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"Racial Disparities in Sleep Health: Epidemiology, Potential Mechanisms, and Implications" Lauren Hale (9.16.2020)

September 18, 2020
  • 00:00Can you guys see this?
  • 00:02Thanks so will start from the beginning.
  • 00:06OK, you guys got this alright.
  • 00:07I'm going to hit somebody
  • 00:09from the waiting room.
  • 00:10OK. I so Lauren.
  • 00:14Thank you so much for the.
  • 00:17A warm introduction.
  • 00:18The overstatement about my accomplishments,
  • 00:21but more importantly,
  • 00:23for the opportunity to talk to
  • 00:27you about racial disparities
  • 00:29in sleep health during this.
  • 00:33Really important time in American history.
  • 00:36I have been studying disparities and
  • 00:39sleep really for almost 20 years,
  • 00:4318 years or so.
  • 00:45But it's never been more relevant
  • 00:49or important than now and I also.
  • 00:53I'm I'm pushing myself in this talk.
  • 00:56I've added some new slides because we all
  • 00:59have opportunities to learn and grow,
  • 01:02and when we think about anti
  • 01:04racism and other things,
  • 01:05so a lot of what I'll be talking
  • 01:08about today is what I typically do.
  • 01:11Epidemiology mechanisms, consequences,
  • 01:13a lot of it maybe seem familiar
  • 01:16to you or what you're used too.
  • 01:18And then I gotta go off a little bit,
  • 01:21but I hope I hope.
  • 01:23You'll enjoy the ride with me.
  • 01:26So let's see I move this forward.
  • 01:29I have people joining the
  • 01:30waiting room right now.
  • 01:32How do I do that?
  • 01:34In Middle.
  • 01:36And just so you know,
  • 01:37Debbie will
  • 01:38let everybody in you don't have met people
  • 01:40from now on. OK, I'm just going to close it,
  • 01:42but the problem is it's popping
  • 01:44up on my screen so I can't do
  • 01:46anything else but OK, I'll try.
  • 01:48I'll try to ignore those messages.
  • 01:51So this is a short talk.
  • 01:53It's hard for me to get.
  • 01:56My highlight in 45 minutes,
  • 01:58but after my introductions I'll
  • 02:01spend a little bit about or I would
  • 02:04say 15 to 20 minutes talking about
  • 02:07sleep health as a social justice
  • 02:10issue and why we need to embrace.
  • 02:13Social justice in our practice
  • 02:16and study of sleep health.
  • 02:19Then because it's my most active
  • 02:21research project right now,
  • 02:23I'm going to go into talking about
  • 02:25disparities in sleep in a study that
  • 02:28I'm doing among teenagers across the
  • 02:30country known as the fragile families study.
  • 02:33And I'll tell you that we're about
  • 02:36to go into the field for age 22,
  • 02:39so that's pretty exciting as well.
  • 02:41And then I'll conclude with a summary
  • 02:44in future directions on this topic.
  • 02:47So as many of you have already heard,
  • 02:50I'm located here at Stony Brook across
  • 02:53the Long Island Sound from you.
  • 02:55I was just reading about some flesh
  • 02:57eating bacteria in the Long Island Sound.
  • 03:00So don't go swimming this week,
  • 03:02but I miss Stony Brook.
  • 03:04I'm also received funding from
  • 03:06NIH as Lauren mentioned.
  • 03:08I was involved in the founding and
  • 03:10execution of this great Journal,
  • 03:12sleep health and a Mayor Krieger,
  • 03:14who's in the room with us is.
  • 03:17It was the founding art editor and
  • 03:20remains on on staff is that are
  • 03:22tender and we love him for that man.
  • 03:25I'm feeling with the National
  • 03:27Sleep Foundation.
  • 03:28I also serve in two advisory panels,
  • 03:30one for the pajama program,
  • 03:32which provides pajamas and books for
  • 03:34low income kids across the country.
  • 03:37So great program,
  • 03:38and I'm also an advisory panel of a
  • 03:40organization called children and screens.
