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About the Editors vii Contributors ix
Part I: An Introduction to Sleep Epidemiology
1. Sleep Epidemiology: A Social Perspective 3
Dustin T. Duncan, Ichiro Kawachi, and Susan Redline
2. Sleep Epidemiology: An Introduction 11
Susan Redline, Brian Redline, and Peter James
Part II: Sleep Health Over the Life Course and Among Special Populations
3. Sleep in Pregnancy 49
Louise M. O’Brien and Galit L. Dunietz
4. Sleep Among Children 93
Judith Owens and Monica Ordway
5. Sleep Among Working Adults 119
Faith S. Luyster, Lynn M. Baniak, Eileen R. Chasens, Christine A. Feeley, Christopher C. Imes, and Jonna L. Morris
6. Sleep Among Older Adults 139
Katie L. Stone and Vicki Li
7. Race as a Social Determinant of Sleep Health 167
Rebecca Robbins, Azizi Seixas, Natasha Williams, Byoungjun Kim, Judite Blanc, João Nunes, and Girardin Jean-Louis
8. Sleep Health Among Sexual and Gender Minorities 187
Brett M. Millar, William C. Goedel, and Dustin T. Duncan
9. Sleep Among Immigrants: Does Acculturation Matter? 205
Sunmin Lee, Natalie Slopen, and Seo Young Hong
Part III: Social Determinants of Sleep
10. Socioeconomic Status and Sleep 235
Michael A. Grandner
11. Exposure to Discrimination and Sleep 257
Tené T. Lewis and Izraelle I. McKinnon
12. Family Relationships in the Context of Sleep 325
Eunjin Lee Tracy and Wendy M. Troxel
13. Bidirectional Relationships Between Work and Sleep 351
Chandra L. Jackson, Soomi Lee, Tori L. Crain, and Orfeu M. Buxton
14. Housing Conditions as Environmental and Social Determinants of Sleep Health 373
Chandra L. Jackson
15. Connecting Neighborhoods and Sleep Health 409
Dayna A. Johnson, Yazan A. Al-Ajlouni, and Dustin T. Duncan
Glossary 431 Index 435
About the Editors
Dustin T. Duncan, ScD, is an associate professor in the Department of Epidemiology at Columbia University Mailman School of Public Health, where he directs Columbia’s Spatial Epidemiology Lab and co-directs the department’s Social and Spatial Epidemiology Unit. Dr. Duncan is a social and spatial epidemiologist. His research broadly seeks to understand how social and contextual factors, especially neighborhood characteristics, influence population health, with a particular focus on HIV epidemiology and prevention and sleep epidemiology and promotion. His work has an emphasis on minority health, intersectionality, and health disparities, especially among sexual and gender minority populations such as Black gay, bisexual, and other men who have sex with men and transgender women of color. His research has a strong domestic (U.S.) focus, but recent work is beginning to span across the globe (including studies in Paris, London, and Abu Dhabi). His research and that of the field of spatial epidemiology is summarized in his coedited book Neighborhoods and Health (2nd edition) with Ichiro Kawachi (Oxford University Press, 2018). Dr. Duncan’s research appears in leading public health, epidemiology, medical, geography, criminology, demography, and psychology journals. He has over 150 publications and book chapters, and his research has appeared in major media outlets including the U.S. News and World Report, The Washington Post, The New York Times, and CNN. His work also extends out of the research world and into classrooms through invited talks, multiple guest lectures across institutions, and his courses including “Assessing Neighborhoods in Epidemiology,” offered at Columbia University Mailman School of Public Health. Dr. Duncan’s recent work has been funded by the National Institutes of Health, Centers for Disease Control and Prevention, HIV Prevention Trials Network, Robert Wood Johnson Foundation, Verizon Foundation, and Aetna Foundation. He is on the editorial board of Geospatial Health, the Journal of Urban Health, and the International Journal of Environmental Research and Public Health. Dr. Duncan completed his doctorate and the Alonzo Smythe Yerby Postdoctoral Fellowship, both in social epidemiology, at Harvard University T. H. Chan School of Public Health.
