Sleep deprivation & disparities in health, economic and social wellbeing: Lauren Hale at TEDxSBU


Translator: Leonardo Silva
Reviewer: Ariana Bleau Lugo Good morning! OK. Raise your hand if you did not
get enough sleep last night. There are many possible reasons for this. Maybe you were up late at night because you had a toddler
screaming for you in the middle of the night. I know I did! Or maybe you were cranking away on that final document
for work or for school. Or maybe you just got sucked in to watching another episode
of the Daily Show. OK. So now, raise your hand if you are regularly not functioning
at your top game because of how you slept. OK. So as sleep deprived as we are, we are among the lucky ones. I say that because to be here today you need to be affiliated
with Stony Brook University. That tells me that you’ve had
the opportunity to pursue higher education. Further, to be here you have to have the ability to make choices
about how you spend your time, control over your life. Imagine how much harder it would be for you to sleep and to function, if you didn’t have that control
over your own time. I know it’s hard to put yourself
in someone else’s shoes, but imagine, for example,
if you didn’t have enough money to feed your children. How hard would it be for you to sleep? Or imagine if your crowded urban apartment was too noisy, or too cold, or too unsafe for you to comfortably fall asleep at night. My goal today is to get you thinking about the social patterning of sleep, why some of us
are sleeping worse than others and what the consequences are for society. In my research,
I investigate the underlying causes and consequences of sleep deprivation and sleep disorders. Today I’ll share with you
some of the results of my research and that of my colleagues. And I hope to convey to you why we, as individuals and as a society, should be deeply concerned
about how we sleep and what we can do about it. So, for everybody,
whether you’re rich or poor, young or old, more educated or less educated, sufficient restorative sleep
has important implications for physical health, for quality of life, for psychological well-being and for cognitive functioning. The scientific understanding of the benefits of sleep to the individual are expanding everyday. For physical health alone, we know that sleep impacts heart health, metabolism, the immune system. Sleep is also essential for learning
and memory consolidation. The list of benefits goes on and on. And when we step back and think about
the societal consequences — let’s think about public safety. Drowsy driving is responsible for up to a third
of deadly automobile accidents. Drowsy driving may be
a bigger issue than drunk driving. Oops… So now, I’ll touch on the three most prevalent high-risk sleep patterns. First, adequate sleep duration. You probably already know
that getting enough sleep is important for your health. But it’s not just about
getting enough sleep. It’s about getting the right amount. Both short and long sleep duration are associated with a range
of adverse health outcomes, including mortality. So, you’re probably wondering,
“What’s the right amount?” For adults, it’s somewhere
between seven and nine hours, and for children and adolescents, it’s a minimum of nine hours per night. Unfortunately, 90% of teenagers are not meeting that recommended amount. Sleep apnea, another prevalent condition, is characterized by breathing pauses and breathing lapses during sleep. It’s prevalent in 5 to 10%
of the population, and highly under-diagnosed. Historically, it’s most diagnosed
among women. And with the rise in obesity
we’ve witnessed, we’ve also seen rising rates of apnea. And now, insomnia. Insomnia is a condition characterized by trouble falling asleep, trouble staying asleep and waking up too early. Insomnia is prevalent
in up to 25% of the population. Both insomnia and apnea are associated with a range of adverse health
and social consequences, including lost economic productivity. So now that we’ve established that there are immense benefits to sleep, and that sleep deprivation
and sleep disorders are extremely common, it would be easy for me to pitch that sleep is a public health problem — sleep deprivation
is a public health problem. Maybe even a crisis. At the very least, we can affirm what the Institute of Medicine
declared in 2006: that sleep deprivation
and sleep disorders are an under-recognized
public health problem. But my angle on this
is a little different, and that distinction is important. Sleep deprivation and disorders are not just a public health problem. They are a matter of social justice. Socially disadvantaged populations are at the highest risk
of not meeting their sleep needs. This is a social justice problem because the unfair distribution
of sleep patterns across society contributes to the emergence
and persistence of disparities. And by disparities I mean differences along economic lines, differences along social lines and differences in health. Let me start by describing
three sociodemographic factors in which we observe
alarming disparities in sleep. First, education. Using four decades of time-use data, we have observed that more educated people are more likely to sleep
the recommended amount than less educated people. People with less
than a high school education are 40% more likely to be short sleepers, and 80% more likely to be long sleepers than people with a college education. Similar patterns are observed when you look at insomnia and sleep apnea. People with lower levels of education have higher prevalence of sleep disorders. Next, let’s move on
to neighborhood context. People who live in densely
populated urban areas have shorter sleep durations than those who live
in the non-central city areas. Further, people who report that their neighborhoods
are highly disordered have more sleep disturbances than those who live
in more ordered neighborhoods. Even among school children we find higher rates of sleep apnea in worse neighborhoods
than in better neighborhoods. And finally, let’s talk about race. As you may already know, there are large health disparities by race in this country. When framed in terms of life expectancy, there’s more than a five-year
life expectancy gap between black men and white men. A disparity also exists by race for sleep. Black men — not just black men — compared to whites,
blacks have shorter sleep duration, spend less time in bed, have less efficient sleep and take longer
to fall asleep than whites. In one Chicago-based study, where they collected
objective data on sleep, they found the difference
in sleep duration between black men and white men was an hour, night after night. And when we compare
the sleep duration of black men to white women,
who are sleeping the longest, the disparity is even bigger. Thinking back
