Sleeping is one of the most natural and indispensable activities all humans partake in to stay alive and live healthily. Yet research shows that up to 70 million adults experience a sleep disorder, and 60% of adults in the US report having problems getting good quality sleep.
Sleep problems are associated with daytime dysfunction, chronic diseases, increased mortality risk, reduced quality of life, and increased healthcare spending.
As innate as sleeping is, numerous factors may limit access to quality sleep. This phenomenon is what experts describe as sleep inequality. Socioeconomic factors such as income, education, employment status, environment, social capital significantly shape a person’s sleep health and are drivers of sleep inequality.
These social determinants of sleep health disproportionately affect disadvantaged groups such as immigrants, black people, people of color, people living in poverty, and others with lower socioeconomic status. These groups are less likely to enjoy adequate sleep duration and quality.
In Part 3 of our Sleep Uncovered sleep report, we’ll deep dive into how our income and socioeconomic status has played a role in our sleep health. The report, a collaboration between SleepScore Labs and Sleep.com, leverages data from 134,885 U.S. adults across 3,501,167 nights, along with an additional survey of 2,855 adults, all aimed at exploring and comparing sleep habits of pre-pandemic (January-March 2020) and pandemic (March 2020-present) time periods.
You can check out the entire report here to uncover the entire story of how our sleep changed over the last two years.
The Sleep Uncovered report found strong associations between income, socioeconomic status, and sleep quality. People with higher household incomes reported feeling better rested than those in low-income households. This finding is well-supported through existing research and studies on the subject, though it appears the pandemic may have exacerbated this trend compared to pre-covid times.
What do we already know about sleep disparities among socioeconomic levels?
Socioeconomic factors that contribute to the unequal availability of optimal sleep health across various groups include:
- Race and ethnicity
- Sexual orientation
- Social capital
- Employment status
Although research on the social determinants of sleep is still sparse, many studies have explored how social and economic factors perpetuate disparities in sleep health.
A 2013 study looked at how race, ethnicity, and socioeconomic status may contribute to sleep problems by analyzing the health information of 4,081 participants of the 2007 to 2008 National Health and Nutrition Examination Survey.
The researchers found that sleep problems like difficulty falling and staying asleep, early morning awakenings (waking up too early in the morning), and non-restorative sleep were predominant in participants identified as female and those who experienced food insecurity.
Snoring and gasping during sleep were symptoms common in participants who were male, Hispanic/Latino, had low education levels, and experienced food insecurity.
The findings of a small and older study suggest that people with poor education status or born in families with low education levels had a significantly higher likelihood of experiencing insomnia.
Another study looked at those who participated in a housing upgrade program, and examined the impact this had on their sleep health.
The researchers observed that a slight improvement in the housing quality of the participants resulted in significant improvements in their sleep quality and living conditions.
The researchers explain that people who live in poor neighborhoods are often exposed to circumstances—such as leaky roofs and consciousness of the possibility of structural collapse—that make them susceptible to sleep problems.
The research showed that the participants reported experiencing better comfort and protection from the rain, the cold, and the humidity, security and feelings of safety, and tranquility, all of which made them feel relaxed enough to enjoy the night’s rest.
In terms of how racial identity affects sleep health, a 2012 study analyzed data from 7,148 adults to identify links between perceived racial discrimination and self-reported sleep quality and daytime functioning.
The results suggest that Black and African American people were more likely to report worse experiences with racism when seeking healthcare than people from other races. They also found a strong association between racism and sleep problems.
Similarly, another study suggests that perceived discrimination is associated with altered sleep architecture (sleep structure). African American participants experienced difficulty falling asleep and had less deep sleep than Caucasian participants.
The researchers posit that perceived discrimination may cause chronic stress—characterized by sympathetic nervous system dominance—may trigger sleep problems and changes in sleep architecture.
Immigration is another socioeconomic driver of sleep inequality. For instance, immigrants often experience acculturation stress—difficulty adapting to a new place—contributing to sleep problems. A 2019 study found associations between acculturation stress, chronic stress, and severe insomnia symptoms.
In addition, a person’s sexual orientation may also affect a person’s sleep quality, duration, and other sleep-related outcomes.
A 2018 study enrolled 6,909 men and 56,080 women to explore the sleep quality and duration of straight, gay, and bisexual US adults. The study found that:
- Gay people were more likely to have trouble falling and staying asleep and use medications to treat these sleep problems than straight and bisexual counterparts.
- Gay people were more likely to have a non-refreshing sleep than straight and bisexual people.
Likewise, a 2021 study with 24,492 adults found that women and sexual minority participants reported more sleep difficulties than men and heterosexual participants. Specifically, bisexual and gay people were more likely to report inadequate sleep quality duration, using medications for sleep, and daytime sleepiness than straight people.
Lastly, a 2011 study enrolled 159,856 participants to investigate sleep complaints among various groups with low socioeconomic status.
The study found that people who were unemployed or had low income, people with lower education levels, and divorced people had more sleep complaints than their counterparts.
The insights from the Sleep Uncovered report echo the growing gap of sleep inequality across socio-economic standings, and re-vitalize the need for broader accessibility to improved sleep hygiene and lifestyle support across economic lines.