  • 03:42If we have time for it,
  • 03:45I'm going to veer from the topic
  • 03:48of racial disparities and talk
  • 03:49about a fun study I did.
  • 03:51Using Twitter data to see if we could
  • 03:54predict NBA basketball players performance,
  • 03:57that's just a good one
  • 03:59for Thanksgiving dinner.
  • 04:00If we're able to have Thanksgiving this year.
  • 04:05Sleep matters,
  • 04:06that's my take home message.
  • 04:08OK,
  • 04:08and as usual,
  • 04:10the typical disclosure,
  • 04:11the content reflects my own ideas and not
  • 04:14necessarily thought that these organizations.
  • 04:17So one other plug and just kind of
  • 04:21detail about what I'm up to now,
  • 04:24because this is a weird weird time.
  • 04:28I am of course working from home
  • 04:30and as a public health professor.
  • 04:32I have teamed up with a.
  • 04:35Sponge almost a dozen female scientists.
  • 04:38We run a social media site called
  • 04:41dear pandemic were on Instagram,
  • 04:44Facebook and Twitter.
  • 04:45Currently we have over 30,000 followers.
  • 04:48We post two to three translations
  • 04:51of the current science on the
  • 04:54pandemic and how that relates to
  • 04:56how to live during the pandemic
  • 04:59and it has been really wonderful
  • 05:02experience for me in terms of.
  • 05:05Coming to terms with what's going on
  • 05:08in the pandemic and helping others,
  • 05:11friends and families,
  • 05:13and generally the public get reliable.
  • 05:15Good advice during this info
  • 05:18demik period that we live in so I
  • 05:22know this is a little off topic
  • 05:24from this issue of racial disparities,
  • 05:28but we're we have to acknowledge
  • 05:31that we're living in a period
  • 05:34of really twin pandemics of.
  • 05:37Racial injustice as well as the pandemic
  • 05:41of kovid, so they are related in that
  • 05:45way because as we know, minorities have
  • 05:49a dish feel disproportionate burden.
  • 05:52Of the COVID-19 pandemic.
  • 05:55So that's it for me in
  • 05:57terms of introductions.
  • 05:58Oh, this is my team.
  • 06:00These are my peeps.
  • 06:01Talk with him every week or so.
  • 06:03We getting so many names the words
  • 06:06are getting squished together.
  • 06:07Most of the people that I work with
  • 06:09are Penn State, Wisconsin Princeton,
  • 06:11but were spreading out and growing
  • 06:13role almost all over the world now.
  • 06:15So I want to acknowledge when I get to
  • 06:18the part on my work and fragile families.
  • 06:21This is a team effort.
  • 06:22It's not just me and a bunch of.
  • 06:25Actigraphy devices,
  • 06:26it's it's a huge group of us,
  • 06:28and I'm lucky to be working with them.
  • 06:31And you might hear My 5 year old in the
  • 06:33background 'cause you just yelled for me.
  • 06:35So my apologies. OK.
  • 06:38So why are we here?
  • 06:40Let's talk about this issue whi.
  • 06:43Is sleep health a social justice issue?
  • 06:47Shouldn't sleep health just be for everyone?
  • 06:50And sure it is.
  • 06:52That's my answer.
  • 06:53Sleep health is for everyone,
  • 06:56but it is especially necessary and
  • 06:59important for disadvantaged populations.
  • 07:01So I have three reasons why sleep health
  • 07:05goes beyond just a public health disorder.
  • 07:08Concern and should be social justice concern.
  • 07:11The number one reason is sleep
  • 07:14deficiency in sleep disorders are common
  • 07:17for the number that NIH throws out.
  • 07:19You know 50 to 70 million Americans
  • 07:22and I think they're referring
  • 07:25to adults suffer from sleep
  • 07:27deficiency or sleep disorder.
  • 07:30Pens which groups are talking about.