to the many benefits of sleep and the negative consequences
of sleep deprivation, this disadvantage by race
persists day after day. Unfortunately, African Americans still endure discrimination: discrimination in the labor market, discrimination in the real estate market, in the consumer markets
and in the credit markets. Perhaps it is not a surprise that they also experience a disadvantage when it comes to sleep. My colleagues and I hypothesize that part of the reason
that we see differences between blacks and whites,
in terms of sleep, might be due to this experience of racism. We found that individuals who report that they’re treated differently
because of their race, even among blacks, are more likely
to report sleep disturbances. So, based on these disparities, I wanted to know — in adults —
I wanted to know: when do they begin? Are we born with them
or when do they start? I looked
at the National Birth Cohort study and found that there are differences in bedtimes, in bedtime routines,
by race and by education as early as the pre-school years. And this got me thinking, “Could this be setting kids
on trajectories to have lower health outcomes, lower cognitive outcomes, worse behavioral outcomes?” So, we investigated the longitudinal data to see: are people without
bedtime routines at age three having worse outcomes at age five? First, we found that lack
of bedtime routines was associated with both worse sleep and shorter sleep duration. And in contrast, we found
that individuals, or children, who had story time at night,
reading and singing, had better cognitive
and behavioral outcomes at age five. You might imagine, if you’re a single mom, working multiple jobs, coming home late at night, you might not have
either the availability or the energy to institute regular bedtimes,
night after night. You could now see
how irregular sleep patterns can get passed on, night after night, generation after generation. We also found that watching
television at night predicted trouble sleeping. Now, this applies to everybody.
It’s not just about disparities. Whether you are a toddler,
a teenager or an adult, watching an illuminated screen
right before you fall asleep is probably the least
sleep-promoting thing you can do. The light emitted from the screen suppresses the sleep-promoting hormone, melatonin, and thereby delays
your natural sleep drive. The National Sleep Foundation
conducted a poll in 2011 and found that 95% of Americans
use a screen-based technology in that hour before bedtime. We are all guilty of it and it is time to put those screens down. So, there are many other important areas in which sleep is socially patterned and these also relate to disparities. I’ll touch on a few right now. First, social and marital
relationships matter. Married people sleep better
than single people. And people in good relationships
sleep better still. Employment matters. It turns out having a job, or most jobs, is good for your sleep: you wake up on a regular schedule and you have a purpose to your day. The exceptions are if you work
irregular hours or have a difficult work quality,
workplace quality. We’ve also found
that an American lifestyle can be detrimental to sleep. You might say,
“What do you mean by that?” But we found that first-generation
immigrants to this country are better sleepers than the rest of us. The more they take on
American lifestyle characteristics, the worse their sleep is. In public health, there’s a term for this: it’s called negative acculturation, and it exists for sleep
as well as other health behaviors. Finally, I want to mention mental health. Mental health
is intricately linked with sleep. Both anxiety and depression are causes and consequences of poor sleep. Now, this bi-directionality is possible for many
of the factors I’ve noted. But when poor sleep is both a cause and a consequence of social disadvantage, this creates a vicious cicle from which it is difficult to escape. And that leads me directly in to thinking about
the societal consequences. If the very people who are
the most socially disadvantaged and most need that extra boost to function better during their days wake up the least prepared, then they are the disadvantaged throughout every aspect of their day. Now, it might be OK
if they’re disadvantaged on the subway, where it might be OK
if they’re to fall asleep. But if they’re disadvantaged
in the classrooms, where they should be learning, this sets them on the path. And if they’re disadvantaged
in their workplace, where they should be productive, this also further disadvantages them. And they are also disadvantaged
in their families, where they should be
engaged and responsive. So, what can we do about this? There are many things
we could do about this. First, I’ll start with the individual
and public health campaigns. We need to increase education about the importance
of sleep and sleep hygiene. This means encouraging
regular bedtimes and routines, increasing exercises in the day, decreasing the caffeine in the afternoon and eliminating screen-time before bed. Nice try on that one. We also need to increase
access to treatment for sleep disorders to all members of society, and we need to implement policies that change our schedules and address sleep disorders. Examples of such policies include delaying high school start times. Other examples include
screening truck drivers for sleep apnea and getting them treated. But I want to ask you this:
Is this enough? Drawing on the work of Michael Marmot
and other social epidemiologists, I believe that limited autonomy and lack of control of your daily life is at the root of our sleep problems. And if lack of control over your life is the cause of many people’s
sleep problems, then just tell them to change
their schedules isn’t going to help, because they don’t have
the control to do so. Instead, we need
to think about and implement policies and programs that facilitate
and empower individuals to gain or regain
this control over their lives. Examples of such policies include things like high quality —
or universal high quality pre-K, which has been shown
to have lasting implications for individuals’ capabilities,
later into life. Other examples of policies might include raising the minimum wage, or improving housing
and living conditions among the poor. Now these might sound like big dreams, especially for a sleep researcher, but I believe
that only through broad social policy can we work to address sleep disparities and other inequalities. I have three take-on points. First, the social patterning of sleep falls along lines
of sociodemographic disadvantage. Second, these disparities of sleep are a matter of social justice
and public health policy. And finally, sleep deprivation
and sleep disorders are a mechanism
through which disparities emerge and persist. Thank you very much for your time. (Applause)

