The Social Patterning of Sleep is a Matter of Social Justice
As described in a prior post, insufficient and disordered sleep are very common across the population, with serious consequences for health and well-being. Approximately one-third of adults are not getting sufficient sleep at 7 hours per night and up to 70 million Americans suffer from a sleep disorder (1). Yet, not all people are equally likely to have trouble with their sleep. In this post, I highlight some of the dimensions in which sleep varies across various sociodemographic subpopulations.
Sleep and Gender
In general, women sleep a little longer than men and report lower sleep quality. Women are also about 40% more likely to have insomnia than men (3). Women in particular spend a lot of time taking care of children and the elderly, and a lot of this caregiving occurs during the night. On the other hand, men are more likely than women to suffer from sleep apnea (4). For many decades, sleep apnea was considered to be a disease of only men, but indeed there are numerous undiagnosed and untreated cases of apnea in both men and women.
Sleep and Social Status
Research has also found that social status, typically measured by education, is a predictor of sleep quality and duration. In one study that investigated 4 decades of time-use data, I found that individuals with less than a high school education are about 43% more likely than college graduates to be short sleepers (<6.5 hours per night) and 61% more likely to be long sleepers (>8.5 hours per night), compared to being a mid-range sleeper (6.5-8.5 hours per night) (5). This association between higher socioeconomic status and longer sleep duration has also been found using objectively measured estimates of sleep duration (6).
Sleep and Race/Ethnicity
Numerous studies have shown that sleep duration varies by race/ethnicity. Consistently, blacks are more likely to be short sleepers than whites. Again these findings have been observed using both self-reported and objectively assessed data (6, 7, 8).
Sleep and Neighborhood Characteristics
A growing body of research has shown that neighborhood factors are also linked to sleep quality and duration. In particular, residents of neighborhoods described as noisy, unclean, or unsafe tend to have worse sleep quality (9, 10). The underlying causes of worse sleep in certain neighborhoods are likely related to both physical and psychological factors. In particular, these high-risk neighborhoods may have more light and noise pollution that make it more difficult to fall and stay asleep at night. In addition, if someone feels unsafe where they live, it will likely be harder to relax at night.
Sleep health as a social justice concern
When you take a step back and look at these epidemiological studies on sleep as a whole, we see a picture in which the least advantaged members of society are at greatest risk of not getting sufficient restorative sleep. And, since we know that sleep is a critical component of healthy functioning, this means that the very individuals who are most disadvantaged in sleep, are also disadvantaged in health, creating a feedback loop that perpetuates disparities across the population. Thus, addressing sleep health of the population may be an opportunity to help ameliorate disparities in health. Social policies that improve opportunities for individuals to gain control over their lives, by increasing financial security and personal safety, in addition to sleep health interventions that improve sleep hygiene and access to medical treatment, are important first steps in helping to reduce disparities in sleep and health.
What can I do to improve my sleep?
While some segments of the population are at higher risk for sleep disorders than others, no matter your sociodemographic status, you should pay attention to your own particular sleep needs, sleep behaviors, and sleep quality. If you are interested in improving your sleep, please refer to my prior posts or to the National Sleep Foundation website for advice on how you can make steps to secure the high-quality sleep that you need to function at your best. If you believe you have a sleep disorder, you should discuss this with your physician.
- Zhang B, and Wing YK. “Sex Differences in Insomnia.” 2006 Jan;29(1):85-93.
- Jordan AS, McEvoy RD. “Gender differences in Sleep Apnea: Epidemiology, Clinical Presentation, and Pathogenic Mechanisms.” Sleep Med Rev.2003 Oct;7(5):377-89.
- Hale, Lauren. “Who Has Time to Sleep?” Journal of Public Health. Volume 27(2): 205-211.
- LauderdaleDS, Knutson KL, Yan LL, Rathouz PJ, Hulley SB, Sidney S, Liu K. “Objectively measured Sleep Characteristics among Early-Middle-Aged Adults: The CARDIA Study.” Am J Epidemiol. 2006 Jul 1;164(1):5-16. Epub 2006 Jun 1.
- Hale, L, and Do DP. 2007. “Racial Differences in Self-Reports of Sleep Duration in a Population-Based Study.” Sleep. 30(9):1096-1103.
- Krueger, P. M., & Friedman, E. M. (2009). The correlates of sleep duration in the United States: a cross-sectional population based study. American Journal of Epidemiology, 169,1052-1063.
- Hale, L, Hill T, Friedman E, Nieto PJ, Galvao L, Engelman C, Malecki K, Peppard PE. 2013. “Perceived Neighborhood Quality, Sleep Quality and Health Status: Evidence from the Survey of the Health of Wisconsin.” Social Science and Medicine. 79:16-22.
- Hale L, Hill TD, Burdette A. 2010. “Does Sleep Quality Mediate the Relationship between Neighborhood Disorder and Self-rated Health?” Preventive Medicine. Sep-Oct; 51(3-4): 275-278.