Sleep deserts are indeed increasing

Dunietz et al’s gracious response to our paper makes several important points.¹ Sleep deserts certainly go beyond economically underprivileged urban neighborhoods. To the circumstances and places Dunietz and her colleagues mentioned, we should also add the community postgraduate medical trainees. Despite almost 20 years of duty hours regulation, they remain significantly sleep deprived and exhibit chronic consequences of insufficient sleep.² People employed in shift-work patterns other than active military¹ have also been shown to live in “sleep deserts” or with “sleep insecurity.” These include emergency workers such as firefighters,³ among others.

As pointed out by Dunietz and colleagues, sleep insecurity can coexist and temporarily worsen insufficient sleep and this impacts women more than men because of pregnancy, the postpartum period, and perimenopause.¹ Women, however, even outside of these life changes bear the brunt of insufficient sleep. This becomes amplified during major events with larger societal impact. A case in point is the coronavirus disease 2019 (COVID-19) pandemic’s effect on sleep quality and duration. Ding et al,⁴ reporting from the United Kingdom, demonstrated that sleep loss was common during the early COVID-19 lockdown, yet more common in women than in men. Moreover, as working from home became the new normal, total sleep duration increased; however, it did so more significantly for men.⁴ This is most likely because home schooling, which occurred with the lockdown, as well as changes in demands of balancing work and home obligations, disproportionally affected women.⁴

Last, with accelerating climate change and lack of robust and consistent policies worldwide to combat it effectively, sleep is being affected everywhere. Sleep duration and quality decline with warmer temperatures globally, particularly when nighttime temperatures go over 10°C (50°F).⁵ Minor et al⁵ discovered this by linking over 7 million measurements from sleep wearables in 47,628 individuals from 68 countries with local, daily meteorological information. This temperature-related sleep loss unevenly affects residents of lower-income countries, those who live in warmer areas, people over 65 years of age, and, again, women.⁵

In conclusion, we hope that papers like that by Dunietz et al and those referenced here will increase awareness of this major source of health inequity.

DISCLOSURE STATEMENT

The author has approved this manuscript. Work for this letter was performed at the Northwestern University Feinberg School of Medicine, Chicago, Illinois. The author reports no conflicts of interest.