There is inequality all around us, whether it is racial, income, or some other thing you might not think of right away. It looks like sleep quality is one of the things affected by your race, social status, and other factors. People who are less financially secured tend to sleep less than wealthy individuals. Also, black people on average have a shorter sleep duration as well as quality compared to Caucasians. We tried to determine why that’s the case, so read on if you want to learn more about the sleep gap in America.
What Does Research Say about This Link?
The CDC regularly conducts surveys to assess health status across the USA. In the latest survey, almost 500,000 adults all across the country reported about their sleep patterns as well. The results show that one-third of adults are not getting the recommended minimum of 7 hours each night. That is a very troubling fact, and that’s why a public sleep quality improvement is one of the current health priorities.
The CDC also compared some socioeconomic factors to see if there is any relationship with the sleep quality of individuals. Specifically, they looked at how poverty affects rest. They defined poverty status in comparison to the federal poverty threshold, which was $11,670 for a household with one individual, and a $23,850 for a four-person family. There was a direct correlation between poverty and the quantity of sleep. Household income below the threshold had 33.6% of people sleeping less than 7 hours a night. Income from above the threshold to 2x of poverty limit had 32.2% of people with insufficient sleep, while these numbers are 30.4% for people with a salary of 2x to 4x the poverty threshold, and 26.8% for those of 4x and above.
The CDC also found a link between racial background and short sleep. It looks like white people sleep the most, while Native Hawaiians and Pacific Islanders are found to have the least rest. Here is how other ethnicities compare:
|Race/ethnicity||Percentage of people sleeping less than 7 hours per day|
|American Indian/Alaskan Native||40.4|
|Native Hawaiian/Pacific Islander||46.3|
Depending on the employment status, students and homemakers sleep the most on average, 69.5% of the respondents reported to sleep more than 7 hours. Only around 50% of the people who aren’t able to work stated so, while for retired and unemployed individuals, the numbers are about 60%. 65% of employed individuals got sufficient rest daily.
The education levels showed some impact on sleep quantity as well. Individuals with a college degree or higher reported to have more sleep than people with some college, high school, or less than that. Marital status was also included in the CDC survey. It showed that married people sleep better on average, followed by the members of unmarried couples, singles, and the least amount of sleep was reported by the divorced, separated, and widowed people.
Other research on the link between ethnicity, socioeconomic status and sleep is consistent with the results from the CDC. Despite the incredible improvement in health care in the last century, there is still a higher prevalence of some conditions between socially disadvantaged populations. Diabetes, asthma, cardiovascular disease, HIV/AIDS, and tuberculosis are more common in African Americans and Hispanic compared to non-Hispanic Whites. Even after adjusting for education and income, there is still a higher prevalence in these populations, which means that they are affected by a number of things. Such health disparities are most likely a combination of structural, psychological, physiological and behavioral differences between the populations. Environment and education play a huge role in improving public health, so teaching the public about these conditions, how to prevent them, and how to spot the initial symptoms, and ask for the professional help is crucial.
A 2010 study found a strong relationship between ethnicity, income levels, and sleep. African Americans and Latinos who participated in this study was over 50% more likely to have poor quality sleep compared to white individuals. Those below the poverty level were also three times more likely to experience poor sleep, than the wealthy participants.
A smaller study looked into differences in sleep architecture between the African Americans and Caucasians, and the results were quite surprising. Black individuals spent more time in Stage 2 of light sleep, while they spent less time in Stage 3, which is also known as deep sleep. The difference was about a little more than 5% in Stage 2, and a bit less than 5% in Stage 3. Deep or slow wave sleep is crucial for body rejuvenation. It is the time when the brain does the needed maintenance, and when muscles and different tissues around the body are repaired. Slow wave sleep is also vital for good cognitive performance, so when you don’t get enough of it, your memory is impaired, you can’t focus as good, and you have a decreased ability to learn new things. Individuals who reported experiencing more discrimination spent less time in deep sleep. That means that stress plays a huge role in sleep architecture and that it needs to be looked at when studying sleep habits.
Another study from 2008 investigated this link and found similar results. They measured sleep patterns using polysomnography, actigraphy, and also sleep questionnaires. Black individuals needed more time to fall asleep; they rested for a shorter durations, had more disturbances that led to fragmented sleep, and spend less time in slow wave sleep. Researches tried ruling out the socioeconomic factors in the statistical analyses, and the results between different ethnicities persisted. That isn’t quite usual, as most of the research on this topic found that the difference is mostly due to those factors. However, the authors acknowledged some limitations to the study, such as smaller sample size, so further research into this link is still needed.
