WEBVTT

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Good morning!

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OK. Raise your hand if you did not 
get enough sleep last night.

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There are many possible reasons for this.

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Maybe you were up late at night

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because you had a toddler 
screaming for you

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in the middle of the night.

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I know I did!

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Or maybe you were cranking away

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on that final document 
for work or for school.

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Or maybe you just got sucked in

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to watching another episode 
of the Daily Show.

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OK. So now, raise your hand

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if you are regularly not functioning 
at your top game

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because of how you slept.

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OK. So as sleep deprived as we are,

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we are among the lucky ones.

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I say that because to be here today

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you need to be affiliated 
with Stony Brook University.

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That tells me that you've had 
the opportunity

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to pursue higher education.

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Further, to be here

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you have to have the ability

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to make choices 
about how you spend your time,

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control over your life.

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Imagine how much harder it would be

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for you to sleep and to function,

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if you didn't have that control 
over your own time.

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I know it's hard to put yourself 
in someone else's shoes,

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but imagine, for example, 
if you didn't have enough money

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to feed your children.

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How hard would it be for you to sleep?

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Or imagine if your crowded urban apartment

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was too noisy, or too cold, or too unsafe

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for you to comfortably fall asleep at night.

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My goal today is to get you thinking

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about the social patterning of sleep,

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why some of us 
are sleeping worse than others

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and what the consequences are for society.

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In my research, 
I investigate the underlying causes

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and consequences of sleep deprivation

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and sleep disorders.

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Today I'll share with you 
some of the results of my research

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and that of my colleagues.

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And I hope to convey to you

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why we, as individuals and as a society,

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should be deeply concerned 
about how we sleep

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and what we can do about it.

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So, for everybody, 
whether you're rich or poor,

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young or old,

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more educated or less educated,

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sufficient restorative sleep 
has important implications

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for physical health, for quality of life,

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for psychological well-being

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and for cognitive functioning.

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The scientific understanding

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of the benefits of sleep to the individual

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are expanding everyday.

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For physical health alone,

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we know that sleep impacts heart health,

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metabolism, the immune system.

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Sleep is also essential for learning 
and memory consolidation.

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The list of benefits goes on and on.

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And when we step back

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and think about 
the societal consequences --

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let's think about public safety.

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Drowsy driving is responsible

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for up to a third 
of deadly automobile accidents.

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Drowsy driving may be 
a bigger issue than drunk driving.

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Oops...

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So now, I'll touch on the three

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most prevalent high-risk sleep patterns.

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First, adequate sleep duration.

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You probably already know 
that getting enough sleep

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is important for your health.

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But it's not just about 
getting enough sleep.

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It's about getting the right amount.

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Both short and long sleep duration

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are associated with a range 
of adverse health outcomes,

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including mortality.

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So, you're probably wondering, 
"What's the right amount?"

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For adults, it's somewhere 
between seven and nine hours,

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and for children and adolescents,

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it's a minimum of nine hours per night.

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Unfortunately, 90% of teenagers

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are not meeting that recommended amount.

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Sleep apnea, another prevalent condition,

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is characterized by breathing pauses

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and breathing lapses during sleep.

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It's prevalent in 5 to 10% 
of the population,

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and highly under-diagnosed.

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Historically, it's most diagnosed 
among women.

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And with the rise in obesity 
we've witnessed,

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we've also seen rising rates of apnea.

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And now, insomnia.

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Insomnia is a condition

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characterized by trouble falling asleep,

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trouble staying asleep

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and waking up too early.

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Insomnia is prevalent 
in up to 25% of the population.

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Both insomnia and apnea are associated

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with a range of adverse health 
and social consequences,

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including lost economic productivity.

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So now that we've established

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that there are immense benefits to sleep,

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and that sleep deprivation 
and sleep disorders

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are extremely common,

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it would be easy for me to pitch

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that sleep is a public health problem --

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sleep deprivation 
is a public health problem.

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Maybe even a crisis.

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At the very least, we can affirm

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what the Institute of Medicine 
declared in 2006:

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that sleep deprivation 
and sleep disorders

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are an under-recognized 
public health problem.

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But my angle on this 
is a little different,

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and that distinction is important.

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Sleep deprivation and disorders

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are not just a public health problem.

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They are a matter of social justice.

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Socially disadvantaged populations

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are at the highest risk 
of not meeting their sleep needs.

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This is a social justice problem

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because the unfair distribution 
of sleep patterns across society

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contributes to the emergence 
and persistence of disparities.

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And by disparities I mean differences

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along economic lines,

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differences along social lines

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and differences in health.

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Let me start by describing 
three sociodemographic factors

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in which we observe 
alarming disparities in sleep.

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First, education.

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Using four decades of time-use data,

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we have observed that more educated people

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are more likely to sleep 
the recommended amount

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than less educated people.

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People with less 
than a high school education

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are 40% more likely to be short sleepers,

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and 80% more likely to be long sleepers

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than people with a college education.