Ichiro Kawachi, MBChB, PhD, is the John L. Loeb and Frances Lehman Loeb Professor of Social Epidemiology at the Harvard T. H. Chan School of Public Health, where he has taught since 1992. Dr. Kawachi received both his medical degree and his PhD (in epidemiology) from the University of Otago, New Zealand. Dr. Kawachi is the coeditor (with Lisa Berkman) of the first textbook on social epidemiology, titled Social Epidemiology (Oxford University Press, 2000; new and revised edition published in 2014 with Lisa Berkman and Maria Glymour). His other books include Neighborhoods
and Health with Lisa Berkman (Oxford University Press, 2003; new and revised edition published in 2018 with Dustin Duncan); Globalization and Health with Sara Wamala (Oxford University Press, 2006); Social Capital and Health with S. V. Subramanian and Daniel Kim (Springer, 2008); the Oxford Handbook of Public Health Practice with Charles Guest, Walter Ricciardi, and Iain Laing (Oxford University Press, 2013); Global Perspectives on Social Capital and Health with Soshi Takao and S. V. Subramanian (Springer, 2013); and Behavioral Economics and Public Health with Christina Roberto (Oxford University Press, 2015). His current NIH-funded R01 project is focused on the longitudinal impacts of community social cohesion/social capital on functional recovery after the March 11, 2011, Great Eastern Japan earthquake and tsunami. In 2013, he launched a massive, open online course (MOOC) through HarvardX called “Health and Society” (PHx 201), which is a version of a class he has taught for 20 years at Harvard. In 2013–2014, 35,000 participants from throughout the world enrolled in the MOOC course. Dr. Kawachi is the coeditor in chief (with S.V. Subramanian) of the international journal Social Science & Medicine. He is an elected member of the Institute of Medicine of the U.S. National Academy of Sciences.
Susan Redline, MD, MPH, is the Peter C. Farrell Professor of Sleep Medicine at Harvard Medical School. She directs programs in Sleep and Cardiovascular Medicine and Sleep Medicine Epidemiology at Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center. Dr. Redline’s research includes epidemiological studies and clinical trials designed to (a) elucidate the etiologies of sleep disorders, including the role of genetic and early life developmental factors, and (b) understand the cardiovascular and other health outcomes of sleep disorders and the role of sleep interventions in improving health. She has led sleep assessments made in numerous community-based cohort studies and clinical trials, as well as national initiatives aimed at identifying the genetic and environmental contributors to sleep disorders. She has published over 450 peer-reviewed articles and has served the sleep research community in a number of capacities, including as a member of the board of directors for the American Academy of Sleep Medicine and the Sleep Research Society, the NIH’s Sleep Disorders Research Advisory Board, and the Institute of Medicine’s Committee on Sleep Medicine and Research; she is also deputy editor for the journal Sleep and for Annals of the American Thoracic Society. She received her BS and MD degrees from Boston University and an MPH degree from the Harvard T. H. Chan School of Public Health and completed internal medicine and pulmonary and critical care medicine training at Case Western Reserve University and a research fellowship in respiratory epidemiology at Harvard Medical School.
