Q&A: Researcher Lauren Hale explains how lousy sleep is widening the health gap in kids

While she was a graduate student in demographics studying the social patterning of health in the early 2000s, Lauren Hale noticed a handful of studies citing sleep as a predictor of life expectancy. At the same time, she knew sleep research wasn’t part of the broader conversation around health disparities. So Hale, now a professor and preventative medicine researcher at Stony Brook Medicine in New York, started working to bring together the two worlds.

Hale has since found that racial minorities are more likely to have short sleep durations associated with increased mortality, black and Hispanic kids get less sleep than their white peers, and kids who sleep too little have poorer overall health and more behavior problems. We recently caught up with her to dig into this emerging field of research.

Image

Q: What have you found out about sleep and health disparities?

LH: The main pattern is that social advantages — whether it's education, money or being a part of the majority group — are positively associated with both more sleep and better quality sleep. And since we know that sleep is critical for health, wellbeing and functioning, this creates a feedback loop in which more advantaged individuals are getting (more sleep) on a nightly basis. It’s an extra boost of advantages so that they can perform better and be healthier the next day. And that type of advantage accumulates over time.

I started looking at sleep patterning and adults and then I moved to children. I found that starting as early as age 3, we see differential patterns of a bedtime routine, bedtime adherence, and early bedtimes. And then it follows through to the teenage years.

Q: Do we know what happens in the long-term to those kids, say, at age 35 or 40?

LH: To date, there hasn't been a lot of work on longitudinal studies looking at sleep early in life as predicting later outcomes. I have a grant under review right now to look at that. There have been longitudinal studies showing, in both kids and adults, an association between a short sleep in childhood and later childhood obesity. Similarly, there is an association between sleep and obesity in adults.

Q: How does the link between poor sleep and obesity work?

LH: There have been good experimental studies on how sleep directly relates to obesity that identify several potential pathways. We know that sleep deprivation affects the hormones that regulate appetite. So when someone is sleep deprived, the next day they have more ghrelin, which makes them hungrier and less leptin, which makes them fuller. So as a result, when exposed to food, they end up choosing more caloric content and less healthy options. We've also seen this in observational studies where teenagers who report less sleep on a regular basis are the ones who are less likely to be eating fruits and vegetables are more likely to be eating fast food.

Q: Why are people in disadvantaged communities getting less sleep?

LH: I wish we knew the exact reasons why. And I have a lot of hypotheses, but I can't say: if we just fixed this one problem, it will be resolved. What underlies a lot of my hypotheses is that individuals who have a less control over their social and physical environment are less able to meet their sleep needs, because they have insecurity about what the next day will bring. It requires a certain amount of safety because you need to know that you're going to be safe and comfortable. If you don't have control over the temperature in the apartment that you're in or the light or noise coming in from the windows and the urban environment, or if you don't know that you're going to be able to feed your kids or be fed by mom and dad the next day, there might be more anxiety. That makes a good night's sleep more difficult.

Q: What are some of the ways to address those factors? What are potential solutions?

LH: The biggest structural change, if we're looking at improving adolescent sleep, is to give them more sleep time in the morning by delaying their school start times. Almost 80 percent of teenagers attend schools that start before 8:30 a.m. in the morning. And biologically, their bodies are staying up later because of something called “sleep phase delay” that occurs during puberty. They want to stay up later, but their social environment is telling them they have to wake up earlier. Teenagers’ bodies need eight to 10 hours of sleep every night.

Of course, it's not only at the school level. Conditions have to also change at home. In particular, I'm concerned about a screen time. Watching an episode on Netflix or Hulu or YouTube before bed is not only psychologically stimulating, it's got the light coming in close to your eyes. That’s interfering with the time that you should be winding down, sleeping and getting your body ready for bed. Exposure to light suppresses melatonin and you need your melatonin to promote sleep onset.

Q: What direction would you like to take this research in the future?

LH: We are interested in researching the long-term consequences of early childhood sleep patterns — and even teenage sleep patterns — on adult outcomes. Not only are we concerned about health as a potential long-term outcome, but other risk-taking behaviors, whether it's substance use or a unsafe driving or drowsy-driving practices. We want to see if the kids who are not getting the sleep they need have worse outcomes into adulthood.

And then the other areas of research really has to do with effective policy and family interventions that can improve sleep quality. So whether that means getting better sleep for the amount of time spent sleeping, or just how to make more time for sleep in the household and community environment. It's hard to get people to change their ways.

[Photo by Lars Plougmann via Flickr.]