  • 07:31Some have more, some of less,
  • 07:33but that's a lot,
  • 07:34and so it's a public health
  • 07:36problem and it's been recognized
  • 07:37as such for at least 15 years.
  • 07:39I would say the apj could do more,
  • 07:41but it's a public health issue.
  • 07:45When I want to convey to you if
  • 07:48you didn't already know it is that
  • 07:50it's also a social justice issue,
  • 07:53because it's unequally distributed,
  • 07:54sleep health is or sleep disorders and
  • 07:57sleep deficiency or more prevalent
  • 07:59among disadvantaged populations.
  • 08:00So those two would have been enough, right?
  • 08:03This is enough to say it's a
  • 08:06social justice issue, maybe,
  • 08:07but the real kicker in the real
  • 08:10reason why we should care is
  • 08:12because of the decades of research.
  • 08:15They have shown time and again that
  • 08:18the consequences of inadequate sleep,
  • 08:20irregular sleep, poorly time,
  • 08:22sleep, interrupted sleep disorder
  • 08:24sleep is linked to all of these
  • 08:27outcomes in multiple domains.
  • 08:29Physical health, psychological well being,
  • 08:31cognitive functioning,
  • 08:33public safety so.
  • 08:35You know?
  • 08:36These three combined make it just
  • 08:39clear as day that we need to be
  • 08:41thinking about sleep health as not
  • 08:44only a public health issue but is
  • 08:46a social justice issue and to me,
  • 08:48and I've been saying this for years.
  • 08:51Based on the data that I've been looking at,
  • 08:54there are three big dimensions
  • 08:57that we care about most.
  • 08:59Lots of little dimensions,
  • 09:01but the three biggest ones I see.
  • 09:04Our education associate conomique
  • 09:06status time and again population
  • 09:08based studies show individuals with
  • 09:10lower levels of education or at the
  • 09:13highest risk of especially short sleep,
  • 09:16but also sleeping too much and
  • 09:18also a range of sleep disorders.
  • 09:21The next dimension is neighborhood context.
  • 09:24Alot of what we see in looking at.
  • 09:30Social and physical environment is that.
  • 09:33Living in urban area, too noisy,
  • 09:36too bright, culturali too awake.
  • 09:38Those types of neighborhoods are
  • 09:40associated with worse sleep behaviors,
  • 09:43and there's a huge Epidemiology literature
  • 09:46on the link between health and place in
  • 09:50these studies show people who live in.
  • 09:53Urban and low income neighborhoods
  • 09:56have worse health outcomes.
  • 09:58My work in Texas.
  • 10:00In Wisconsin, show that about 20% of
  • 10:03the reason or the mechanism between
  • 10:06poor health and poor neighborhoods.
  • 10:09Is mediated through the
  • 10:11pathway of poor sleep.
  • 10:12Poor sleep can be part of that and what's
  • 10:15nice about sleep compared to, you know,
  • 10:17move out of the neighborhood is sleeping.
  • 10:19You can modify sleep in some ways.
  • 10:21Not.
  • 10:22Not always.
  • 10:22Not everything about sleep is modifiable,
  • 10:24but there are steps you can take
  • 10:27to help improve sleep health.
  • 10:29And we've also shown this with my
  • 10:33work with Wendy Troxel in Pitts burg.
  • 10:36We've looked at data acta
  • 10:39graphic data of sleep,
  • 10:41and objective measures of neighborhood
  • 10:44context, including household.
  • 10:47Factors like broken windows and pests,
  • 10:49those types of things are also
  • 10:52predictive of poor sleep,
  • 10:53but you know,
  • 10:54like 50 poor sleep and shorter like
  • 10:5715 to 20 minutes less per night sleep
  • 11:00actigraph Exley when you live in a
  • 11:02household where you report maintenance
  • 11:04problems in litter and graffiti.
  • 11:07So those things matter why I think
  • 11:10probably many of you were here today
  • 11:13is to talk about this much bigger.
  • 11:17An pressing and very relevant
  • 11:19challenge of what do we know about
  • 11:22race and sleep or bigger than that?