A review from 2015 looked into all the research of the topic. The study pointed out the use of a “race” as a category in this type of studies, as there is a debate going on in a scientific community about this. The race is not a biologically supported category, as there are no evident genes, features, and other markers that would make a difference between the races. There is more variability between individuals of the same race than there is between races. That would mean that this is more of a social construct and that the following sleep problems are a result of socioeconomic factors. Ethnicity might be a more suitable alternative, as it includes shared history, culturally and usually a geographic ancestry.
Besides this, they looked into the literature of how ethnicity, social, environmental and other factors impact sleep. They found out that non-whites slept less on average, had more difficulty falling and staying asleep, but also that they were a lot less likely to report the sleep problems. There is also a higher risk among the African Americans of having a sleep-related breathing disorder such as sleep apnea. They suggested many possible explanations for these findings, including socioeconomic factors such as income, education, and marital status, as well as the environment, culture, various stressors including discrimination, and many other things. They also suggested that additional research is needed to unpack this relationship between ethnicity and sleep quality further, and they propose to look at the more socioeconomics and other factors that may play a vital role in this link.
What Is the Reason for This Sleep Gap in America?
It looks like the problem is not that people who are at the social disadvantage don’t know about the good sleep hygiene, it’s just that they have a much harder time enforcing it. It is a cyclical problem; disadvantaged people face more obstacles to getting the right amount of sleep, and then insufficient sleep also prevents them from performing in the best way they could. Some of these obstacles are:
- Less time for rest. Poor people often have to work multiple jobs to make ends meet. When you are working daytime, and also a night shift, there is just not enough time when you can rest, even though you might feel exhausted. Due to lower income, people are also made to move more to the outside of the city, where the housing is cheaper. That means longer commutes to the jobs that are usually located at the center of the town. Even if using public transportation, which is a cheaper alternative than driving a car to work, longer commutes just cost too much. That additionally takes a toll on an already limited budget. It is estimated that 10-15% of American work multiple jobs, and as much as 60% of them sleep for fewer than 6 hours on a weeknight. People working various jobs have a disrupted circadian rhythm because they are more likely to work more extended hours and also later at night. This decreases performance and increases the risk of job-related injuries. People working shifts are at the highest risk of this since having to stay awake at night brings a lot of consequences. Switching day for a night might not seem like a problem when you are young, but the chronic sleep deprivation is awful for your health.
- Poor health. Unfortunately, higher quality food costs more, and because of that, people who struggle with money often go for lower quality options. That usually means high sugar and fat content, and junk food that is terrible for overall health and sleep. Less sleep also makes you crave unhealthier food and increases your appetite. That leads to weight gain and obesity, which is linked to a number of health conditions like diabetes, high blood pressure, and cardiovascular diseases. Obesity is linked with sleep-related breathing disorders, like obstructive sleep apnea, and it also leads to snoring. All of that results in the decreased quality of sleep, and overall quality of life in general. To make things worse, these people often don’t have health insurance to cover the treatment of their conditions. That’s why they often ignore the symptoms as they can’t afford to treat them, and that leads to worsening of the situation. Poor people often seek professional help when the diseases progress so much that the treatment is much more complicated. Mental health disorders are much more common among poor people, especially the homeless. 25% of the homeless have some mental condition, compared to 6% of the general population. Sleep problems go hand in hand with conditions such as depression, anxiety, and bipolar disorder.
- Home environment. Non-white people often have a hard time finding better jobs and housing due to discrimination. Housing and job instability leads to increased stress in the family, which can affect children the most. A stressful home environment can make them sleep less, which additionally impacts their cognitive performance, meaning that they have more troubles with homework assignments and keeping up with school work. That leads to impaired academic performance and worse grades. Poorer neighborhoods also tend to be more crowded, noisy and light polluted. All of that makes them a bad sleep environment since it ideally should be dark, quiet, cool, and free of any distractions.
- Increased stress. Racial discrimination is a huge stressor. Additionally, housing and food insecurity are growing stress in more unfortunate people. When you always have to think about what are you going to eat tomorrow, how to get the next months rent, and whether it is safe to walk in your neighborhood, it is hard to fall asleep. When you are under stress, your nervous system is active, and you produce some hormones like cortisol that are keeping you more alert. That’s why people who live in safer areas, and with a steady income have better sleep quality.
- Lower education. People with a college or a higher education degree usually sleep better than those with lower education. It makes sense since education usually correlates with income. That’s why a good education is the best way for the more unfortunate people out of poverty, but it is hardly achievable due to the extremely harsh conditions that they are facing.
Sleep inequality is a serious problem in America and fixing it will take a lot of work. We need the core changes in our system and an active fight against poverty and racism. Doing this, combined with stimulating people to get more education can improve public sleep quality, and overall health and quality of life as well.