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Similar patterns are observed

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when you look at insomnia and sleep apnea.

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People with lower levels of education

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have higher prevalence of sleep disorders.

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Next, let's move on 
to neighborhood context.

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People who live in densely 
populated urban areas

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have shorter sleep durations

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than those who live 
in the non-central city areas.

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Further, people who report

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that their neighborhoods 
are highly disordered

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have more sleep disturbances

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than those who live 
in more ordered neighborhoods.

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Even among school children

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we find higher rates of sleep apnea

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in worse neighborhoods 
than in better neighborhoods.

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And finally, let's talk about race.

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As you may already know,

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there are large health disparities

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by race in this country.

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When framed in terms of life expectancy,

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there's more than a five-year 
life expectancy gap

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between black men and white men.

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A disparity also exists by race for sleep.

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Black men -- not just black men --

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compared to whites, 
blacks have shorter sleep duration,

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spend less time in bed,

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have less efficient sleep

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and take longer 
to fall asleep than whites.

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In one Chicago-based study,

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where they collected 
objective data on sleep,

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they found the difference 
in sleep duration

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between black men and white men

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was an hour, night after night.

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And when we compare 
the sleep duration of black men

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to white women, 
who are sleeping the longest,

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the disparity is even bigger.

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Thinking back 
to the many benefits of sleep

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and the negative consequences 
of sleep deprivation,

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this disadvantage by race 
persists day after day.

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Unfortunately, African Americans

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still endure discrimination:

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discrimination in the labor market,

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discrimination in the real estate market,

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in the consumer markets 
and in the credit markets.

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Perhaps it is not a surprise

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that they also experience a disadvantage

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when it comes to sleep.

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My colleagues and I hypothesize

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that part of the reason 
that we see differences

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between blacks and whites, 
in terms of sleep,

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might be due to this experience of racism.

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We found that individuals who report

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that they're treated differently 
because of their race,

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even among blacks, are more likely 
to report sleep disturbances.

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So, based on these disparities,

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I wanted to know -- in adults -- 
I wanted to know: when do they begin?

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Are we born with them 
or when do they start?

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I looked 
at the National Birth Cohort study

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and found that there are differences

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in bedtimes, in bedtime routines, 
by race and by education

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as early as the pre-school years.

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And this got me thinking,

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"Could this be setting kids 
on trajectories

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to have lower health outcomes,

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lower cognitive outcomes,

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worse behavioral outcomes?"

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So, we investigated the longitudinal data

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to see: are people without 
bedtime routines at age three

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having worse outcomes at age five?

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First, we found that lack 
of bedtime routines

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was associated with both worse sleep

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and shorter sleep duration.

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And in contrast, we found 
that individuals, or children,

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who had story time at night, 
reading and singing,

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had better cognitive 
and behavioral outcomes at age five.

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You might imagine, if you're a single mom,

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working multiple jobs,

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coming home late at night,

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you might not have 
either the availability or the energy

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to institute regular bedtimes, 
night after night.

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You could now see 
how irregular sleep patterns

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can get passed on, night after night,

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generation after generation.

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We also found that watching 
television at night

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predicted trouble sleeping.

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Now, this applies to everybody. 
It's not just about disparities.

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Whether you are a toddler, 
a teenager or an adult,

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watching an illuminated screen 
right before you fall asleep

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is probably the least 
sleep-promoting thing you can do.

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The light emitted from the screen

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suppresses the sleep-promoting hormone,

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melatonin, and thereby delays 
your natural sleep drive.

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The National Sleep Foundation
conducted a poll in 2011

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and found that 95% of Americans 
use a screen-based technology

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in that hour before bedtime.

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We are all guilty of it

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and it is time to put those screens down.

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So, there are many other important areas

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in which sleep is socially patterned

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and these also relate to disparities.

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I'll touch on a few right now.

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First, social and marital 
relationships matter.

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Married people sleep better 
than single people.

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And people in good relationships 
sleep better still.

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Employment matters.

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It turns out having a job, or most jobs,

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is good for your sleep:

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you wake up on a regular schedule

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and you have a purpose to your day.

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The exceptions are if you work 
irregular hours

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or have a difficult work quality, 
workplace quality.

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We've also found 
that an American lifestyle

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can be detrimental to sleep.

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You might say, 
"What do you mean by that?"

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But we found that first-generation 
immigrants to this country

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are better sleepers than the rest of us.

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The more they take on 
American lifestyle characteristics,

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the worse their sleep is.

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In public health, there's a term for this:

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it's called negative acculturation,

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and it exists for sleep 
as well as other health behaviors.

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Finally, I want to mention mental health.

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Mental health 
is intricately linked with sleep.

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Both anxiety and depression are causes

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and consequences of poor sleep.

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Now, this bi-directionality

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is possible for many 
of the factors I've noted.

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But when poor sleep is both a cause

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and a consequence of social disadvantage,

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this creates a vicious cicle

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from which it is difficult to escape.

