Race Is Not a Risk Factor for Disrupted Sleep, but Racism Is

Race is often considered a risk factor for certain health conditions, including heart attacks, stroke, and insomnia. However, a panel of experts at the SLEEP 2022 meeting argued that racism and racial discrimination is the true underlying risk factor.

The SLEEP 2022 annual meeting of the Associated Professional Sleep Societies is being held in Charlotte, North Carolina from June 4 to June 8.

During the session entitled “Understanding the role of structural racism and discrimination in sleep disparities,” the panel laid forth the historical context of racism that has led to disrupted sleep of Black Americans as well as the gaps in the current bodies of evidence that need to be filled, including the need for more research on how racial discrimination impacts sleep and the intersectionality of identities regarding sleep.

How Racism Created and Reinforced Sleep Disparities

Benjamin Reiss, PhD, professor and chair of the Department of English at Emory University, outlined the history of White European people placing their comfort and privacy over that of Black Americans, showing the long-standing impact that 400 years of slavery has had on sleep quality.

During America’s slavery era, enslaved Black people were forced to work difficult, labor-intensive jobs for long periods of the day and were forced to sleep in small, cramped sleeping quarters that made it difficult to sleep and work effectively.

“The depressing, exhausting, and soul-killing aspects of enslavement, disenfranchisement, and poverty could simply be interpreted as an aversion to work, an inability to control the body’s urges, and the need for imposed discipline,” Reiss explained.

Philip Cheng, PhD, assistant scientist at Thomas Roth Sleep Disorders and Research Center of 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 of stigmatized minority groups face higher levels of stress compared with members who are not a part of those groups.

Dayna Johnson, PhD, MPH, MSW, MS, assistant professor in the Department of Epidemiology at Emory University, mentioned some of her ongoing research that is considering how racial stereotypes and racial microaggressions, particularly those directed at Black women, impact dimensions of sleep health.

“When we see sleep disparities today, today, we are also seeing the effects of history that lives on in the body,” Reiss described. "The centuries long, oppressive conditions that produce disparities are created and justified by people who took their own access to comfort, safety, privacy, and hygiene for granted."

What the Research Shows and Where It Needs to Go

In regard to current research on race and sleep disparities, Chandra Jackson, PhD, MS, Earl Stadtman investigator in the epidemiology branch of the National Institute of Environmental Health Sciences for the National Institutes of Health, noted the knowledge gaps and study limitations that remain.

“For far too long, we've been considering race an innate risk factor for disease and for sleep, often searching for some genetic polymorphism,” said Jackson. "So, that sounds kind of silly [considering] all this historical context provided. Even if there is polymorphism, does it explain away the disparities we can see across 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 analyses have been cross-sectional, relied on self-reporting, had small sample sizes, did not test for interactions or stratify by race, and measured discrimination and sleep dimensions differently. She said there is also a need for more research on adolescents, young adults, and children.

Cheng shared his research on the impact of analyzing race vs racial discrimination on insomnia severity, showing that although race was linked with more severe insomnia, when taking into account racial discrimination, the relationship was more dramatic.

“We really want to push past describing racial disparities and understanding mechanisms, because without understanding mechanisms, particularly those that are driving these disparities, it's too easy, and we have clearly done this historically, to conflate race as a causal risk factor, as opposed to what really is, which is a marker,” explained Cheng.

The main recommendation that Jackson had for future research was to treat race as a proxy for racism and to treat racism as the risk factor. Researchers should evaluate their own personal biases along with the biases embedded in published works of literature.

Johnson added that future studies should use qualitative and quantitative data and incorporate historical context. She also expressed the need for more studies that take into account the environment that minoritized individuals live in and the intersectionality of identities, such as race with gender or sexual orientation.

“I think just targeting one level is not going to work, especially targeting the individual level," Johnson said. "We live within an environment that is a hinderance to sleep. So, [analyzing] many things, like housing, is definitely important.”