35 thoughts on “Sleep deprivation & disparities in health, economic and social wellbeing: Lauren Hale at TEDxSBU

  1. Fascinating presentation. Definitely gives one food for thought. (Okay, MAYBE I'll stop watching television before I go to bed. Maybe. And no computer screen time too? Oh boy.)

  2. Exceptional presentation. Enlightening, particularly in regard to having one more clue that can help explain our health care and socioeconomic disparities in this country. Well done, Dr. Hale.

  3. Dr. Hale's work and her presentation focus on frequently disregarded implications of "not enough" sleep. The social implications are vast and the short term needs relate to everything from safety to productivity.

  4. Very interesting! As someone who worked overnight for several years and tried to live a normal life on the weekends, I am all too well aware of the consequences of sleep deprivation. But I had never thought of it as a public health problem. And the reduction of melatonin from looking at a screen before (or while, in my case) trying to fall asleep? Uh-oh! Thanks, Dr. Hale, for the info and plenty to think about as I try to fall asleep tonight!

  5. as social/economic inequality and class division is a terribly persistent and also increasing global problem, shining a light on perhaps the most important factor in health and well-being and how it relates to this problem would seem quite important and yet it is not discussed enough. so thanks for this, dr. hale.

  6. How proud I was to watch you speak so eruditely, Lauren. I appreciated your conversational approach to a scientific topic regarding a phenomena we take for granted! I had never thought of the socio/economic effects of not getting enough sleep. Of course, tired children will not learn, and tired, harried adults will not be productive in the workplace. How in the world will we slow down our demanding and distracting existence? Congratulations, and I look forward to hearing more from you.

  7. Great presentation of the problem, the data AND the solution. A lot to think about, both in terms of one's personal sleep habits and broader social issues.

