In fact, a study published last month using data from the National Health Interview Survey from 2004 to 2018 found that the percentage of people reporting short sleep duration (defined as fewer than seven hours per night) was nearly 11 percentage points higher among Black people compared to white, whereas that same disparity was 7.5 percentage points in 2004. (Interestingly, the percentage of Black people reporting long sleep duration—or, sleeping more than nine hours per night—was also 1.5 percent higher than white people; and like short sleep duration, long sleep duration can be a health detriment.)
“There may be factors related to working and job conditions that disproportionately prevent Black adults from having adequate sleep.” —César Caraballo-Cordovez, MD, postdoctoral associate at Yale
Though the study didn’t examine the causes of these growing racial disparities in sleep duration, considering the breakdown of demographics in light of previous research sheds some light. In particular, the gap in sleep quantity was largest among those ages 18 to 64 years old, after which point, it narrowed slightly. “This suggests that there may be factors related to working and job conditions that disproportionately prevent Black adults from having adequate sleep,” says lead author César Caraballo-Cordovez, MD, postdoctoral associate at Yale’s Center for Outcomes Research and Evaluation (CORE). “These include having multiple jobs, long working hours, long transportation times, shift work, and other working-related conditions that may be more common among young and middle-aged Black adults than white adults of the same age.”
- Angela Holliday-Bell, MD, board-certified physician, certified sleep specialist, sleep coach, and founder of The Solution is Sleep LLC
- César Caraballo-Cordovez, MD, César Caraballo-Cordovez, MD, is a postdoctoral associate at Yale School of Medicine. He is currently working at the Yale Center for Outcomes Research & Evaluation (CORE). His research interests are patient-centered outcomes and quality of care in cardiovascular diseases.
Undoubtedly, these workplace realities can also create stress, which we know has a negative impact on sleep. In fact, research has shown that being frequently stressed by work is linked with poor sleep quality, and also that the higher levels of psychosocial stress (work-related and otherwise) that Black people face are connected to lower average sleep duration and lower quality sleep. Interestingly, measurements of stress in the latter study included stress tied to experiencing racism and discrimination, which has also been identified as its own factor driving disparities in sleep quality (reflected by lower levels of deep, slow-wave sleep prevalent among Black people as compared to white people).
Additionally, the unique stress triggered by racism may help to explain why the above Yale study found the racial sleep disparity to be even sharper among folks of middle or high income, as opposed to low. “This suggests that Black people of higher income may be even more frequently exposed to stressors like discrimination in the workplace,” says Dr. Caraballo-Cordovez, referencing a previous study showing how higher levels of professional and educational achievement similarly lead to worse sleep, on average, for Black people.
How racial disparities in sleep quantity and quality create a vicious, health-worsening cycle
Understanding just how racial disparities in sleep arise and worsen requires zooming out to view the broader discriminatory setup at play. At a foundational level, Black people experience more barriers than their white counterparts to achieving and maintaining a healthy life, says Dr. Caraballo-Cordovez. “These barriers can manifest through racial discrimination in daily life, but also as a result of income distribution inequality; exposure to social and environmental conditions that affect health and sleep, including housing conditions such as light, noise, and air pollution [a phenomenon called ‘neighborhood disadvantage’ that’s been shown to mediate racial disparities in sleep]; and restricted access to medical care,” he says.
That higher health burden is further emphasized by the potent racial discrimination within the health-care system that leads to Black folks receiving less adequate care when they do see a doctor, says sleep specialist Angela Holliday-Bell, MD: “They’re less likely to be asked about their sleep in a health visit, and, in turn, less likely to be diagnosed with sleep conditions like obstructive sleep apnea (despite the fact that Black people are at particularly high risk for it).” To follow that thread one step further? Untreated sleep apnea then puts folks at higher risk for heart disease, which is already more common and more fatal in Black people than white.
Dr. Holliday-Bell describes this phenomenon as a chicken-and-egg scenario: Not getting sufficient and high-quality sleep can certainly put someone more at risk for the above health conditions (not to mention, a host of others, like depression and diabetes), but at the same time, any of these health conditions themselves can lead to someone not sleeping well, she says. And because studies have shown clear racial disparities in both sleep and many elements of health, it’s very likely that one thing is perpetuating the other, and vice versa.
What can be done to solve this persistent sleep-health disparity
First, it’s worth saying outright, there are no simple solutions to any problem rooted in racial discrimination, be it the disparity in sleep or otherwise. But, generating awareness through articles like this one is a good start, says Dr. Holliday-Bell. “I find that people often don’t know that sleep is something that can really affect their health, so if their doctor doesn’t ask, they’re not likely to bring it up,” she says. The more people who are made aware of this reality, the more people will also mention it to their doctor and hopefully get the help they need, she says.
At the community level, there are also initiatives designed to reach Black folks who might not make it into a doctor’s office in the first place, adds Dr. Holliday-Bell, referencing how certain sleep doctors are working to spread information about conditions like obstructive sleep apnea by distributing flyers and providing screenings at neighborhood businesses like barbershops and churches.
As sleep increasingly becomes an issue of widespread concern, new legislation could also help to diminish some of the racial disparity. “Local ordinances around noise, air, and light pollution at night could make the conditions in some neighborhoods populated mostly by Black people more suited to good sleep,” says Dr. Holliday-Bell.
Crucially, however, the other underlying barriers preventing Black people from getting sufficient sleep will also need to be cleared in order to reverse the course we’re headed down, says Dr. Caraballo-Cordovez. That means broader legislation aimed at improving working conditions, decreasing workplace and home stress levels, and minimizing the impacts of racial discrimination could all contribute toward lifting the sleep disparity, as well.
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