Sleep is fundamentally necessary for life, yet racial and ethnic groups are disproportionately affected by poor sleep health and sleep disorders. A growing body of research helps establish that sleep health disparities affecting racial and ethnic groups are a substantial public health problem. We must continue to work to identify and understand the causes, extent, and implications of unequally distributed sleep problems in America in order to intervene.

Shorter sleep duration and/or poor sleep quality are associated with adverse health outcomes, including heart disease, type 2 diabetes, high blood pressure, poor mental health, and obesity. Addressing impediments to sleep health equity can help improve the overall health and lives of historically marginalized Americans.

Foundations of Sleep Health™, the first book from the National Sleep Foundation (NSF), presents sleep as a critical element of overall individual and population health. This new book provides a historic and current perspective of the state of sleep with an emphasis on the interplay between several levels of determinants and factors that influence sleep health. The text discusses sleep health from a theoretical, research, and practice perspective, including evidence-based discussion of the social and contextual determinants of sleep and their biological and societal consequences.

As contributing authors of chapters within Foundations of Sleep Health, we were proud to join other leading experts from around the world to produce this volume with a public health focus. Our research has encompassed a variety of topics related to racial/ethnic sleep disparities including discrimination and sleep health, neighborhood as well as housing factors associated with sleep duration and sleep quality, differences in self-reported and measured sleep duration, as well as the connection between sleep quality and chronic diseases such as obesity, metabolic syndrome, hypertension, type 2 diabetes, kidney disease, and cardiovascular disease. For instance, research suggests that the risk of obesity is increased when the body is sleep-deprived since the stomach hormone ghrelin – associated with increased hunger – is upregulated, and leptin – the hormone associated with satiety – is downregulated. While these appetite-regulating hormones can act in concert to ultimately lead to weight gain and eventually obesity, poor sleep also activates a region of the brain associated with hedonic behavior, including craving unhealthy sweet and salty foods. Hypertension risk can also be increased due to, at least in part, the non-dipping of blood pressure, which occurs when nocturnal blood pressure does not drop lower than 10-20% of daytime blood pressure. Furthermore, sleep deprivation appears to increase risk of type 2 diabetes by impairing insulin sensitivity and glucose homeostasis.

To help achieve sleep health equity, we have a shared responsibility to disseminate our research findings to the next wave of professionals, policy makers, and providers, so they can firmly and routinely integrate these insights on sleep health into the public health agenda. Undoubtedly, the agenda will need to focus on the assurance of the environmental and social conditions needed to promote sleep health for all regardless of the social identities known to shape opportunities and access. This approach would include addressing and avoiding historical injustices and providing health-promoting resources based on level of need until sleep health is equally distributed.

Key changes are needed to achieve sleep health equity, including addressing discriminatory policies and practices across sectors (e.g., housing; labor market) of society that lead to unequal burdens that can affect sleep health, expanding evidence-based and culturally-sensitive sleep health resources, improving equitable access to clinical sleep healthcare, and addressing sleep health equity across the continuum of sleep health care delivery. Other strategic focuses include funding research and policy actions.

When we better understand the barriers to sleep health equity for underrepresented Americans, we can act to help ensure everyone has the opportunity to get sleep they need to thrive.

Lauren Hale is Board Chair of the National Sleep Foundation and a member of its Sleep Health Equity Task Force. Chandra Jackson is a Stadtman Investigator at the National Institute of Environmental Health Services and National Institute on Minority Health and Health Disparities at the National Institutes of Health.

Citation:

Jackson CL, Gaston SA. Environmental Determinants of Sleep. In: Grandner M, editor. Sleep Health. 1^st. Academic Press (Elsevier): 2019.

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