Transcriber: Leonardo Silva Reviewer: Ariana Bleau Lugo
Good morning!
OK. Raise your hand if you did not get enough sleep last night.
There are many possible reasons for this.
Maybe you were up late at night
because you had a toddler screaming for you
in the middle of the night.
I know I did!
Or maybe you were cranking away
on that final document for work or for school.
Or maybe you just got sucked in
to watching another episode of the Daily Show.
OK. So now, raise your hand
if you are regularly not functioning at your top game
because of how you slept.
OK. So as sleep deprived as we are,
we are among the lucky ones.
I say that because to be here today
you need to be affiliated with Stony Brook University.
That tells me that you've had the opportunity
to pursue higher education.
Further, to be here
you have to have the ability
to make choices about how you spend your time,
control over your life.
Imagine how much harder it would be
for you to sleep and to function,
if you didn't have that control over your own time.
I know it's hard to put yourself in someone else's shoes,
but imagine, for example, if you didn't have enough money
to feed your children.
How hard would it be for you to sleep?
Or imagine if your crowded urban apartment
was too noisy, or too cold, or too unsafe
for you to comfortably fall asleep at night.
My goal today is to get you thinking
about the social patterning of sleep,
why some of us are sleeping worse than others
and what the consequences are for society.
In my research, I investigate the underlying causes
and consequences of sleep deprivation
and sleep disorders.
Today I'll share with you some of the results of my research
and that of my colleagues.
And I hope to convey to you
why we, as individuals and as a society,
should be deeply concerned about how we sleep
and what we can do about it.
So, for everybody, whether you're rich or poor,
young or old,
more educated or less educated,
sufficient restorative sleep has important implications
for physical health, for quality of life,
for psychological well-being
and for cognitive functioning.
The scientific understanding
of the benefits of sleep to the individual
are expanding everyday.
For physical health alone,
we know that sleep impacts heart health,
metabolism, the immune system.
Sleep is also essential for learning and memory consolidation.
The list of benefits goes on and on.
And when we step back
and think about the societal consequences --
let's think about public safety.
Drowsy driving is responsible
for up to a third of deadly automobile accidents.
Drowsy driving may be a bigger issue than drunk driving.
Oops...
So now, I'll touch on the three
most prevalent high-risk sleep patterns.
First, adequate sleep duration.
You probably already know that getting enough sleep
is important for your health.
But it's not just about getting enough sleep.
It's about getting the right amount.
Both short and long sleep duration
are associated with a range of adverse health outcomes,
including mortality.
So, you're probably wondering, "What's the right amount?"
For adults, it's somewhere between seven and nine hours,
and for children and adolescents,
it's a minimum of nine hours per night.
Unfortunately, 90% of teenagers
are not meeting that recommended amount.
Sleep apnea, another prevalent condition,
is characterized by breathing pauses
and breathing lapses during sleep.
It's prevalent in 5 to 10% of the population,
and highly under-diagnosed.
Historically, it's most diagnosed among women.
And with the rise in obesity we've witnessed,
we've also seen rising rates of apnea.
And now, insomnia.
Insomnia is a condition
characterized by trouble falling asleep,
trouble staying asleep
and waking up too early.
Insomnia is prevalent in up to 25% of the population.
Both insomnia and apnea are associated
with a range of adverse health and social consequences,
including lost economic productivity.
So now that we've established
that there are immense benefits to sleep,
and that sleep deprivation and sleep disorders
are extremely common,
it would be easy for me to pitch
that sleep is a public health problem --
sleep deprivation is a public health problem.
Maybe even a crisis.
At the very least, we can affirm
what the Institute of Medicine declared in 2006:
that sleep deprivation and sleep disorders
are an under-recognized public health problem.
But my angle on this is a little different,
and that distinction is important.
Sleep deprivation and disorders
are not just a public health problem.
They are a matter of social justice.
Socially disadvantaged populations
are at the highest risk of not meeting their sleep needs.
This is a social justice problem
because the unfair distribution of sleep patterns across society
contributes to the emergence and persistence of disparities.
And by disparities I mean differences
along economic lines,
differences along social lines
and differences in health.
Let me start by describing three sociodemographic factors
in which we observe alarming disparities in sleep.
First, education.
Using four decades of time-use data,
we have observed that more educated people
are more likely to sleep the recommended amount
than less educated people.
People with less than a high school education
are 40% more likely to be short sleepers,
and 80% more likely to be long sleepers
than people with a college education.
Similar patterns are observed
when you look at insomnia and sleep apnea.
People with lower levels of education
have higher prevalence of sleep disorders.
Next, let's move on to neighborhood context.
People who live in densely populated urban areas
have shorter sleep durations
than those who live in the non-central city areas.
Further, people who report
that their neighborhoods are highly disordered
have more sleep disturbances
than those who live in more ordered neighborhoods.
Even among school children
we find higher rates of sleep apnea
in worse neighborhoods than in better neighborhoods.
And finally, let's talk about race.
As you may already know,
there are large health disparities
by race in this country.
When framed in terms of life expectancy,
there's more than a five-year life expectancy gap
between black men and white men.
A disparity also exists by race for sleep.
Black men -- not just black men --
compared to whites, blacks have shorter sleep duration,
spend less time in bed,
have less efficient sleep
and take longer to fall asleep than whites.
In one Chicago-based study,
where they collected objective data on sleep,
they found the difference in sleep duration
between black men and white men
was an hour, night after night.
And when we compare the sleep duration of black men
to white women, who are sleeping the longest,
the disparity is even bigger.
