Drivers of sleep disparities
Although there’s been much emphasis on the importance of good sleep habits, sometimes called “sleep hygiene,” many other social and economic factors can override individual efforts.
Research in the past two decades has shown substantial inequities in sleep that parallel other racial, ethnic and socioeconomic disparities in health outcomes.
For instance, studies find that the stress of experiencing of discrimination can disrupt sleep.
A study published in Sleep Medicine in 2015 reviews 17 research papers and finds that discrimination — whether based on race, nationality, religion, gender, sexual orientation or other social factors — is associated with poorer sleep.
The authors of a 2017 review paper published in Population Research and Policy Review, write, “The body’s ongoing anticipation of experiencing racism-related stressors disrupts sleep, a behavior highly responsive to stress reactivity.”
Another study, published in the Journal of Racial and Ethnic Health Disparities in February 2022, finds experiences of discrimination and psychological distress are associated with racial disparities in sleep. “Specifically, Black participants reported more experiences of discrimination, which was associated with greater psychological distress, which was related to poorer sleep health,” the authors write.
One study, published in the Journal of Racial and Ethnic Health Disparities in October 2021, focuses on the role of sleep and fatigue among first-generation Hispanic immigrants. It highlights the importance of understanding how racial discrimination can affect sleep, leading to health declines among Hispanic and Latinx immigrants.
Speaking during a virtual event on sleep hosted in February by the Harvard T.H. Chan School of Public Health, Dr. Carmela Alcántara, an associate professor at Columbia University who studies how discrimination and other stressors affect sleep and health, noted that it’s important to remember that the racial and ethnic disparities are not due to genetic differences, rather it’s the impact of social, economic and environmental factors that can affect sleep.
Buildings, roads, traffic patterns, noise, light pollution, neighborhood safety can disrupt sleep.
“We know for example that marginalized communities, racial/ethnic minorities, are more likely to live in neighborhoods with socioeconomic disadvantage and so that can include neighborhoods that might have higher policing and the influence of greater exposure to noise pollution, or greater exposure to light pollution,” said Alcántara during the Chan School webinar.
Shift work, which refers to a work schedule outside the conventional daytime hours can also affect sleep.
About 16% of the U.S. workers had non-daytime schedules in 2017-2018, including 6% who worked in the evening and 4% who worked at night, according to the Bureau of Labor Statistics.
Local, state and federal policies can also affect sleep.
“Social and health care policies affect financial stress, safety concerns, residential segregation practices, and individual autonomy, which may restrict or facilitate opportunities for achieving good sleep health,” write the authors of a 2020 paper published in Annual Review of Public Health.
Loneliness and social isolation are also associated with poorer sleep health.
Other factors include marital status and level of education. People who are married and have higher levels of education tend to report better sleep health.
“While some of these associations may not be causal, they point to the possibility of higher levels of stress due to everyday challenges encountered by more disadvantaged populations, owing to financial insecurity and less autonomy over their life choices,” write the authors of the Annual Review of Public Health paper.
Also important: Access, and lack of access, to health care.
“It’s access to the medicines for sleep, and access to [continuous] positive airway pressure (CPAP) machines, which cost a lot of money,” says Matsumura.
Below we’ve summarized three studies on the topic and listed a dozen more to help you with your reporting.
