Where you live; How well you sleep

1. Where you live; How well you sleep John Sonnega, Lee Bell University of Michigan – Flint Public Health and Health Sciences

2. 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. ”

3. Questions • How many of you got a good nights sleep? • How many of you used your snooze alarm this morning? • What is your sleep debt? (56 hours a week – actual hours of sleep). • How many of you have sacrificed sleep for work? For play? • How many of you make sleep a health priority?

4. Talk Outline • A public health focus on sleep • What is a good night’s sleep? • How do we compare? • The Flint Sleep Project • Sleep and place • Directions

5. 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

6. Allostatic Load- Where’s Sleep?

7. 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.”

8. 12 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.

9. 2009 Speak to your health data • 44% of Genesse County reports less than 7 hours of sleep. • 64 % are 7 hours or less.

10. Quality of Sleep in Genesee County • How many hours do you sleep during a typical night? 6.7 Hours • How many nights a month do you have difficulty sleeping? 8 Nights a month • During the past month have you taken sleep medicine to help you sleep? 27% Yes • During the PAST MONTH, how would you rate your sleep quality overall? One-Third said “Fair” or “Poor”

11. Summary • 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.

12. Stable Sleep trends

13. Hours of Sleep

14. Nights a month with difficulty sleeping

15. The Flint Sleep Project • Community Based Participatory Research (CBPR) MICHR funded pilot. Community Partner Lee Bell • Identify neighborhoods at risk of poor sleep with GIS • Inform CBOP and Neighborhood rountable. Raise awareness. • Conduct 7 focus groups in neighborhood. (N=71)

16. Percentage sleeping fewer than 7 hours by zip code

17. Sleep Disorders by city • Have you ever been diagnosed with a sleep disorder? • Fenton 5.6 % • Linden 9.1 % • Grand Blanc 11.2% • Davison 12.4% • Flushing 14.7 % • Swartz Creek 16.7% • Clio 17.3% • Genesee County 18.1% • Mount Morris 18.6% • Burton 20.3% • Flint 20.8%

18. What accounts for sleep disparities by area? • Proximal Environment. Noise. Lack of quality sleeping environment. • Knowledge of sleep hygiene. • Behavior and motivational factors for sleep hygiene. • Social Determinants. Stress

20. Sample 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).

21. Sleep as a community topic • Do you talk about sleep with family and friends? • Rarely • In a Negative context • “We only talk about sleep when we don’t get a good night’s rest. Kinda like giving folks a warning.”

22. What is a good nights sleep? • Consistent: “When I don’t wake up.” • Deep: “One where you fall asleep whe your head hit the pillow and don’t even know you are sleeping”. • Restful: “Where I wake up in the morning feeling good.”

23. What is a bad nights sleep? • Trouble failing asleep: “ I can’t get to sleep no matter what I do.” • Night wakenings: “When I keep tossing and turning all night.” • Early awakening: “ When I wake up after a few hours and can’t get back to sleep.” • Bedtime rumination: “When thoughts just keep going through my mind and I can’t tell if I’m sleeping.”

24. What are the effects of poor sleep? • Poor health • Irritability • Lack of focus • “Most folks don’t really think about what sleep means for their health. I don’t think we’re aware of all that it means.” • Participants thought that awareness of sleep issues were not as widespread as other health behaviors

25. “Reasons” for a poor nights sleep • Poor health or pain, Hormones, Substance use • Sleep hygiene: Temperature, light, comfort, time of day, activity, Media, crowding • Stress was the most common cited reason for poor sleep.

26. “Stress Themes” • Economic or employment • Safety or crime • Sleep itself : “I can’t sleep because I can’t sleep”. • Neighborhood or community

27. Apprehension • “Sometimes I get up just to make sure my car is okay. If it was gone I’d probably sleep.” • “The sirens make me worry. The noise doesn’t really keep me awake – it’s wondering what ‘s happening that does. • “ I wonder where Flint is going. I don’t like to think about the future.” • “I’m sleeping better now that I don’t have a job. It was the work that was keeping me awake. “ • “I worry about everyone. All my friends and family.”

28. Apprehension and Insecurity • Anxiety, uneasiness, worry, dread, concern, nervousness, fear. • lack of confidence. “Things aren’t going to get better.”

29. Quantitative correlations Correlations for sample neighborhoods only (n=409) Sleep Quality Safety Insecurity .149** Financial Insecurity .123*

30. Community Suggestions • Exercise and improved sleep hygiene as individual remedies to sleep difficulties. • Addressing financial and safety insecurities was a community- based suggestion.

31. Sleep hygiene tips • “Simple education regarding sleep hygiene alone does not have proven efficacy for the treatment of insomnia. “ (S. Schutte-Rodin, Broch, Buysse et al, 2008). • Respondent: “That Sh*t don’t work. Everybody has their own way to do it.”

32. Faith based interventions • “I’m so close to the edge sometime. Just juggling so much that I worry about crashing. When I can’t sleep I turn to my faith. Faith and forgiveness.” • Respondents suggested engaging the faith community in sleep programs.

33. Financial problems and sleep I have trouble sleeping because of my financial problems?