Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
Facts about Sleep Differences among Ethnic Groups | Possible Causes of Sleep Inequalities Among Ethnicities | Health Implications of Racial and Ethnic Sleep Disparities | The Next Steps
Overview
Sleep abnormalities are among the most typical causes of ill health globally.
Anyone can experience sleep troubles regardless of age, sex or race. However, an increasing body of evidence indicates a significant disparity in the amount of sleep different racial and ethnic groups get.[1]
These sleep differences may explain other health inequalities, such as the higher incidence of cardiovascular disease among Black Americans.
This article will highlight sleep disparities among different ethnic groups and also explain the possible consequences of these disparities.
Facts about Sleep Differences Among Ethnic Groups
A study published in the Nature and Science of Sleep journal indicates significant sleep differences among ethnic groups.[2]
The research suggested that minority ethnic groups like African Americans, Hispanics, and other minority groups in America are more likely than White Americans to experience difficulty falling asleep, remaining asleep, and achieving deep, quality sleep.[2]
People who belong to these ethnic minorities are more likely to experience other sleep and medical abnormalities linked to poor sleep, like obstructive sleep apnea, hypertension, heart disease, depression, and diabetes. Additionally, they are less likely to seek medical care for their sleep troubles.[2]
According to Dayna Johnson, Ph.D., the study’s lead author, “we believe that everyone should have access, on an equitable basis, to restful sleep because it is a fundamental human right.”
Johnson continues, “We may be able to lessen this burden on people’s health if we can improve and target sleep, which will simultaneously lessen the strain on our healthcare system and economy.”[2]
The finding of this study is corroborated by another exceptional study conducted by scientists from the Harvard T.H. Chan School of Public Health.[3]
The study assessed sleep inequities among 2330 people belonging to different racial groups, including the Black, Chinese, Hispanic, and White racial groups.[3]
The sleep of the participants of the study was assessed using sleep diaries and wearable sleep-tracking devices.[3]
Furthermore, the sleep duration and quality of the participants who belong to the minority ethnic groups were compared to those of the participants who belong to the White ethnic group. The results of the study showed that:
- People who belong to the Black ethnic group were approximately five times more likely to have little sleep (i.e., sleep for six hours or less per night). Also, Black people were 57 percent more likely to have poor sleep quality and 78 percent more likely to suffer from sleep apnea. In addition, Black men had the shortest sleep duration, receiving 75 minutes less sleep than White women, who slept the longest. Also, Black women received 43 minutes less than White women.
- The study participants who are Hispanics had a 47 percent higher risk of having sleep apnea and an 80 percent higher risk of sleeping for six hours or less. It also showed that Hispanics had a 39 percent higher risk of having poor sleep quality and a 20 percent higher risk of having excessive daytime sleepiness.
- Furthermore, Chinese study participants had 2.3 times the likelihood of sleeping six hours or less every night and 94 percent the likelihood of having poor sleep quality. Also, the Chinese group had a 25 percent likelihood of having obstructive sleep apnea symptoms compared to the White ethnic group.
Furthermore, another study conducted by scientists from the National Center for Chronic Disease Prevention and Health Promotion found that while 33.2 percent of White people reported getting seven or fewer hours of sleep per night, 40.4 percent of American Indians/Native Alaskans and 46.3 percent of Native Hawaiians/Pacific Islanders reported the same.[4]
Possible Causes of Sleep Inequalities Among Ethnicities
It’s difficult to know with absolute certainty what causes the disparities in sleep patterns observed among the various ethnic and racial groups in the United States due to the vast number of factors that might affect sleep.
When people sleep, however, in controlled environments (such as sleep labs), disparities in sleep are typically not found.[5] This finding indicates that sociocultural and economic factors influence the sleep differences observed among ethnicities.[5]
Scientists have linked the increased prevalence of sleeping disorders among persons of color to various possible factors.[6]
The presence of higher levels of physical and mental stress is a trend that runs throughout many of these contributing factors. Stress contributes to reduced sleep duration and quality because it causes changes in numerous systems of the body and places a person in a state of constant alertness.[7]
Some other possible contributors to sleep disparities among different ethnic and racial groups include:
- Work Shifts: People who belong to minority ethnic groups are more prone to work night shifts, irregular hours, or overtime, unlike the white majority.[8] This schedule interferes with their circadian rhythm and reduces sleep duration and quality.
- Racial Prejudice: The controversial issue of racial discrimination still lingers. According to Dr. Thomas A. Mellman, Professor of Psychiatry and Director of the Stress-Sleep Studies Program at Howard University College of Medicine in Washington, DC, “Ruminating on instances of racism and stress from the day could disrupt sleep by altering the autonomic nervous system.”[9] Another study shows that people who felt more racism in their daily lives slept less soundly than those who felt less racism.[10]
- Economic Disparity: A disproportionately high number of individuals of color are unemployed and living in poverty. These two conditions can put enormous strain on one’s financial situation and contribute significantly to day-to-day anxiety leading to impaired sleep.
- Neighborhood Disadvantage: In many cases, the levels of pollution, noise, and other possible stressors that contribute to poor sleep are significantly higher in neighborhoods that have a higher number of residents who identify as belonging to a minority group. A study conducted by researchers from Auburn University shows that neighborhood disadvantage accounted for 24 percent of the difference in sleep interruptions between Black and White individuals.[11]
- Unequal Access to Quality Healthcare: Inequalities in the provision of medical treatment have a multiplicative impact on the health status of persons of color. For instance, diseases such as sleep apnea may have a lower probability of being recognized or efficiently treated, and individuals may be less willing to report their sleeping issues to a medical professional.
