“Divided We Sleep”
by Rodrigo Pérez Ortega
Science, October 28, 2021
Sleep disparities in minorities: How researchers are tackling them
Studies in sleep quality and duration, as well as sleep disturbances show over and over a disparity in sleep health among ethnical and racial minorities. Compared to whites, Black and Hispanic people are more likely to sleep less, have undiagnosed and untreated snoring and sleep apnea, and insomnia. This correlates with a higher incidence of cardiovascular disease, mental health disorders and overall mortality.
Years of research show that the causes of these sleep health disparities are based in social determinants of health. Black and Hispanics, whose sleep health is the most affected, are more likely to work night shifts, live in noisy neighborhoods and cities, and have higher levels of stress due to discrimination, poverty, unemployment and acculturation. Unequal access to quality healthcare also prevents minorities to get treatment for sleep disorders.
Over the past 20 years, sleep researcher Girardin Jean-Louis at the University of Miami has been studying what are these disparities in sleep health, what are some of the causes, and how do we begin to implement solutions.
One of the main issues he has encountered is the lack of information about the importance of sleep heath tailored to specific communities. Jean-Louis says he frequently goes to barbershops and hears that Black people think that “snoring is a good thing, it means you’re in deep sleep.” In these, communities, he says, these disparities have to do with education. In the last years, he has focused on reaching out to Black communities to get the word out that sleep health is important. “We are going where they are, instead of expecting them to come to us at the clinic, come to us to the university, come to us to the hospital, we go to them at the barbershop, beauty salon, churches.”
His research has shown that a tailored website that shows Black patients telling their struggles with sleep is effective in improving sleep health education among Black people. “They get the message, they can see themselves through those stories through those vignettes,” he told me.
He also has a program that educates and “certifies” community leaders, like priests, to get the word out, and convince people to pay attention to their sleep.
But once people go to the doctor, sleep is almost never among the questions from the doctor. Sleep medicine is fairly new, he says, and physicians still don’t see sleep as a major diver of health. “In fact, there’s almost a ‘Don’t Ask Don’t Tell’ policy,” Jean-Louis told me. “If you ask a question about sleep, well, the typical 15-minute encounter becomes 30 minutes.”
If patients do get a referral to go to a sleep clinic, discrimination and systemic racism still make minorities turn around. The barriers are multilevel.
But Jean-Louis and other researchers are leading efforts to understand these communities, and create solutions to address them.
In Nogales, AZ, for example, Michael Grandner is leading The Nogales Cardiometabolic Health and Sleep (NoCHeS) Study, which is looking into these disparities at the US-Mexico border. Some of the first papers to come out of this study show that Mexican food and culture are associated with sleep duration and snoring.
And in Columbia University, clinical psychologist Carmela Alcántara is studying insomnia among Hispanic people and how cultural adaptations of treatment can serve minorities. She is adapting and developing Cognitive behavioral therapy for insomnia for Latinos, tailored for Spanish-speaking people.
In this story, I will give a brief overview of the sleep health disparities that research has found, but I would like to focus on the strategies researchers are using to try to narrow the gap. I have already interviewed Jean-Louis, who gave me a good background of the issue and tips of the other projects. I would also like to mention some of the changes in policy that can potentially help decrease these disparities.