HEALTH Research Institute

Dr. Alfano, some of your research involves investigating the effects of trauma in under-served communities. Can you tell us how current events could be linked to increased stress loads and poor quality of sleep, particularly among minorities? 

First, we need to appreciate that while the entire country is trying to cope with the life-altering effects of a global pandemic, minority communities, and African Americans especially, are being impacted most severely. Rates of COVID-19 infection and hospitalization are approximately 5x higher in Black and Hispanic populations than in Whites. Well-known systemic social and health inequities contribute to lowered immune responses, but stress also plays a vital role. The racial trauma unfolding on the national stage right now is a microcosm of a legacy of traumatic stress for African Americans, and when stress levels are chronically elevated, the sleep-wake system malfunctions. Accordingly, African Americans are routinely found to sleep less, have poorer quality sleep and higher rates of serious sleep disorders than virtually all other racial/ethnic groups. These sleep disparities are particularly concerning during a pandemic because sleep serves as a major line of immunological defense via enhanced resistance to bacteria, toxins and viruses. Adequate sleep also provides psychological resilience by helping us manage strong emotions, control impulses and better empathize with others’ experiences. Clearly, the country as a whole should be prioritizing sleep health right now.

What are some of the most common forms of sleep disturbance when stress levels are high?

Sleep is highly responsive to stress because increased levels of psychological and physiological arousal caused by stress are at odds with feelings of safety and calm necessary for relaxing vigilance to sleep. So one of the most common forms of sleep disturbance being reported right now is insomnia. In a recent online survey conducted by our research team among approximately 300 Americans from across the U.S., 25% reported severe to very severe problems falling asleep and 20% confirmed severe to very severe problems staying asleep - much higher percentages than we typically see in the population. Other stress-induced sleep disturbances being reported include nightmares or bizarre dreams and altered sleep timing. Many are struggling to maintain a regular sleep schedule because they are working from home, spending less time outdoors and social distancing, which throw typical routines, including sleep, out of whack.

Are there any simple steps our community members can take to improve their quality of sleep during these unprecedented times?

Definitely. First, try to keep a regular sleep schedule. The internal clock that controls our sleep (along with other critical functions like immune responses) works best when it is consistently set to the same sleep and wake times. Although spending more time at home can make it tempting to stay up late or take daytime naps, these behaviors confuse our internal clock and increase the probably of subsequent sleep problems. Also, try to get outside each day, even for a few minutes. Sunlight is the single most powerful cue for setting our internal rhythms.

Second, create an ideal sleep environment. We sleep best when it’s dark, quiet, and cool. Black out curtains, eye masks, earplugs, white noise, an overhead fan, and/or lowered thermostat settings can all promote better sleep. Also, resist the urge to use the bed for anything other than sleep as this can disrupt the conditioned association between our bed and sleeping.

Be sure to give your mind a ‘wind down’ period before getting into bed. Instead of watching or reading the news (wherein content is largely negative and upsetting) engage in quiet, calming activities under dim lighting, such as reading, talking with family/friends, or listening to music. 

Lastly, remember that we cannot ‘force’ sleep. If you are having trouble initiating sleep or staying asleep during the night, get out of bed and do something relatively boring under dim lighting. Return to your bed when you feel sleepy. This will strengthen the conditioned association between the bed and sleep.

HEALTH Research Institute fellow, Dr. Candice Alfano is a Professor of Psychology, a licensed clinical psychologist, and Director of the Sleep and Anxiety Center of Houston (SACH) at the University of Houston.