Thinking back to the many benefits of sleep
and the negative consequences of sleep deprivation,
this disadvantage by race persists day after day.
Unfortunately, African Americans
still endure discrimination:
discrimination in the labor market,
discrimination in the real estate market,
in the consumer markets and in the credit markets.
Perhaps it is not a surprise
that they also experience a disadvantage
when it comes to sleep.
My colleagues and I hypothesize
that part of the reason that we see differences
between blacks and whites, in terms of sleep,
might be due to this experience of racism.
We found that individuals who report
that they're treated differently because of their race,
even among blacks, are more likely to report sleep disturbances.
So, based on these disparities,
I wanted to know -- in adults -- I wanted to know: when do they begin?
Are we born with them or when do they start?
I looked at the National Birth Cohort study
and found that there are differences
in bedtimes, in bedtime routines, by race and by education
as early as the pre-school years.
And this got me thinking,
"Could this be setting kids on trajectories
to have lower health outcomes,
lower cognitive outcomes,
worse behavioral outcomes?"
So, we investigated the longitudinal data
to see: are people without bedtime routines at age three
having worse outcomes at age five?
First, we found that lack of bedtime routines
was associated with both worse sleep
and shorter sleep duration.
And in contrast, we found that individuals, or children,
who had story time at night, reading and singing,
had better cognitive and behavioral outcomes at age five.
You might imagine, if you're a single mom,
working multiple jobs,
coming home late at night,
you might not have either the availability or the energy
to institute regular bedtimes, night after night.
You could now see how irregular sleep patterns
can get passed on, night after night,
generation after generation.
We also found that watching television at night
predicted trouble sleeping.
Now, this applies to everybody. It's not just about disparities.
Whether you are a toddler, a teenager or an adult,
watching an illuminated screen right before you fall asleep
is probably the least sleep-promoting thing you can do.
The light emitted from the screen
suppresses the sleep-promoting hormone,
melatonin, and thereby delays your natural sleep drive.
The National Sleep Foundation conducted a poll in 2011
and found that 95% of Americans use a screen-based technology
in that hour before bedtime.
We are all guilty of it
and it is time to put those screens down.
So, there are many other important areas
in which sleep is socially patterned
and these also relate to disparities.
I'll touch on a few right now.
First, social and marital relationships matter.
Married people sleep better than single people.
And people in good relationships sleep better still.
Employment matters.
It turns out having a job, or most jobs,
is good for your sleep:
you wake up on a regular schedule
and you have a purpose to your day.
The exceptions are if you work irregular hours
or have a difficult work quality, workplace quality.
We've also found that an American lifestyle
can be detrimental to sleep.
You might say, "What do you mean by that?"
But we found that first-generation immigrants to this country
are better sleepers than the rest of us.
The more they take on American lifestyle characteristics,
the worse their sleep is.
In public health, there's a term for this:
it's called negative acculturation,
and it exists for sleep as well as other health behaviors.
Finally, I want to mention mental health.
Mental health is intricately linked with sleep.
Both anxiety and depression are causes
and consequences of poor sleep.
Now, this bi-directionality
is possible for many of the factors I've noted.
But when poor sleep is both a cause
and a consequence of social disadvantage,
this creates a vicious cicle
from which it is difficult to escape.
And that leads me directly in
to thinking about the societal consequences.
If the very people who are the most socially disadvantaged
and most need that extra boost
to function better during their days
wake up the least prepared,
then they are the disadvantaged
throughout every aspect of their day.
Now, it might be OK if they're disadvantaged on the subway,
where it might be OK if they're to fall asleep.
But if they're disadvantaged in the classrooms,
where they should be learning,
this sets them on the path.
And if they're disadvantaged in their workplace,
where they should be productive,
this also further disadvantages them.
And they are also disadvantaged in their families,
where they should be engaged and responsive.
So, what can we do about this?
There are many things we could do about this.
First, I'll start with the individual and public health campaigns.
We need to increase education
about the importance of sleep and sleep hygiene.
This means encouraging regular bedtimes and routines,
increasing exercises in the day,
decreasing the caffeine in the afternoon
and eliminating screen-time before bed.
Nice try on that one.
We also need to increase access to treatment for sleep disorders
to all members of society,
and we need to implement policies
that change our schedules
and address sleep disorders.
Examples of such policies
include delaying high school start times.
Other examples include screening truck drivers for sleep apnea
and getting them treated.
But I want to ask you this: Is this enough?
Drawing on the work of Michael Marmot and other social epidemiologists,
I believe that limited autonomy
and lack of control of your daily life
is at the root of our sleep problems.
And if lack of control over your life
is the cause of many people's sleep problems,
then just tell them to change their schedules isn't going to help,
because they don't have the control to do so.
Instead, we need to think about and implement
policies and programs that facilitate and empower individuals
to gain or regain this control over their lives.
Examples of such policies include things
like high quality -- or universal high quality pre-K,
which has been shown to have lasting implications
for individuals' capabilities, later into life.
Other examples of policies
might include raising the minimum wage,
or improving housing and living conditions among the poor.
Now these might sound like big dreams,
especially for a sleep researcher,
but I believe that only through broad social policy
can we work to address sleep disparities
and other inequalities.
I have three take-on points.
First,
the social patterning of sleep
falls along lines of sociodemographic disadvantage.
Second, these disparities of sleep
are a matter of social justice and public health policy.
And finally, sleep deprivation and sleep disorders
are a mechanism through which disparities emerge
and persist.
Thank you very much for your time.
(Applause)