also included as those experiencing health disparities (this includes lesbian, gay, bisexual, transgender, and gender-nonbinary individuals). These groups are designated Health Disparity Populations, or HDPs, based on the established criteria of the National Institutes of Health (NIH). While resources have been directed to this effort of reducing health disparities among HDPs, studies like the workshop on health disparities in America have emphasized the need for further research, education, and public health policy to serve those affected.

Policy Recommendations

The Workshop on Sleep Disparities in America lists a number of strategies to address SHDs, recommended by the National Institute on Minority Health and Health Disparities (NIMHD), the National Heart, Lung, and Blood Institute (NHLBI), and the Office of Behavioral and Social Sciences Research (OBSSR). These include the following:

(1) Development and promotion of “integrative research on SHDs,”

(2) Further Investigation into the causes and consequences of SHDs,

(3) Further interventions to address SHDs and SHD-related issues, and

(4) Creating new and better research and training opportunities.

These guidelines represent a range of focus areas aimed at developing an entire new infrastructure of support for underserved populations. While some of these strategies are research-based, they also require the funding and infrastructure to be carried out effectively and consistently in the coming years.

Along with the workshop report, the organization Project Sleep has published a list of policy recommendations to better serve those populations experiencing disadvantages. For example, Project Sleep has pledged “to highlight sleep research focused on race, racism, and sleep and health disparities, as well as advocate for more research in this area.” The Project Sleep recommendations include:

(1) “Training and Career Development” (for example, funding for early-career programs to help individuals from underrepresented groups, particularly in medical and research fields),

(2) “Community-Led Interventions” (including those for the treatment of sleep disorders and sleep debt (loss), using research and outreach as tools for intervention),

(3) “Education for Healthcare Providers” (on signs of sleep loss and sleep disorders affecting underrepresented groups),

(4) More Research Funding (specifically, research targeting SHDs),

(5) and Later School Start Times (this issue particularly affects low socio-economic and minority communities, where transportation and/or occupational constraints can impact school accessibility).

There are many similarities between these policy recommendations and those developed by the workshop group, but together they provide an extremely comprehensive approach to addressing sleep health disparities in a way that is both thorough and inclusive. Along with addressing sleep health disparities, Project Sleep includes the advancement of social justice and improvement of “equitable training and career development” as primary goals of their recommendations, emphasizing the bigger picture of how longstanding social, cultural, and economic disparities contribute to health and wellbeing. Both groups emphasize the need for further research and transdisciplinary approaches to closing the SHD gap. As the workshop report points out, it the right of every individual to achieve “satisfactory, efficient amounts of sleep with appropriate timing that promotes physical and mental wellbeing,” regardless of race, ethnicity, sexual orientation, or socioeconomic status.