Where you live; How well you sleep

Where you live; How well you sleepJohn Sonnega, Lee Bell

University of Michigan – FlintPublic Health and Health

Sciences

John Sonnega, Lee BellUniversity of Michigan – Flint

Public Health and Health Sciences

Student Quote from yesterday

Student Quote from yesterday

“I am a person that needs sleep to study and by golly, I definitely don’t get enough sleep, then my drive to school is almost an hour. ”

“I am a person that needs sleep to study and by golly, I definitely don’t get enough sleep, then my drive to school is almost an hour. ”

QuestionsQuestions

How many of you got a good nights sleep?How many of you got a good nights sleep?

How many of you used your snooze alarm this How many of you used your snooze alarm this morning?morning?

What is your sleep debt? (56 hours a week – What is your sleep debt? (56 hours a week – actual hours of sleep).actual hours of sleep).

How many of you have sacrificed sleep for How many of you have sacrificed sleep for work? For play?work? For play?

How many of you make sleep a health priority?How many of you make sleep a health priority?

Talk OutlineTalk Outline

A public health focus on sleep

What is a good night’s sleep?

How do we compare?The Flint Sleep ProjectSleep and placeDirections

A public health focus on sleep

What is a good night’s sleep?

How do we compare?The Flint Sleep ProjectSleep and placeDirections

Sleep and public health

Sleep and public health

Sleep is a fundamental human need.

Poor quality sleep is associated with adverse health outcomes, including mortalilty

Sleep is an important public health goal, perhaps more than diet

Sleep is a fundamental human need.

Poor quality sleep is associated with adverse health outcomes, including mortalilty

Sleep is an important public health goal, perhaps more than diet

Allostatic Load- Where’s Sleep?

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CDC MMWR March 3rd

CDC MMWR March 3rd

“Sleep is increasingly recognized as important to public health, with sleep insufficiency linked to motor vehicle crashes, industrial disasters, and medical and other occupational errors.”

“Sleep is increasingly recognized as important to public health, with sleep insufficiency linked to motor vehicle crashes, industrial disasters, and medical and other occupational errors.”

12 state BRFSS data12 state BRFSS data

35.3% reported <7 hours of sleep during a typical 24-hour period,

48.0% reported snoring, 37.9% reported unintentionally

falling asleep during the day at least once in the preceding month,

and 4.7% reported nodding off or falling asleep while driving at least once in the preceding month.

35.3% reported <7 hours of sleep during a typical 24-hour period,

48.0% reported snoring, 37.9% reported unintentionally

falling asleep during the day at least once in the preceding month,

and 4.7% reported nodding off or falling asleep while driving at least once in the preceding month.

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2009 Speak to your health data

2009 Speak to your health data

44% of Genesse County reports less than 7 hours of sleep.

64 % are 7 hours or less.

44% of Genesse County reports less than 7 hours of sleep.

64 % are 7 hours or less.

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Quality of Sleep in Genesee CountyQuality of Sleep in Genesee County

How many hours do you sleep during a typical night? How many hours do you sleep during a typical night?

6.76.7 Hours Hours How many nights a month do you have difficulty How many nights a month do you have difficulty sleeping? sleeping?

88 Nights a month Nights a month During the past month have you taken sleep medicine to During the past month have you taken sleep medicine to help you sleep?help you sleep?

27%27% Yes YesDuring the PAST MONTH, how would you rate your sleep During the PAST MONTH, how would you rate your sleep quality overall?quality overall?

One-Third One-Third said “Fair” or “Poor”said “Fair” or “Poor”1010

SummarySummary

The majority of respondents do not get the recommended hours of sleep.

1 out of 9 respondents have trouble sleeping every single night, report poor sleep quality, and take sleep medications three or more times a week.

The majority of respondents do not get the recommended hours of sleep.

1 out of 9 respondents have trouble sleeping every single night, report poor sleep quality, and take sleep medications three or more times a week.