Yazan A. Al-Ajlouni, BA
Contributors
New York University School of Medicine
Department of Population Health
New York, NY
Lynn M. Baniak, PhD, RN University of Pittsburgh School of Nursing Pittsburgh, PA
Judite Blanc, PhD
New York University School of Medicine Department of Population Health, NYU Langone Health
New York, NY
Orfeu M. Buxton, PhD
Harvard Medical School Division of Sleep Medicine Boston, MA
Harvard T. H. Chan School of Public Health Department of Social and Behavioral Sciences Boston, MA
Brigham and Women’s Hospital Departments of Medicine and Neurology, Sleep Health Institute Boston, MA
Pennsylvania State University
Department of Biobehavioral Health University Park, PA
Eileen R. Chasens, PhD, RN
University of Pittsburgh School of Nursing Pittsburgh, PA
Tori L. Crain, PhD
Colorado State University Psychology Department Fort Collins, CO
Dustin T. Duncan, ScD
New York University School of Medicine Department of Population Health New York, NY
Galit L. Dunietz, MPH, PhD University of Michigan, Michigan Medicine
Department of Neurology, Division of Sleep Medicine Ann Arbor, MI
Christine A. Feeley, PhD, RN University of Pittsburgh School of Nursing Pittsburgh, PA
William C. Goedel, BA Brown University School of Public Health Department of Epidemiology Providence, RI
Michael A. Grandner, PhD, MTR University of Arizona College of Medicine Department of Psychiatry, Sleep and Health Research Program Tucson, AZ
Seo Young Hong, MPH University of Maryland School of Public Health
Department of Epidemiology College Park, MD
Christopher C. Imes, PhD, RN
University of Pittsburgh School of Nursing Pittsburgh, PA
Chandra L. Jackson, PhD, MS
National Institutes of Health
Department of Health and Human Services, Epidemiology Branch, National Institute of Environmental Health Sciences
Research Triangle Park, NC
National Institutes of Health Department of Health and Human Services, Intramural Program, National Institute on Minority Health and Health Disparities Bethesda, MD
Peter James, ScD
Harvard Medical School and Harvard Pilgrim Health Care Institute Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse (CoRAL) Boston, MA
Girardin Jean-Louis, PhD
New York University School of Medicine Department of Population Health
New York, NY
Dayna A. Johnson, PhD, MPH, MS, MSW
Emory University, Rollins School of Public Health
Department of Epidemiology Atlanta, GA
Ichiro Kawachi, MD, PhD
Harvard T.H. Chan School of Public Health
Department of Social and Behavioral Sciences Boston, MA
Byoungjun Kim, MUP
New York University School of Medicine
Department of Population Health
New York, NY
Soomi Lee, PhD
University of South Florida School of Aging Studies Tampa, FL
Sunmin Lee, ScD
University of Maryland School of Public Health
Department of Epidemiology College Park, MD
Tené T. Lewis, PhD
Emory University, Rollins School of Public Health
Department of Epidemiology Atlanta, GA
Vicki Li
University of California San Francisco California Pacific Medical Center Research Institute San Francisco, CA
Faith S. Luyster, PhD
University of Pittsburgh School of Nursing Pittsburgh, PA
Izraelle I. McKinnon, MPH
Emory University, Rollins School of Public Health
Department of Epidemiology Atlanta, GA
Brett M. Millar, PhD
City University of New York New York, NY
Jonna L. Morris, PhD, RN
University of Pittsburgh School of Nursing Pittsburgh, PA
João Nunes, MD
The City College of New York School of Medicine
New York, NY
Louise M. O’Brien, PhD, MS
University of Michigan, Michigan Medicine
Department of Neurology, Division of Sleep Medicine
Ann Arbor, MI
University of Michigan, Michigan Medicine
Department of Obstetrics & Gynecology
Ann Arbor, MI
Monica Ordway, PhD, APRN, PPCNP-BC
Associate Professor
Yale University School of Nursing
West Haven, CT
Judith Owens, MD, MPH Director of Sleep Medicine
Boston Children’s Hospital Professor of Neurology
Harvard Medical School
Brian Redline, BA
University of Southern California
USC Suzanne Dworak-Peck School of Social Work
Los Angeles, CA
Susan Redline, MD, MPH
Harvard Medical School, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center
Department of Medicine Boston, MA
Harvard T. H. Chan School of Public Health
Department of Epidemiology Boston, MA
Rebecca Robbins, PhD
New York University School of Medicine Department of Population Health
New York, NY
Azizi Seixas, PhD
New York University School of Medicine Department of Population Health New York, NY
Natalie Slopen, ScD
University of Maryland School of Public Health Department of Epidemiology College Park, MD
Katie L. Stone, PhD
University of California San Francisco California Pacific Medical Center Research Institute San Francisco, CA
Eunjin Lee Tracy, PhD University of Utah Department of Psychology Salt Lake City, UT
Wendy M. Troxel, PhD RAND Corporation Behavioral and Health Sciences Division Pittsburgh, PA
Natasha Williams, EdD
New York University School of Medicine Department of Population Health New York, NY
The Social Epidemiology of Sleep
Part I
An Introduction to Sleep Epidemiology
1
Sleep Epidemiology A Social Perspective
Dustin T. Duncan, ScD, Ichiro Kawachi, MBChB, PhD, and Susan Redline, MD, MPH
When we sleep, where we sleep, and with whom we sleep are all important markers or indicators of social status, privilege, and prevailing power relations.
