Search

The home environment is an important yet understudied determinant of sleep health. Although little is known about the living conditions that negatively affect sleep, many naturally occurring and artificial external factors in a person’s immediate physical and social sleeping environment can impact his or her sleep health and subsequent acute as well as chronic risk of disease and premature mortality. Using the socioecological model as a framework, this chapter discusses the indoor and immediate outdoor physical surroundings of spaces used for shelter including exposure to light and noise pollution, suboptimal room temperature/humidity, poor air quality, improper ventilation, and subpar mattress quality. Household crowding, safety, and housing insecurity are among social conditions of the living quarters that are also discussed as the aforementioned exposures may negatively impact sleep health across the life course. Published observational as well as experimental research findings investigating the impact of these factors on various sleep dimensions along with their potential impact on disease and mortality risk are also discussed before identifying important gaps in the current literature and providing future research directions.

This chapter focuses on how work and work experiences such as occupational demands, job autonomy, job stress, work hours, and work-related discrimination influence sleep across populations. A model of sleep and work is offered that accounts for the role of social factors. Empirical evidence demonstrates how these work factors such as occupational demands, autonomy, work schedules, long work hours, selection or placement into labor market sectors, work stress, social support at work, and work-related discrimination impact sleep health. Epidemiological evidence is further provided for sleep health disparities in the work–sleep relationship by race/ethnicity and immigration status.

Study Objectives Most epidemiological studies assess sleep duration using questionnaires. Interpreting this information requires understanding the extent to which self-reported habitual sleep reflects objectively assessed sleep duration, particularly among African Americans, who disproportionately experience poor sleep health. Methods Among African-American participants of the Jackson Heart Sleep Study, we investigated differences in questionnaire-based self-assessed average sleep duration and self-assessed wake-bed time differences compared to actigraphy-based assessments of total sleep time (TST) and average time in bed (TIB). Linear regression models provided estimates of concordance between actigraphy-based and self-reported sleep duration. Results Among 821 adults, self-assessed average sleep duration was lower than self-assessed wake-bed time differences (6.4 ± 1.4 vs. 7.5 ± 1.7 h, p < 0.0001). Mean actigraphy-based TST was 6.6 ± 1.2 h, and actigraphy-based average TIB was 7.6 ± 1.2 h. Self-assessed average sleep duration and actigraphy-based TST were moderately correlated (r = 0.28, p < 0.0001). Self-assessed average sleep duration underestimated actigraphy-based TST by −30.7 min (95% confidence intervals [CI]: −36.5 to −24.9). In contrast, self-assessed wake-bed time differences overestimated actigraphy-based TST by 45.1 min (95% CI: 38.6–51.5). In subgroup analyses, self-assessed average sleep duration underestimated actigraphy-based measures most strongly among participants with insomnia symptoms. Conclusions Among African Americans, self-assessed average sleep duration underestimated objectively measured sleep while self-assessed wake-bed time differences overestimated objectively measured sleep. Sleep measurement property differences should be considered when investigating disparities in sleep and evaluating their associations with health outcomes.

Job discrimination is a social stressor that may lead to sleep health disparities in workers; however, limited research has examined the relationship, especially with specified sources of job discrimination. Using longitudinal data from the Sister Study, we tested the associations of perceived job discrimination (due to race, sex, age, and health conditions) with sleep health among working women (n=26,085). Among those without sleep difficulty at Time 1, race- and age-specific job discrimination was associated with increased odds of new onset sleep difficulty at Time 2. Moreover, among those without excessive sleepiness at Time 1, sex-, age-, and health-specific job discrimination predicted new onset of excessive sleepiness at Time 2. There was no association with sleep duration. We also found a dose-response relationship such that those who experienced job discrimination due to ≥3 reasons had greater odds of developing a sleep problem. Results suggest sleep health disparities emanating from the workplace.

Short sleep duration, which is associated with increased morbidity and mortality, has been shown to vary by occupation and industry, but few studies have investigated differences between black and white populations. By using data from a nationally representative sample of US adult short sleepers (n = 41,088) in the National Health Interview Survey in 2004–2011, we estimated prevalence ratios for short sleep duration in blacks compared with whites for each of 8 industry categories by using adjusted Poisson regression models with robust variance. Participants' mean age was 47 years; 50% were women and 13% were black. Blacks were more likely to report short sleep duration than whites (37% vs. 28%), and the black-white disparity was widest among those who held professional occupations. Adjusted short sleep duration was more prevalent in blacks than whites in the following industry categories: finance/information/real estate (prevalence ratio (PR) = 1.44, 95% confidence interval (CI): 1.30, 1.59); professional/administrative/management (PR = 1.30, 95% CI: 1.18, 1.44); educational services (PR = 1.39, 95% CI: 1.25, 1.54); public administration/arts/other services (PR = 1.30, 95% CI: 1.21, 1.41); health care/social assistance (PR = 1.23, 95% CI: 1.14, 1.32); and manufacturing/construction (PR = 1.14, 95% CI: 1.07, 1.20). Short sleep generally increased with increasing professional responsibility within a given industry among blacks but decreased with increasing professional roles among whites. Our results suggest the need for further investigation of racial/ethnic differences in the work-sleep relationship.