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Stable Sleep trends

Hours of Sleep

0123456789

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Average Sleep Hours per Night

6.6 6.9 FlintOut County

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Nights a month with difficulty sleepingNights a month with difficulty sleeping

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The Flint Sleep ProjectThe Flint Sleep Project

Community Based Participatory Research Community Based Participatory Research (CBPR) MICHR funded pilot. Community (CBPR) MICHR funded pilot. Community Partner Lee BellPartner Lee Bell

Identify neighborhoods at risk of poor sleep with Identify neighborhoods at risk of poor sleep with GISGIS

Inform CBOP and Neighborhood rountable. Inform CBOP and Neighborhood rountable. Raise awareness.Raise awareness.

Conduct 7 focus groups in neighborhood. Conduct 7 focus groups in neighborhood. (N=71) (N=71)

Percentage sleeping fewer than 7 hours Percentage sleeping fewer than 7 hours by zip codeby zip code

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Sleep Disorders by citySleep Disorders by city

Have you ever been diagnosed with a sleep Have you ever been diagnosed with a sleep disorder?disorder?Fenton Fenton 5.6 %5.6 %

Linden Linden 9.1 %9.1 %

Grand Blanc Grand Blanc 11.2%11.2%

Davison Davison 12.4%12.4%

Flushing Flushing 14.7 %14.7 %

Swartz Creek Swartz Creek 16.7%16.7%

Clio Clio 17.3%17.3%

Genesee CountyGenesee County 18.1%18.1%

Mount Morris Mount Morris 18.6%18.6%

Burton Burton 20.3%20.3%

Flint Flint 20.8%20.8%

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What accounts for sleep disparities by area?What accounts for sleep disparities by area?

Proximal Environment. Noise. Proximal Environment. Noise. Lack of quality sleeping Lack of quality sleeping environment.environment.

Knowledge of sleep hygiene.Knowledge of sleep hygiene.

Behavior and motivational factors Behavior and motivational factors for sleep hygiene.for sleep hygiene.

Social Determinants. Stress Social Determinants. Stress

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Sample sleep characteristicsSample sleep characteristics

Participants (n=71) reported sleeping an

average of 6.2 hours a night and gave themselves a

median grade of C for sleep quality (A-E).

Participants (n=71) reported sleeping an

average of 6.2 hours a night and gave themselves a

median grade of C for sleep quality (A-E).

Sleep as a community topic

Sleep as a community topic

Do you talk about sleep with family and friends?RarelyIn a Negative context“We only talk about sleep

when we don’t get a good night’s rest. Kinda like giving folks a warning.”

Do you talk about sleep with family and friends?RarelyIn a Negative context“We only talk about sleep

when we don’t get a good night’s rest. Kinda like giving folks a warning.”

What is a good nights sleep?What is a good nights sleep?

Consistent: “When I don’t wake up.”Consistent: “When I don’t wake up.”

Deep: “One where you fall asleep whe your Deep: “One where you fall asleep whe your head hit the pillow and don’t even know you are head hit the pillow and don’t even know you are sleeping”.sleeping”.

Restful: “Where I wake up in the morning feeling Restful: “Where I wake up in the morning feeling good.” good.”

What is a bad nights sleep?What is a bad nights sleep?

Trouble failing asleep: “ I can’t get to sleep no Trouble failing asleep: “ I can’t get to sleep no matter what I do.”matter what I do.”

Night wakenings: “When I keep tossing and Night wakenings: “When I keep tossing and turning all night.”turning all night.”

Early awakening: “ When I wake up after a few Early awakening: “ When I wake up after a few hours and can’t get back to sleep.”hours and can’t get back to sleep.”

Bedtime rumination: “When thoughts just keep Bedtime rumination: “When thoughts just keep going through my mind and I can’t tell if I’m going through my mind and I can’t tell if I’m sleeping.” sleeping.”

What are the effects of poor sleep?What are the effects of poor sleep?