WHY FOCUS ON SLEEP?
Simon J. Williams, 2005 University of
Warwick
Sleep has become recognized, along with healthy nutrition, regular exercise, and nonsmoking, as one of the major behavioral drivers of health and well-being. Yet worldwide large numbers of people are sleep deprived. Prior to the invention of modern artificial lighting, people had little to do but go to bed when the sun went down. The invention of the light bulb, television, and the Internet changed human behavior forever. During the past half-century, we have witnessed ever-encroaching demands on our wake-time, crowding out the hours when we can sleep. There was a time (not so long ago that the senior editors still remember it) when television programming ended promptly at midnight with the broadcast of the Star-Spangled Banner. Things have changed, and now we find major industries (drugs, wellness coaches, and swaddling blankets) devoted to marketing a good night’s sleep to the public.
As the epidemic of bad sleep has swelled, the social determinants of sleep are also changing. The ability to stay up all night began as a marker of economic power and privilege. Even today, satellite photographs of light at night fairly accurately replicate the planet’s distribution of gross domestic product. The ability to afford a subscription to all-night cable television started out as a marker of household economic status, but with the spread of “free” access to programming on the Internet, sleep deprivation has become more democratized. Moreover, there has been a growth in industries requiring a “24/7” workforce, with individuals of low income overrepresented in nonstandard or night shifts. Low-income and less educated workers often are paid strictly on the numbers of hours worked (with increased pay for overtime) and need to address personal
and family economic pressures by increasing the numbers of work hours and duration of work shifts. In contrast, “exempt” workers have work hour flexibility and can have economic value not directly related to hours worked but level of complexity, creativity, or innovation of their work contributions. Differences in economic resources provide higher income individuals the resources to assist with home and family obligations, while lower income working individuals need to find time to address a myriad child and elder care and household obligations in a finite number of nonoccupational work hours. These days, the ability to get a decent night’s sleep has become a symbol of power, prestige, and status.
What are the consequences of poor sleep for population health? Answering this question using an epidemiological framework has been limited by the relative dearth of sleep data included in community studies and the late emergence of sleep epidemiology as a discipline, as discussed in Chapter 2. When we sift through the surveys of early cohort studies (like the Framingham Heart Study, established in 1948), we can see that the other health behaviors are all represented on early questionnaires (i.e., smoking, drinking, exercise, diet) but not sleep, which was not included in surveys until the 1980s. In 1977, the National Health Interview Survey included a single question on sleep duration, and, in 1982–1984, the National Health and Nutrition Examination Survey included seven items on sleep quality, sleeping medications, and sleep duration. The Nurses Health Study (NHS) began in 1976 but did not include questions regarding sleep until 1986. No objective measurements of sleep were included in any NHS examination, although a pilot study of sleep apnea screening is planned for 2020. Objective measurements of sleep were not included in large cohort studies until the launch of the Wisconsin Sleep Cohort in 1993 and the Sleep Heart Health Study in 1994.
