Sleep Isn’t Equal: A Conversation about Sleep Disparities with Dr. Wu

Sleep disorders can have enduring consequences that could potentially impact almost every aspect of our health. According to Healthline, getting less than seven hours of sleep a night can cause memory and cognition issues, a weakened immune system, high blood pressure, increased risk for heart disease and diabetes, mood changes, and poor balance, among other effects. Like so many health issues, sleep disorders disproportionately affect minority communities, and are less likely to be diagnosed among people of color. An extensive 2015 study showed that Black individuals were five times more likely to sleep for shorter periods than white Americans while Hispanics and Chinese Americans were roughly two times as likely to sleep for shorter periods.

Dr. Ivan H.C. Wu, a researcher and trained clinical psychologist at the Department of Health Disparities Research at the University of Texas MD Anderson Cancer Center, has been researching these disparities for years. We sat down with Dr. Wu to discuss the origins of sleep disparities, how they manifest, and what we can do about them.

How did you become interested in sleep disparities?

I’ve been researching health disparities my whole career, but my interest in sleep disparities was based on my clinical training at the Raymond G. Murphy VA Medical Center in Albuquerque, New Mexico, and research at MD Anderson Cancer Center where I closely examined a large data set of African American churchgoers. My preliminary research found that there were more than twice the number of those not getting the recommended amount of sleep (7-9 hours for adults) than the national average in the data set. Consistent with what others have found, there was also a link between lack of sleep and obesity. This sparked my interest in sleep disparities and its potential link to cancer prevention and obesity control.

Can you tell us what elements are part of a good night’s sleep?

There are a number of factors that go into a good night’s sleep. These include how rested someone feels after sleep (sleep quality), how much sleep someone gets (sleep duration), how long it takes someone to fall asleep, how often someone wakes up in the middle of the night (sleep fragmentation), how much time is actually spent asleep vs. lying in bed awake (sleep efficiency), and how long someone spends in the various stages of sleep.

What groups are most at risk for developing sleep disorders?

Compared to whites, racial/ethnic minorities are more likely to report sleep apnea, and more likely to report severe insomnia. In particular, African Americans tend to report less sleep duration, less quality sleep, and higher rates of specific sleep disorders than their white counterparts.

What are the roots of these disparities?

One factor I am particularly interested in is racial discrimination and stressors that are unique to belonging to a racial/ethnic minority group. One hypothesis for ongoing sleep disparities is the cumulative stress that minorities experience can negatively impact their sleep and they tend to sleep less and less well. Additionally, contextual factors that affect sleep are also important. Historically, different racial groups have been physically segregated into neighborhoods. If you look at a map of racial density and examine a map of how much sleep people are getting in that area, it will likely show that neighborhoods in which minority groups are concentrated will tend to report less sleep. It is also crucial to understand the environmental factors that go into such geographic determinants such as living in an unsafe neighborhood.

How can we address these disparities?

A multilevel intervention perspective is necessary to address this sleep disparities challenge, this will require the involvement of people from lawmakers to community members. Funding needs to be provided to raise awareness about issues such as getting screened for obstructive sleep apnea, which minorities are tested for less and less likely to follow-up for treatment. Changes could also be made to school scheduling to allow for later start times that encourage more sleep among students. Working with those groups most affected is critical to craft solutions to promote healthier sleep.