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And that leads me directly in

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to thinking about 
the societal consequences.

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If the very people who are 
the most socially disadvantaged

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and most need that extra boost

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to function better during their days

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wake up the least prepared,

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then they are the disadvantaged

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throughout every aspect of their day.

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Now, it might be OK 
if they're disadvantaged on the subway,

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where it might be OK 
if they're to fall asleep.

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But if they're disadvantaged 
in the classrooms,

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where they should be learning,

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this sets them on the path.

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And if they're disadvantaged 
in their workplace,

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where they should be productive,

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this also further disadvantages them.

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And they are also disadvantaged 
in their families,

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where they should be 
engaged and responsive.

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So, what can we do about this?

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There are many things 
we could do about this.

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First, I'll start with the individual 
and public health campaigns.

00:15:11.604 --> 00:15:14.077
We need to increase education

00:15:14.077 --> 00:15:17.184
about the importance 
of sleep and sleep hygiene.

00:15:17.184 --> 00:15:21.640
This means encouraging 
regular bedtimes and routines,

00:15:21.064 --> 00:15:23.530
increasing exercises in the day,

00:15:24.106 --> 00:15:26.310
decreasing the caffeine in the afternoon

00:15:26.031 --> 00:15:29.397
and eliminating screen-time before bed.

00:15:30.336 --> 00:15:31.844
Nice try on that one.

00:15:31.844 --> 00:15:35.579
We also need to increase 
access to treatment for sleep disorders

00:15:35.579 --> 00:15:37.732
to all members of society,

00:15:38.522 --> 00:15:40.529
and we need to implement policies

00:15:41.682 --> 00:15:44.399
that change our schedules

00:15:44.399 --> 00:15:46.578
and address sleep disorders.

00:15:46.578 --> 00:15:48.289
Examples of such policies

00:15:48.289 --> 00:15:51.286
include delaying high school start times.

00:15:51.286 --> 00:15:55.039
Other examples include 
screening truck drivers for sleep apnea

00:15:55.039 --> 00:15:56.846
and getting them treated.

00:15:57.536 --> 00:16:01.269
But I want to ask you this: 
Is this enough?

00:16:01.969 --> 00:16:07.293
Drawing on the work of Michael Marmot 
and other social epidemiologists,

00:16:07.293 --> 00:16:10.605
I believe that limited autonomy

00:16:10.605 --> 00:16:13.656
and lack of control of your daily life

00:16:13.656 --> 00:16:16.495
is at the root of our sleep problems.

00:16:16.495 --> 00:16:18.457
And if lack of control over your life

00:16:18.457 --> 00:16:21.265
is the cause of many people's 
sleep problems,

00:16:21.265 --> 00:16:24.729
then just tell them to change 
their schedules isn't going to help,

00:16:24.729 --> 00:16:27.378
because they don't have 
the control to do so.

00:16:27.378 --> 00:16:31.130
Instead, we need 
to think about and implement

00:16:31.013 --> 00:16:36.524
policies and programs that facilitate 
and empower individuals

00:16:36.641 --> 00:16:41.193
to gain or regain 
this control over their lives.

00:16:41.193 --> 00:16:44.422
Examples of such policies include things

00:16:44.422 --> 00:16:49.170
like high quality -- 
or universal high quality pre-K,

00:16:49.017 --> 00:16:51.406
which has been shown 
to have lasting implications

00:16:51.559 --> 00:16:54.787
for individuals' capabilities, 
later into life.

00:16:54.787 --> 00:16:56.625
Other examples of policies

00:16:56.625 --> 00:16:59.534
might include raising the minimum wage,

00:16:59.534 --> 00:17:03.560
or improving housing 
and living conditions among the poor.

00:17:03.094 --> 00:17:05.516
Now these might sound like big dreams,

00:17:06.362 --> 00:17:08.638
especially for a sleep researcher,

00:17:08.638 --> 00:17:13.085
but I believe 
that only through broad social policy

00:17:13.085 --> 00:17:16.769
can we work to address sleep disparities

00:17:16.769 --> 00:17:19.533
and other inequalities.

00:17:21.423 --> 00:17:24.352
I have three take-on points.

00:17:25.192 --> 00:17:26.801
First,

00:17:28.011 --> 00:17:30.110
the social patterning of sleep

00:17:30.011 --> 00:17:34.398
falls along lines 
of sociodemographic disadvantage.

00:17:34.947 --> 00:17:37.538
Second, these disparities of sleep

00:17:37.538 --> 00:17:41.591
are a matter of social justice 
and public health policy.

00:17:42.151 --> 00:17:46.394
And finally, sleep deprivation 
and sleep disorders

00:17:46.394 --> 00:17:50.990
are a mechanism 
through which disparities emerge

00:17:50.099 --> 00:17:51.864
and persist.

00:17:52.755 --> 00:17:54.854
Thank you very much for your time.

00:17:54.854 --> 00:17:56.921
(Applause)