As epidemiologists started to ask about sleep, it became quickly apparent that poor sleep health contributes to a broad range of health outcomes across populations, including premature death, chronic disease, and mental health conditions—not to mention accidents/injuries, (un)happiness, marital discord, learning impairment, and cognitive decline (see Chapter 2). Despite the strong evidence linking poor sleep to the population’s leading causes of death and disability, poor sleep is not identified as a risk factor in the World Health Association’s Global Burden of Disease. The U.S. government has an Office on Smoking and Health at the Centers for Disease Control and Prevention and a National Institute of Alcohol Abuse and Alcoholism; the Surgeon General has issued Reports on Physical Activity and Health across the Atlantic; and the UK government recently even appointed a Minister of Loneliness—but sleep has yet to reach a comparable level of policy attention. However, early success in recognizing sleep as a public health concern is reflected in the recent inclusion of sleep health as an objective in the United States’ Healthy People 2020 goals. For the first time, the U.S. Department of Health and Human Services specifically prioritized the goal to “Increase public knowledge of how adequate sleep and treatment of sleep disorders improve health, productivity, wellness, quality of life, and safety on roads and in the workplace.” Moreover, internationally, the highly influential Wellcome Trust convened
a workforce on healthy sleep and endorsed efforts to improve recognition of healthy sleep and activities to improve the measurement and study of sleep across the population. Other international efforts, such as by the Spanish-based Global Observatory for Healthy Sleep, also have recently aimed to increase the public’s attention on the role of sleep as the “fourth pillar of health.”
In short, sleep health has not received the same level of policy attention relative to the other major behaviors that contribute to population health, although efforts in the United States and internationally are beginning to highlight this gap and suggest efforts at improving knowledge, research, and advocacy. In the realm of research, the situation is improving, as evidenced by the publication of several excellent textbooks on the epidemiology of sleep (Altevogt & Colten, 2006; Avidan & Zee, 2011; Cappuccio, Miller, & Lockley, 2010; Lichstein, Durrence, Riedel, Taylor, & Bush, 2013). The goal of this book is not to duplicate these efforts but rather to draw attention to an emerging area of scholarship, that is, the social epidemiology of sleep. Social epidemiology is defined as that subbranch of epidemiology devoted to understanding the social determinants of population health and health equity (Berkman & Kawachi, 2000b). For example, if nutritional epidemiologists are concerned with answering the question “What should we eat?” social epidemiologists want to know “Who is at risk of poor nutritional habits, and why?” In other words, behaviors do not emerge in a vacuum but are shaped by the social conditions in which people are born, grow, work, live, and age (Berkman & Kawachi, 2000b; Berkman, Kawachi, & Glymour, 2014; World Health Organization, n.d.). As exemplified by the quote from the British sociologist Simon J. Williams at the beginning of this chapter, sleep is a socially patterned habit, and an understanding of the social determinants of sleep is key to developing policies and interventions to address the growing epidemic of bad sleep.
Accumulating research in the field of social epidemiology demonstrates that social factors can impact a range of health outcomes and health behaviors (Berkman et al., 2014; Duncan, 2015; Berkman & Kawachi, 2000b; Oakes & Kaufman, 2006). While a relatively new field of scientific inquiry as compared to established social science disciplines such as sociology, anthropology, and geography, social epidemiological investigations have been conducted for decades (Berkman & Kawachi, 2000a). The development of social epidemiology as a distinct field of study begun in the early 19th century during the formative years of epidemiology as a unique discipline with the studies of neighborhood variations in social conditions and health in Paris, France, conducted by Louis René Villermé (Julia & Valleron, 2011).
HOW DO SOCIAL FACTORS RELATE TO SLEEP?
A range of conceptual models could be invoked to link social factors to sleep. A good starting point are theories of the social production of disease (SPD)/political economy of health that refer to the economic and political determinants of health and distributions of disease within and across societies (Krieger, 2001). According to SPD theory, who gets to sleep for how long is patterned by institutions and relations of
economic production in society. Karl Marx said as much, commenting on the invention of night work and shift work during the Industrial Revolution:
The prolongation of the working day beyond the limits of the natural day, into the night, only acts as a palliative [to the extraction of maximum surplus value from labourers]. It only slightly quenches the vampire thirst for the living blood of labour. Capitalist production therefore drives, by its inherent nature, towards the appropriation of labour throughout the whole of the 24 hours of the day. (Marx, 2018, p. 367)
And even though nine-year-old children are no longer put to work in the steel furnaces and cotton mills of wealthy countries in the 21st century, the social patterning of sleep still persists due to disparities in people’s employment contracts, working conditions, and commuting patterns as well as a host of other social dimensions such as dealing with family/home demands and stress related to being from a low socioeconomic status background and experiencing discrimination across contexts, including at work.