Health Implications of Racial and Ethnic Sleep Disparities
Virtually all elements of health and wellness depend on sleep. Quality sleep supports physical well-being and healing, impacting practically all bodily systems.
Sleep is essential for memory, concentration, cognitive function, and maintenance of emotional well-being.
Poor sleep has been suggested by experts researching health disparities as a possible explanation for the poor health outcomes in minority populations.
For instance, higher rates of sleep apnea may directly affect the prevalence of cardiovascular disease in individuals of color.
Understanding how sleep disorders affect people of color can help public health authorities to build more effective initiatives to address sleep and other inequities in health that may be associated with it.
Typically, explicit activities can be taken to promote sleep among ethnic minorities. These activities may serve as a valid focal point for strategies to eliminate health system disparities.
The Next Steps
Resolving sleep and health inequities among ethnicities demands an audacious effort to learn more about the extent of these disparities, their causes, and their consequences to build a specific approach to address them.
It is vital to collect not only more data but data of a higher quality to address the health inequities that are associated with sleep.
The information would be more robust if it took an intersectional approach and reflected potential difficulties in data collection, such as the fact that many people incorrectly report the amount of sleep they get. The degree to which this occurs may differ among racial and ethnic groups.
It’s vital to have better data about the scope of the problem, but this alone is not enough.
The efficacy of many medications currently recommended for insomnia is based on research studies that mostly excluded people of color.
Treatment modalities such as cognitive behavioral therapy for insomnia (CBT-I) and education on sleep hygiene will need to be adapted to improve the efficacy of these treatments for patients of a racial or ethnic minority.[12]
Only well-designed research studies that expand their reach to include more demographically varied and representative people can provide light on the most effective treatments for these patients.
If successful, interventions designed to improve sleep quality can potentially have a broader range of beneficial effects, including cardiovascular health.
Addressing the underlying factors that cause sleep disparities among racial and ethnic groups, such as equal access to health care, institutional racism, and job and economic opportunities, is critical to a successful program to tackle sleep disparities among racial groups.
References:
- Pérez-Stable, E. J. (2020, May 26). Spotlight on COVID-19 and Health Disparities: Opportunities to Achieve Better Understanding and Equality for Vulnerable Populations. https://nimhd.blogs.govdelivery.com/2020/05/26/spotlight-on-covid-19-and-health-disparities-opportunities-to-achieve-better-understanding-and-equality-for-vulnerable-populations/
- Johnson, Dayna A, et al. “Are Sleep Patterns Influenced by Race/Ethnicity – A Marker of Relative Advantage or Disadvantage? Evidence to Date.” Nature and Science of Sleep, Dove, 23 July 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664254/.
- Chen X;Wang R;Zee P;Lutsey PL;Javaheri S;Alcántara C;Jackson CL;Williams MA;Redline S; “Racial/Ethnic Differences in Sleep Disturbances: The Multi-Ethnic Study of Atherosclerosis (MESA).” Sleep, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/25409106/.
- “Prevalence of Healthy Sleep Duration among Adults – United States, 2014.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 25 Aug. 2017, https://www.cdc.gov/mmwr/volumes/65/wr/mm6506a1.htm.
- Cappuccio, F. P., D’Elia, L., Strazzullo, P., & Miller, M. A. (2010). Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep, 33(5), 585–592. https://doi.org/10.1093/sleep/33.5.585
- Jackson, C. L., Redline, S., & Emmons, K. M. (2015). Sleep as a potential fundamental contributor to disparities in cardiovascular health. Annualreview of public health, 36, 417–440. https://doi.org/10.1146/annurev-publhealth-031914-122838
- Roth T. (2007). Insomnia: definition, prevalence, etiology, and consequences. Journal of clinical sleep medicine: JCSM : official publication of the American Academy of Sleep Medicine, 3(5 Suppl), S7–S10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319/
- Kingsbury, J. H., Buxton, O. M., & Emmons, K. M. (2013). Sleep and its Relationship to Racial and Ethnic Disparities in Cardiovascular Disease. Current cardiovascular risk reports, 7(5), 10.1007/s12170-013-0330-0. https://doi.org/10.1007/s12170-013-0330-0
- Lianne, Tomfohr et al. “Racial Differences in Sleep Architecture: The Role of Ethnic Discrimination.” National Center for Biotechnology Information, U.S. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/.
- Johnson , Dayna et al A. “Associations between Everyday Discrimination and Sleep Quality and Duration among African-Americans over Time in the Jackson Heart Study.” National Center for Biotechnology Information, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/.
- Fuller-Rowell TE; Curtis DS; El-Sheikh M; Chae DH; Boylan JM; Ryff CD; “Racial Disparities in Sleep: The Role of Neighborhood Disadvantage.” Sleep Medicine, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/27938909/.
- Johnson, D. A., Jackson, C. L., Williams, N. J., & Alcántara, C. (2019). Are sleep patterns influenced by race/ethnicity – a marker of relative advantage or disadvantage? Evidence to date. Nature and science of sleep, 11, 79–95. https://doi.org/10.2147/NSS.S169312