  • 11:25Racism in sleep and.
  • 11:27I could go on for a long time about this,
  • 11:30but I'm trying to cover a lot at one time.
  • 11:34And I'm going to go back to one
  • 11:36of the very first actor graphics
  • 11:39studies on race and sleep,
  • 11:41and this was a study done by
  • 11:44a Diane Lauderdale.
  • 11:45The Cardia study in Chicago of young adults,
  • 11:48and they show early on that.
  • 11:51As I already mentioned,
  • 11:52income or socioeconomic status is
  • 11:54associated with longer sleep duration.
  • 11:56At the time I said,
  • 11:58what about sleeping too long or highly
  • 12:02educated people sleeping too long?
  • 12:04Or or vice versa,
  • 12:05and she said we don't have anybody
  • 12:08sleeping over 9 hours at that point.
  • 12:11So and that wasn't really
  • 12:13a problem in this sample.
  • 12:15But even after adjusting
  • 12:16for socioeconomic status,
  • 12:18what this important study showed
  • 12:19is that compared to whites,
  • 12:21Blacks had shorter sleep duration,
  • 12:23lower sleep efficiency took longer to
  • 12:26fall asleep and spent less time in bed.
  • 12:29So on all of those dimensions you
  • 12:31know now we think about sleep.
  • 12:34Health is a multidimensional concept.
  • 12:36All of those dimensions we're
  • 12:38seeing kind of worse outcomes
  • 12:40for Blacks compared to whites.
  • 12:41And here's the figure to show it in
  • 12:45case you like to see actual numbers.
  • 12:48Between white women and African American men,
  • 12:51which I know,
  • 12:52it's kind of a weird comparison,
  • 12:54but we see on a nightly basis.
  • 12:571.4 fewer hours per night to huge difference.
  • 13:00Let me. It's like you know,
  • 13:02over 10 hours less sleep per week
  • 13:05between black men and white women.
  • 13:07And then if sleep efficiency
  • 13:09we see a similar big drop.
  • 13:11Almost 9 percentage point drop in sleep
  • 13:14efficiency or difference, not a drop.
  • 13:18Between white women in African American
  • 13:21men and in my work using NHIS,
  • 13:24another nationally representative studies,
  • 13:26we found time and again that minorities,
  • 13:30especially Blacks compared to whites
  • 13:32see shorter sleep duration than whites.
  • 13:35And here's a summary article written
  • 13:38by my colleagues, Dana Johnson,
  • 13:41Shandra Jackson.
  • 13:42This was in the journal Nature
  • 13:46and science of sleep.
  • 13:48It's hard to summarize the
  • 13:50entire field in a few slides,
  • 13:52but I wanted to just go across this row.
  • 13:55Don't know if you can see my cursor if
  • 13:58you look at Blacks compared to whites,
  • 14:01they have lower sleep duration.
  • 14:03These numbers are just the references,
  • 14:05so they're not going to be able
  • 14:08to interpret them.
  • 14:09Lower shorter sleep duration,
  • 14:11lower sleep quality more and more sleepiness.
  • 14:14And mixed results on sleep complaints.
  • 14:17What we see for Hispanics compared
  • 14:19to whites as shorter sleep duration.
  • 14:23But Interestingly, fewer sleep complaints.
  • 14:25And then I just want to highlight what
  • 14:29we really don't know a lot about at all.
  • 14:33Insufficient evidence is the Native
  • 14:36American populations and Native
  • 14:38Hawaiian and Pacific Islanders.
  • 14:40There's really not a lot
  • 14:42of information on these,
  • 14:44but we have enough kind of consistent and
  • 14:48replicated data showing that especially
  • 14:50Blacks and Hispanics are as a population.
  • 14:54Not every individual,
  • 14:55but as a population getting
  • 14:58insufficient sleep and just
  • 15:00come back to my original slide.
  • 15:02We know that these factors that sleep
  • 15:05matters for a huge range of life outcomes,
  • 15:08health,
  • 15:09economic outcomes and beyond.