When we broaden the lens to encompass broader upstream forces, Uri Bronfenbrenner’s social ecological model demonstrates that individual-, network-, community-, and public policy–level factors independently and synergistically influence health and well-being (Duncan, Al-Ajlouni, & Chaix, 2019). From the lens of the social ecological model, social factors at these multiple levels can influence sleep. Thus, for example, an immigrant in America working at a minimum wage night shift job in the service sector not only has to endure the disruption of his or her circadian rhythm through the employment contract but may additionally experience the daily challenges of workplace sexual harassment, stresses related to loss of autonomy, discrimination against minorities and immigrants in society, doubling up in crowded housing conditions, and living in a noisy, unsafe neighborhood. Addressing these broader social forces will require more than educational tips on sleep hygiene (“avoid coffee before going to bed”) or the occasional dose of a hypnotic medication.
WHO SHOULD READ THIS BOOK?
Despite the growing amount of research showing how and why a myriad of social factors relate to sleep and disparities, no book currently exists that brings together the accumulated evidence on the social epidemiology of sleep health in a focused way. This book intends to fill that gap.
Existing textbooks of social epidemiology tend to guide the reader, chapter by chapter, on the major social determinants of health including socioeconomic status, discrimination, working conditions, and neighborhood contexts (e.g., Berkman et al., 2014). Interestingly, the same texts have not linked these social determinants to sleep health in any systematic way. For example, the index of the seminal text in the field lists just three mentions of “sleep” throughout the 600-page volume.
Given that sleep is an important, modifiable determinant of many health outcomes, further research in social epidemiology can help to develop improved interventions
and therapies for poor sleep health, which this book hopes to inspire. Accordingly this book is targeted to (a) social epidemiologists who wish to study sleep as a health behavior and health outcome; (b) sleep epidemiologists who want to learn about the social determinants of sleep; and (c) other scholars working in the intersection of sleep health, social epidemiology, and health disparities.
STRUCTURE OF THE BOOK: SUBSTANTIVE AREAS IN THE SOCIAL EPIDEMIOLOGY OF SLEEP HEALTH
This textbook discusses a range of social factors related to sleep. Chapter 2 by Redline and colleagues provides a systematic overview of sleep epidemiology as a field, including methods used and detailing associations between sleep and multiple health outcomes. Chapter 3 starts Part II. Part II focuses on what we know about the basic descriptive epidemiology of sleep, including consideration of sleep across the lifespan (e.g., children and the elderly) and among special populations (i.e., racial/ethnic minorities and sexual/gender minorities). Each chapter of the remaining sections of the book (Part III) covers the major social determinants of sleep (socioeconomic status, immigration status, neighborhood contexts, etc.) from the accumulated research and indicates research needs/opportunities as they relate to that social dimension of sleep health. While Chapters 10 to 15 in Part III mainly discuss a social dimension of sleep in isolation or with minimal focus on how one major social dimension may interact with another, we recognize that social dynamics of sleep may be more complex. Put differently, these social factors do not exist in isolation. For example, an individual’s status as an immigrant is not isolated from his or her work context. As briefly discussed in Chapter 13, immigrants are often forced into certain labor sectors. In addition, an individual’s housing conditions are also not isolated from their neighborhood conditions. In fact, disadvantaged neighborhoods are more likely to have a poor housing stock. Although it is not discussed at length in the forthcoming chapters, we acknowledge the role of “intersectionality” (Bowleg, 2012) at multiple levels and its importance to population health and sleep science, including in Chapter 11’s discussion on discrimination and sleep. Intersectionality is a theoretical framework that posits that multiple social categories (e.g., gender, race, sexual orientation, socioeconomic status) intersect to produce unique experiences and expressions of privilege and oppression (e.g., sexism, racism, heterosexism; income discrimination Bowleg, 2012).