  8. Interesting. I’ve enjoyed many TED presentations in the past, but, Dr, Hale not only provides an intriguing and often underestimated issue, but she paces the presentation in a controlled and coherent fashion. Though, nearly all TED talks are fascinating, I often feel that many are unnecessarily rushed.

  9. As someone with sleep apnea and on autopap therapy for many years, I'm glad to hear someone talking about the effects of sleep deprivation.  But I can't help but think she's missing some key things, that many others have missed as well.  Probably long sleepers are ones with sleep problems, like apnea, that motivate them to sleep more, trying desperately to get better caught up on sleep — and that would skew the results about how long sleepers tend to be less healthy.  Studies have shown that in 1900, adults slept 9-10 hours a night; it's possible that 7-9 hours is not really ideal.

    Also, sleep apnea tends to be inherited and does make it harder to function, especially untreated.  That leads an adult to a lower socioeconomic class and raising kids who are then disadvantaged by both that and things like fewer bedtime stories.  Building awareness of sleep disorders, getting more diagnosed and treated would go a long way to helping with this.

    I'm not keen on adding more regulations and the like; they tend to try to make more people fit in boxes that don't fit terribly well.  The sleep hygiene stuff always makes me wince some as it just feels like hinting around the edges of the problem.  If you wake up in a panic in the middle of the night, it may well be because you were having trouble breathing.  It didn't have much to do with using a computer in the hour before you went to bed, really, as opposed to simply having the lights on then.  Something like starting high school later probably does make sense, but increasing minimum wage doesn't seem particularly helpful, compared to getting people diagnosed, as needed, and then they can function better and get better jobs — and improve themselves.

  10. hope i am not destined to failure since i sleep 7 hours a day since i was 5 but have changed my sleeping habits from 7 to 5 or 6 hours and in this i feel like i should just consider suicide since many signs tell me that i am not worthy of having a good sleep and mostly a good healthy life which is all that life really matters. 

  11. implementing policy to help with sleep deprivation well not be effective. Good sleep is widely dependent on personal choice for example, policy in regulating sleep apnea for truck drivers won't necessarily stop them from drinking too much coffee or starting ash cell phone before bed. same with high school students. delaying school start time will give them more of an excuse to not be responsible and they well just find things to do to stay up later.

  12. We need to show society how ridiculous it is that they need the pointless feature of the car honking when they lock it with their car keys.

  13. Wow I wish I could meet or tlk to this lady. Because I feel like she was tlkn about me when it came to almost everything she was tlkn about. I need help

  14. Ok…. so now we need to lobby our congressmen and women and get a few laws and regulations in place. We can start with mandating 8 hours of sleep for adults and 9 hours for children. We can include fines (imposed by the IRS) and jail time for those who persist in breaking the law. Sure this will limit people's freedom to make their own choices, but the cost will be worth it. The president should create a Department of Sleep Deprivation. The DSD of course will need billions of dollars in its budget to hire people to look into people's bedrooms, buy stopwatches and logbooks to make sure everyone complies. All a small price to pay to stop this horrific , socially racist environment. Since blacks don't get enough sleep, this may be seen as unfair to them, but after all, it's for their own good. I will personally sleep better tonight knowing this problem is being confronted boldly by the DSD. Another great idea would be a war on poverty, but that's another topic.

  15. One of the worst Ted Talks I have heard. Seems like there is A LOT of Confirmation Bias was used to gather her statistical data. I am sure there is truth to some of it, but a lot of it seems like a stretch. She is right about the light, high-school start times, and the other actual scientifically studied sleep points she mentioned though but many other Ted Talks on sleep address this issue much better. Correlation does NOT equal causation, graduate lesson 101.

  16. To sum this up. I can't sleep because…Racism. I'm so sleepy & uneducated I didn't even realize this until she wrote out the narrative for me. Thank you random lady who's speech I'm listening to when I should be sleeping. 😉🤦🏾‍♂️👌🏾

  17. The American lifestyle effects sleep, murders, need for mass quantities of mood enhancers, lots of suicides, obesity, divorce, and letting day care people raise our children.  Materialism has made us much better people, hasn't it?

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