A recent report from the Centers for Disease Control and Prevention confirmed that more than one-third of Americans are sleep deprived. But a closer look at the data shows that some groups suffer even higher rates of sleeplessness: on average, only 54.2 percent of non-Hispanic blacks got at least 7 hours of sleep a day, compared to 66.8 percent of non-Hispanic whites.
This "black-white sleep gap" gained national attention last year, when a groundbreaking study on race and sleep disturbances published in the journal Sleep found that black Americans got less sleep than white Americans and suffered a higher incidence of disorders like sleep apnea and insomnia. Neither the CDC report nor the research published in Sleep investigated why this is the case, but the lead author of the latter study is working to get answers.
"It was impossible to ignore the fact that African-Americans, as a group, are getting the least sleep, and among the worst sleep, of all Americans," Dr. Susan Redline, a Harvard Medical School professor and researcher at Boston's Brigham and Women's Hospital, told The Huffington Post.
According to the CDC study, it's not only black Americans who sleep poorly: respondents who identified as Native Hawaiians/Pacific Islanders, multiracial and American Indians/Alaska Natives all had low rates of adequate sleep. The proportion of those groups who slept at least seven hours a night ranged from 53.6 percent to 59.6 percent, compared to 65.2 percent of all respondents.
To investigate why black people don't get enough sleep, Redline spoke to a group of residents in Boston's predominantly black, low-income Mission Hill neighborhood. She is leading a three-year community outreach effort there, funded by the National Institutes of Health, to learn about the obstacles to good sleep.
Redline found that the people she spoke with already knew about good sleep hygiene, or the habits conducive to sleeping well on a regular basis. "So it's not like public health guidance is falling on deaf ears. But talking to them makes it clear that there are big practical challenges."
Grassroots outreach is important because researchers routinely craft sleep hygiene recommendations without considering how they will be practically applied, Redline said.
But it's not just the public health policy that's skewed, she says. The research methods are, too.
"Besides the dramatic sleep gap, what became really apparent from our 2015 study was that the tools we've developed to scientifically study sleep were designed for predominantly white -- and particularly, white male -- populations," she told HuffPost. She hopes her work with Mission Hill residents will help reveal better ways to survey people about sleep.
People in Mission Hill say they face challenges like noisy streets and have trouble creating a sleep schedule because many residents are shift workers.
Compliance with medical advice can also be an issue. For example, Redline found that residents with sleep apnea, a disorder marked by halted or shallow breathing during sleep, are less likely to consistently use the CPAP device that treats it. This bears out in population data, even after controlling for socio-economic factors and impediments like affordability.
Sleepless and Stressed
The most striking hypothesis for the racial sleep gap is that it results from stress caused by discrimination. There is a well-known relationship between stress and decreased sleep, and for a host of reasons, it is stressful to be nonwhite in America. A recent study suggested that socio-economic discrimination, in addition to racial discrimination, is linked to poor sleep in black communities.
To this end, one of Redline's students is analyzing the data from an ongoing study of heart disease in African-Americans to determine whether there's a relationship between perceived discrimination and sleep quality. If there is, the real challenge will be mitigating discrimination's effect on sleep -- a tall order, admits Redline.
Finally, on the practical front, Redline is experimenting with "yoga interventions" to help Mission Hill residents sleep better. She says that improving the mind-body connection is a surprisingly powerful way to help people sleep in challenging circumstances.
Though Mission Hill residents are already taxed by stress and limited free time, they requested group yoga instruction, says Dr. Emily Kontos, a medical instructor at Brigham & Women's Hospital who is overseeing the yoga program. "Many of them feel that they can dedicate 20 minutes a night to yoga, and they would also like an assortment of materials to assist them, so we are looking into audio, visual and print aids," she said.
Community engagement is key to addressing the health needs of underserved populations, says Amanda Latimore, an epidemiology expert at Johns Hopkins Bloomberg School of Public Health. "People often say data speaks for itself," she said, "but that's often not true. The people who are most marginalized often don’t make it into the studies."
Latimore was involved in a project called "Healthy Minds at Work," which ran from 2008-2012 and worked with Baltimore youth to discuss obstacles to mental health and overcoming substance abuse. Community research has also been a helpful way to address heart disease prevention and obesity in underserved, low-income communities.
Redline is only working in Boston for now, but she hopes other communities will confront the racial sleep gap soon. "Until recently, no one had thought to tailor our sleep health messages to communities that need them the most," she said "But what use is public policy if it can't be applied?"
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