This book has several limitations in knowledge presentation: Some areas are not included in the book because of the scant literature, such as the impact of social networks on sleep health outcomes (although some chapters discuss relationships in sleep such as sleep among couples). We do not focus on this area and others, given the limited amount of research in these areas. However, we recognize that these factors (such as social networks) can be important for health outcomes and health behaviors, including sleep. To illustrate, Maume (2013) found that supportive peer ties are associated with less sleep disruption and that recent increases in positive peer associations lengthens sleep on school nights in children aged 12 to 15. In another study among elderly patients with dementia, social isolation was shown to significantly increase
sleep disruption (Eshkoor, Hamid, Nudin, & Mun, 2014). Religion/spirituality and sleep is also not explicitly focused on in the book. No chapters explicitly focus on psychological factors, such as stress, coping, or resilience. However, psychological factors (especially stress) are highlighted as a pathway linking social determinants to sleep across chapters, including in Chapter 14 on housing and sleep. We did not include a separate chapter on gender and sleep, given the large and consistent body of research documenting gender differentials in sleep: women tend to report more sleep duration but poorer sleep quality as compared to men (Burgard & Ailshire, 2013; Fatima, Doi, Najman, & Mamun, 2016; Mallampalli & Carter, 2014). Instead, there is mention of this important component of sleep health throughout the book. Among other sociodemographic factors, gender is thought to modify existing relationships between social determinants and sleep; this is discussed in several of the ensuing chapters and is essential to the discussion in the ensuing chapters on life course issues in sleep. Because sleep exists in a social context, we hope that this book encourages new research on sleep science and sleep disorders within the social context. The emerging science of the social epidemiology of sleep health offers many opportunities for social justice and population health improvement.
ACKNOWLEDGMENTS
We thank Orfeu Buxton, William Goedel, Dayna Johnson, and Byoungjun Kim for providing comments on an earlier version of this chapter. We also thank Yazan AlAjlouni for completing the chapter formatting.
Dr. Dustin Duncan was funded by grants from the National Institute on Mental Health (Grant Number R01MH112406), National Institute on Minority Health and Health Disparities (Grant Number R01MD013554), and the Centers for Disease Control and Prevention (Grant Number U01PS005122).
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2
Sleep Epidemiology
An Introduction
Susan Redline, MD, MPH, Brian Redline, BA, and Peter James, ScD
INTRODUCTION
Sleep is that golden chain that ties health and our bodies together Thomas Dekker (playwright; 1572–1632)
The phenomenon of sleep—and its role in health, development, and well-being—has intrigued philosophers, writers, artists, physicians, as well as “everyday” people for generations. Often thought of in poetic or emotive terms, alternatively compared to processes resembling “rebirth” or “death,” sleep is frequently interpreted to be the antithesis of “work.” Unfortunately, this conceptualization of an antithetical relationship between sleep and work has bolstered beliefs that sleep reduces individual productivity and can be curtailed to prioritize social, recreational, family, and work-related activities, creating a milieu that accepts, or even encourages, sleep deprivation. Countering pressures to meet the demands of a “24/7” society by curbing sleep, however, is the growing scientific evidence and public awareness of the multiple harmful effects of insufficient sleep, including adverse effects on cognition, behavior, mental and physical health, well-being, safety, and productivity.
Over the last three decades, basic, clinical, and translational research studies have significantly advanced our knowledge of the physiological need for sleep and the impact of sleep and sleep disturbances on neurologic, endocrine, cardiovascular, and metabolic functions. For example, between 1980 and 2018, the number of articles identified in PubMed using the terms “sleep” and “epidemiology” or “community” or “population” increased from virtually none to 900 per year (Figure 2.1). Epidemiological studies often report the results of community-based surveys of sleep and, less commonly, results from studies using objective assessments of sleep. These studies reflect the contributions of investigators across the globe working broadly in an area described as “sleep epidemiology,” which often includes multidisciplinary teams reflecting expertise in epidemiology, as well as in medicine, psychology, sociology, anthropology, and other disciplines.
To provide a framework for interpreting the sleep epidemiological literature from a social perspective, in this chapter we suggest a definition of sleep epidemiology;
