Good sleep is fundamental to our overall health and well-being. Data suggests that sleep loss irrespective of the etiology, eg, personal choices (party, video games, surfing), circumstantial (long work hours), or environmental (poor social support or unsafe conditions) may not only trigger undesirable biological mechanisms leading to myriad health problems1–4 but may also shorten life span.5 Inadequate sleep duration may also worsen other sleep disorders and negatively impact work performance, including absenteeism and work-related accidents.6 While poor insight and the lure of activities “more interesting” than sleep is increasingly part of the culture, there is a far more complex interplay of factors driving this phenomenon.
If this was not bad news in itself, the situation is further exacerbated in some racial and ethnic groups, as well as people with lower incomes. Data suggests that Black/African American people have significantly shorter duration of sleep compared to White individuals.7 Similarly, Hispanic/Latino people and individuals with lower income have been shown to experience shorter sleep duration.8 Given the growing presence of these racial differences in an increasingly sleep-deprived society, there is an urgent need to focus on sleep health disparities. It is important to examine health care disparities from a socioecological lens to understand the factors contributing to sleep disparities at multiple levels.9 Through understanding the interplay between factors that contribute to the racial differences seen in sleep health data, we can better design interventions to reduce sleep heath disparities and improve overall well-being of the community at large.
It is with this context that the study published in this issue of the Journal of Clinical Sleep Medicine by Johnson et al10 further explores factors contributing to sleep health disparities. The authors looked at the role of social support (defined as number of friends, financial, marital, church attendance, and emotional support) on the duration of sleep. The authors used the most recent National Health and Nutrition Examination Survey data of more than 10,000 individuals analyzing both structural and functional dimensions of social support. Sleep durations were self-reported. Although there were trends supporting better social support leading to improved sleep duration, only financial support was independently associated with lower prevalence of short sleep duration. This association was lost in individuals over the age of 65 years. Interestingly, financial support was not associated with total sleep duration in Black participants. This finding suggests that source of social support leading to better sleep may vary based on race. Not surprisingly, as the number of social support sources increased, so did sleep duration.
Approaching sleep health through a socioecological and pathological framework will help to not only define the relevant role and relative weight of individual social support factors but also inform intervention designs. In that regard, a broader net must be cast that includes social factors not studied in the current study, including stress (occupational and psychosocial stressors) and housing segregation (redlining). The role of cultural impact on sleep in the immigrant population and subsequent acculturation also need to be factored in.9
Lastly, minorities are also at a greater risk for underlying sleep-disordered breathing, which may impact sleep duration perception. Screening undiagnosed sleep apnea in this highly vulnerable population may also help reduce sleep heath disparities.11
Concomitant development and trials of interventions may also not only help test their effectiveness but also allow us to further understand the role of each contributing factor.
Sleep deprivation is a silent pandemic disproportionately impacting vulnerable populations. A concerted effort to determine the myriad factors contributing to it and develop intervention plans directed to improve sleep outcomes would go a long way in creating a healthier, well-rested society.
DISCLOSURE STATEMENT
The author reports no conflicts of interest.
Citation: Sharma S. Sleep well live well. J Clin Sleep Med. 2023;19(7):1173–1174.
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