Race is often considered a risk factor for certain health conditions, including heart attacks, strokes and insomnia. However, an expert panel at the SLEEP 2022 meeting argued that racism and racial discrimination is the real underlying risk factor.
The 2022 SLEEP Annual Meeting of the Associated Professional Sleep Societies is being held in Charlotte, North Carolina, June 4-8.
During the session titled “Understanding the Role of Structural Racism and Discrimination in Sleep Disparities,” the panel presented the historical context of racism that led to Black American sleep disorders as well as gaps in current evidence that needs to be addressed, including the need for more research on how racial discrimination affects sleep and the intersectionality of identities regarding sleep.
How Racism Created and Reinforced Sleep Disparities
Benjamin Reiss, PhD, professor and chair of the English department at Emory University, described the history of white Europeans placing their comforts and privacy over those of black Americans, showing the longstanding impact that 400 years of slavery had on sleep. quality.
During the era of slavery in America, enslaved black people were forced to perform heavy, labor-intensive labor for long periods of the day and were forced to sleep in small, cramped dormitories that made it difficult to sleep and work efficiently.
“The depressing, exhausting and destructive aspects of slavery, disenfranchisement and poverty could simply be interpreted as an aversion to work, an inability to control the urges of the body and the need for enforced discipline” , explained Reiss.
Philip Cheng, PhD, assistant researcher at the Thomas Roth Sleep Disorders and Research Center at the Henry Ford Health System, described how his research on racial discrimination and insomnia seemed to prove the minority stress theory, which is the idea that members stigmatized minority groups face higher levels of stress compared to members who are not part of these groups.
Dayna Johnson, PhD, MPH, MSW, MS, an assistant professor in the Department of Epidemiology at Emory University, mentioned some of her ongoing research that examines how racial stereotyping and racial microaggressions, particularly those directed against women black, have an impact on sleep health. .
“When we see sleep disparities today, today we also see the effects of history that is perpetuated in the body,” Reiss described. “The centuries-old, oppressive conditions that produce disparities are created and justified by people who have taken their own access to comfort, safety, privacy and hygiene for granted.”
What the research shows and where it needs to go
Regarding current research on racial and sleep disparities, Chandra Jackson, PhD, MS, Earl Stadtman Researcher in the Epidemiology Branch of the National Institute of Environmental Health Sciences for the National Institutes of Health, said noted remaining knowledge gaps and study limitations.
“For too long, we’ve viewed race as an innate risk factor for disease and sleep, often looking for genetic polymorphism,” Jackson said. “So that sounds kinda silly [considering] all that historical context provided. Even if there is polymorphism, does this explain the disparities we can see in all dimensions of sleep? Probably not.”
Jackson commented on how the majority of studies have focused on direct or interpersonal racism, rather than institutionalized, structural or internalized racism. Additionally, most analyzes were cross-sectional, relied on self-report, had small sample sizes, did not test for interactions or stratified by race, and measured discrimination and sleep dimensions. differently. She said there was also a need for further research on adolescents, young adults and children.
Cheng shared his research on the impact of analyzing race versus race discrimination on the severity of insomnia, showing that although race is linked to more severe insomnia, when accounting for discrimination racial, the relationship was more dramatic.
“We really want to go beyond describing racial disparities and understanding the mechanisms, because without understanding the mechanisms, especially those that are driving these disparities, it is too easy, and we have it clearly done historically, to confuse risk as a causal risk factor, as opposed to what really is, which is a marker,” Cheng explained.
Jackson’s main recommendation for future research was to treat race as an indicator of racism and to treat racism as a risk factor. Researchers should assess their own personal biases as well as biases embedded in published works.
Johnson added that future studies should use qualitative and quantitative data and incorporate historical context. She also expressed the need for more studies that consider the environment in which minority individuals live and the intersectionality of identities, such as race with gender or sexual orientation.
“I think targeting just one level won’t work, especially targeting the individual level,” Johnson said. “We live in an environment that interferes with sleep. So, [analyzing] many things, such as housing, are certainly important.