Health disparities can be defined as inequitable and preventable differences in health outcomes between racial and ethnic groups that remain unsolved because of historical, socioeconomic and cultural or political contexts. Sleep disparities refer to the differences in sleep duration, quality and efficiency impacting individuals from diverse racial, gender and socioeconomic statuses. It is critical to clarify that biological traits do not generate these differences—they are a consequence of racism, discrimination and social stigma impacting racial, gender and social minorities.
Gender, racial and ethnic minorities and people from low socio-economic statuses, often experience a more significant burden from sleep disorders and chronic conditions. Socioeconomic aspects such as household income, housing, neighborhood, access to health care, and experiencing racism and discrimination have been linked to differences in sleep duration, quality and access to diagnosis and treatment for sleep disorders. Consequently, these groups are more likely to experience poor health outcomes and co-morbidities such as diabetes, hypertension and obesity.
Examining sleep disparities in women and underrepresented minorities is critical to better assisting this population, identifying their needs and tailoring interventions to promote sleep health and overall wellness.
Women & Sleep
Historically, women are less likely than men to be diagnosed with a sleep disorder. In addition, underrepresented minorities may have limited access to diagnosis and treatment and limited knowledge of sleep disorder symptoms.
Women experience significant hormonal impact on sleep across their lifespan, from puberty and menstruation, to pregnancy, childbirth, postpartum and menopause. These are clinically significant for their metabolism, mental health and sleep. Research has recently made more progress in addressing these changes. However, there is still more to explore to promote better care. Aeroflow Sleep surveyed more than 1,000 women to investigate sleep patterns and their connection to wellness. The majority (71%) of participants were white, followed by 8% Asian, 6% Black, 7% Hispanic or Latino and 2% of mixed-race background. Thirty percent of participants were middle-aged women (30-44 years), followed by post-menopausal (aged>60; 32%) and perimenopausal (age 45-60; 30%) women. The predominant household income from the survey respondents was $25,000-49,000 per year (18%), followed by $50,000-74,999 (15%) and $75,000-99,999 (10%). This background information is important to contextualize the data and discuss sleep disparities.
Data & Disparities
Overall, respondents indicated getting six to seven hours of sleep per night (50%), which is less than the National Sleep Foundation recommendation for their age. Additionally, roughly 80% of women have trouble sleeping either every night (45%) or a few nights per week (40%). Difficulty falling asleep is one of the typical signs of insomnia, a disorder prevalent in women. However, women are less likely to receive a diagnosis of a sleep disorder than men. Notably, in the survey, only 37% of the respondents received a formal sleep disorder diagnosis, and 25% do not know if they have a sleep disorder.
Trouble sleeping and poor sleep quality may be signs of an undiagnosed or untreated sleep disorder. Obstructive sleep apnea (OSA), a common sleep disorder, is characterized by repeated stops in breathing due to upper airway blockage that reduces airflow to the lungs and brain. OSA disproportionately affects racial minorities such as African Americans and Asians.
Women are particularly impacted during the post-menopausal phase of their lives due to hormonal changes. In addition, OSA symptoms in women tend to differ from men, including headache, irritability, fatigue and insomnia, along with the classic snoring. In our survey, participants reported snoring (63%), having poor sleep quality (59%), feeling tired throughout the day (69%) and needing a nap to recover (56%).
Raising awareness about sleep disparities is critical to increasing knowledge about disorders, diagnosis and treatment, and empowering women to advocate for themselves. Respondents said that they do not discuss sleep issues with medical providers (44%) and were not proactively asked about their sleep (52%). Lastly, creating culturally sensitive educational content is also essential to promoting knowledge and empowering self-advocacy.