Poor healthPoor health

IrritabilityIrritability

Lack of focusLack of focus

““Most folks don’t really think about what sleep Most folks don’t really think about what sleep means for their health. I don’t think we’re aware means for their health. I don’t think we’re aware of all that it means.”of all that it means.”

Participants thought that awareness of sleep Participants thought that awareness of sleep issues were not as widespread as other health issues were not as widespread as other health behaviorsbehaviors

““Reasons” for a poor nights sleepReasons” for a poor nights sleep

Poor health or pain, Hormones, Substance usePoor health or pain, Hormones, Substance use

Sleep hygiene: Temperature, light, comfort, time Sleep hygiene: Temperature, light, comfort, time of day, activity, Media, crowdingof day, activity, Media, crowding

Stress was the most common cited reason for Stress was the most common cited reason for poor sleep. poor sleep.

““Stress Themes”Stress Themes”

Economic or employmentEconomic or employment

Safety or crimeSafety or crime

Sleep itself : “I can’t sleep Sleep itself : “I can’t sleep because I can’t sleep”.because I can’t sleep”.

Neighborhood or community Neighborhood or community

ApprehensionApprehension

““Sometimes I get up just to make sure my car is okay. If Sometimes I get up just to make sure my car is okay. If it was gone I’d probably sleep.” it was gone I’d probably sleep.”

““The sirens make me worry. The noise doesn’t really The sirens make me worry. The noise doesn’t really keep me awake – it’s wondering what ‘s happening that keep me awake – it’s wondering what ‘s happening that does.does.

“ “ I wonder where Flint is going. I don’t like to think about I wonder where Flint is going. I don’t like to think about the future.”the future.”

““I’m sleeping better now that I don’t have a job. It was I’m sleeping better now that I don’t have a job. It was the work that was keeping me awake. “the work that was keeping me awake. “

“ “I worry about everyone. All my friends and family.”I worry about everyone. All my friends and family.”

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Apprehension and Insecurity

Apprehension and Insecurity

Anxiety, uneasiness, worry, dread, concern, nervousness, fear.

lack of confidence. “Things aren’t going to get better.”

Anxiety, uneasiness, worry, dread, concern, nervousness, fear.

lack of confidence. “Things aren’t going to get better.”

Quantitative correlationsQuantitative correlations

Correlations for sample neighborhoods only Correlations for sample neighborhoods only (n=409)(n=409)

Sleep QualitySleep Quality

Safety InsecuritySafety Insecurity .149**.149**

Financial InsecurityFinancial Insecurity .123*.123*

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Community SuggestionsCommunity

SuggestionsExercise and improved

sleep hygiene as individual remedies to sleep difficulties.

Addressing financial and safety insecurities was a community- based suggestion.

Exercise and improved sleep hygiene as individual remedies to sleep difficulties.

Addressing financial and safety insecurities was a community- based suggestion.

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Sleep hygiene tipsSleep hygiene tips

““Simple education regarding sleep hygiene Simple education regarding sleep hygiene alone does not have proven efficacy for the alone does not have proven efficacy for the treatment of insomnia. “ (S. Schutte-Rodin, treatment of insomnia. “ (S. Schutte-Rodin, Broch, Buysse et al, 2008).Broch, Buysse et al, 2008).

Respondent: “That Sh*t don’t work. Everybody Respondent: “That Sh*t don’t work. Everybody has their own way to do it.” has their own way to do it.”

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Faith based interventionsFaith based interventions

““I’m so close to the edge sometime. Just juggling I’m so close to the edge sometime. Just juggling so much that I worry about crashing. When I so much that I worry about crashing. When I can’t sleep I turn to my faith. Faith and can’t sleep I turn to my faith. Faith and forgiveness.”forgiveness.”

Respondents suggested engaging the faith Respondents suggested engaging the faith community in sleep programs. community in sleep programs.

I have trouble sleeping because of my financial problems?I have trouble sleeping because of my financial problems?

Financial problems and sleep