What is the Black-white sleep gap, and how is it manifesting during the coronavirus pandemic?
America has long been obsessed with talking about sleep, a curiosity that the coronavirus pandemic seems to have further stoked. But how sleep has affected health seems to largely ignore a critical element: race.
Why there’s been an uptick in sleep think-pieces and studies is easy to understand. With more than 2.4 million cases of COVID-19 in the U.S., skyrocketing anxiety, a disruption of daily schedules and reports of depression spiking, the moment has all the ingredients necessary to create — as one expert put it during an April webinar hosted by Harvard University— the “perfect storm of sleep problems.”
The thing is, in many studies thus far, it almost appears as if no such storm exists. A March poll from the American Psychiatric Association, for example, found that just 19 percent of Americans were having trouble sleeping. An analysis of Fitbit data from users in six U.S. cities found that individuals were getting 30 extra minutes in April compared with January, and more hours of REM. A study from the University of Colorado Boulder in June concluded that college students’ sleep “became more regular and better aligned with their body’s natural sleep-wake cycle” due to the coronavirus.
To be sure, there are studies showing that sleep has been disrupted, but there are even more showing the opposite — and anecdotal evidence too. Dr. William Winter, a board-certified sleep specialist at Charlottesville Neurology and Sleep Medicine in Virginia, tells Yahoo Life that many of his patients are “doing great” sleep-wise — which he attributes to a “slower, less sort of hectic lifestyle” that includes no commuting and more time with family.
For those who are safely working from home or not having to worry about their family’s health, this may have the potential to be a restful time. But for many, it’s the opposite of peaceful — especially for people of color. Black people not only are suffering record numbers of job losses and are more than four times as likely to die from COVID-19 as white people, they’re also overrepresented in jobs deemed “essential work,” putting them on the frontlines of the crisis. Add to that a national uprising against police brutality and you’ve got more than a “perfect storm” for a sleep crisis among Black people.
But even more concerning, experts tell Yahoo Life, is that this crisis already existed.
The Black-white sleep gap
“Black and brown people do not get as much sleep as white people,” says Dr. Natasha Williams, a behavioral research scientist and assistant professor at NYU School of Medicine. In 2015, Williams — a renowned expert on what’s known as the Black-white sleep gap — published a study with others at NYU looking at data on sleep duration dating back to the 1970s. They concluded that Black people were more likely to experience what they called “very short sleep” (under five hours). “Not only did we find there is a disparity … but that difference has been consistent over time for three decades,” Williams tells Yahoo Life.
Williams’s research bolstered two earlier studies that form the foundation of this work. The first, a 2006 study in the American Journal of Epidemiology, found that, while white women and white men sleep over six hours a night on average, Black women sleep just 5.9 hours a night and Black men 5.1 hours. The second study, published in Sleep in 2007, analyzed sleeping patterns of more than 32,000 people and concluded that Black people were more likely to be at risk of “short sleeping,” meaning less than the recommended number of hours (seven to nine) per night. Both studies pointed out that shorter sleep duration has been linked to conditions such as hypertension, diabetes and obesity, as well as a weakened immune system. As a result, a shorter sleep duration is also linked to a higher mortality rate.
Dr. April Rogers, an assistant professor and research scientist at St. John's University who studies sleep disorders, specifically among minority communities, is concerned about the pandemic’s impact. “The rapid spread, increasing death rates and uncertainty related to COVID-19 have contributed to increased fear, worry and anxiety,” Rogers tells Yahoo Life. “The stress associated with this pandemic may contribute to impaired sleep by prolonging sleep onset and increasing fragmented sleep.”
Rogers is quick to clarify that if COVID-19 stress is causing sleep disturbances among Black people, it’s exacerbating an existing problem, not causing a new one. “When you talk about communities that are at a social-economic disadvantage, they are already experiencing high levels of stress,” she says. “Now you compound that with the stress associated with COVID-19, that also increases your stress. … So uncertainties related to loss of income, caring for those who may be sick and/or navigating health care systems will bring additional challenges for communities of color, which can further increase sleep disruption.”
‘Discrimination has been reported as a contributor to poor sleep’
Rogers says the coronavirus has undoubtedly worsened sleep among some in this demographic, a statement confirmed by a recent piece on San Francisco’s KQED radio exploring the mental toll on Black frontline health care workers. “I’m the type of person that, when I’m tired, I can go to sleep immediately,” Dr. Georgia Davies, an emergency medicine physician at Rutgers University, told KQED. “And for the first time ever in my life, like, last week and the week before, I’ve not really been able to.”
This is understandable, says Rogers. On top of anxiety about the pandemic, she says that Black people have to face concern about their own safety. “Another factor that can increase this Black-white sleep gap is the social stress that minority communities have to face with regards to discrimination and systemic racism, which can increase fear, worry and anxiety that is experienced among minority communities,” says Rogers. “When you are fearful, when you are experiencing anxiety, this can increase your stress level.”
This stress, she says, can literally impede the body’s ability to get rest. “Your body’s natural response is to release a stress hormone called cortisol,” says Rogers. “As your level of cortisol starts to rise, it can really cause a lot of damage in the body.” On top of weakening your immune system and putting you at risk of other conditions like hypertension, obesity and diabetes, too much cortisol can propel the brain into a state of high alert. In an extensive piece on the topic from 2015, a researcher explained it to the National Journal this way: “If people are feeling really discriminated against, then of course they are not going to want to get into a really deep stage of sleep.”
“We’ve known that discrimination has been reported as a contributor to poor sleep,” says Williams. “If you do not have those added pressures … you’re more likely to probably get restful sleep.”
But social issues are far from the only factors that fuel the Black-white sleep gap. Black people are more likely than any other race to work non-daytime hours; nontraditional work shifts have been linked to insomnia. Black people are more likely to be caregivers, an occupation linked with major sleep disturbances. Black people are less likely to live near parks and other green space, which are positively correlated to sleep. Black people often have less access to healthy food; diets high in sugar and saturated fats have been shown to cause shorter sleep durations. And Black people are less likely to report sleep issues in the first place.
‘Sleep awareness [helps] improve overall sleep health’
How all of these issues have influenced Black people’s sleep during this pandemic, says Williams, has yet to be explored. “There’s not a lot of data, which is more reason why these stories need to be written,” she says.
Rogers hopes that for any who are experiencing issues, articles like this one can help provide clarity on how to tackle them. So what’s her advice? Go to bed and wake up at consistent times, exercise daily, minimize high-carb foods and stimulants, ensure your room is dark and cool and — if you end up tossing for more than 20 minutes — get out of bed and do something else until you become tired.
Her hope is that this not only helps individuals sleep better, but helps attack the inequities that exist in America’s sleep today. “A key factor that may contribute to narrowing the gap is through sleep awareness to help improve overall sleep health,” says Rogers. “Research has shown that increasing awareness about sleep health can play a role in promoting healthful changes to increase sleep hygiene.”
For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.
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