  • 15:10So I care about these.
  • 15:15The question is.
  • 15:16And this is a big question.
  • 15:19What are the underlying causes?
  • 15:21Why do we see that?
  • 15:23And I'll say that we know
  • 15:25some of these reasons.
  • 15:27We know that there are some compositional
  • 15:29differences in populations between
  • 15:31African Americans and whites.
  • 15:33For example,
  • 15:33we know that Blacks are more likely
  • 15:36to work night shifts or irregular hours.
  • 15:39We know that there may be lower levels
  • 15:42of education or more urban living.
  • 15:44A higher percentage living
  • 15:46in urban environments,
  • 15:47and so we have some.
  • 15:49Account for that we can say some
  • 15:51of the differences between Blacks
  • 15:53and whites in sleep might be
  • 15:55related to where they live or
  • 15:57their educational differences.
  • 15:58But even when we adjust for that,
  • 16:01we don't fully adjust for it.
  • 16:02The effects don't go away,
  • 16:04and that's a key point we adjust.
  • 16:06Friend doesn't go away.
  • 16:07And then a good statistician would
  • 16:09rightly come back to me and say,
  • 16:11Yeah,
  • 16:11but the measures you are using their
  • 16:14crappy measures you know look at education.
  • 16:16Just grab their course measures what
  • 16:18is graduating high school mean for a
  • 16:21black person versus a white person doesn't?
  • 16:23It doesn't mean the same thing that
  • 16:25doesn't get into quality or skills learned.
  • 16:27It just tells you whether their credentials
  • 16:30you have the degree and I agree with it.
  • 16:33I agree that some of these
  • 16:35measures are not good enough,
  • 16:36but I still believe and you
  • 16:38know others support this.
  • 16:40Other studies support this,
  • 16:41that there's enough evidence
  • 16:42to say that there are.
  • 16:44There's a cloud of other things
  • 16:47that kind of fall under this.
  • 16:49Immeasurable category of discrimination.
  • 16:51ISM discrimination,
  • 16:52racism,
  • 16:53chronic vigilance,
  • 16:54that cluster together and you can't measure
  • 16:57that in a nationally representative study.
  • 17:01That's that's too hard.
  • 17:03It's there's.
  • 17:04You can try,
  • 17:05and I'm encouraged us to try and
  • 17:09figure it out,
  • 17:10but it's not easy to do,
  • 17:13and I would say that.
  • 17:17This is a moment for us as a field
  • 17:21sleep researchers to listen to our.
  • 17:24Our colleagues and friends outside
  • 17:27of sleep health who are talking
  • 17:30about anti racism and talking about
  • 17:33being black in America to think
  • 17:36about how we as asleep field can
  • 17:39excuse the expression wake up.
  • 17:42To incorporate these ideas in our research,
  • 17:45because I think.
  • 17:47They are.
  • 17:49Totally playing a role in
  • 17:52understanding why sleep is harder,
  • 17:56harder to achieve.
  • 17:59For some people,
  • 18:00some populations than for other populations,
  • 18:02so this is the part of my talk where I
  • 18:05say I'm going outside of my comfort zone
  • 18:08and I'm going to talk about this expression.
  • 18:11What does it mean to be woke now?
  • 18:14Granted,
  • 18:14this is not what you know.
  • 18:17Usually when I say woke is
  • 18:19the opposite of sleep, but.
  • 18:21For now,
  • 18:21let's listen to my friends on YouTube
  • 18:25to talk about what it means to be woke,
  • 18:28and I, you know.
  • 18:29If you guys want to comment on it
  • 18:31later or right in the chat section
  • 18:33about what it means to be woke,
  • 18:35I'd love to hear your thoughts.
  • 18:37Let's see if this works.
  • 19:34Hi Lauren, I think it's a little
  • 19:36hard for us to hear it hears
  • 19:38any way for you to turn out.
  • 19:39Darn it, I know you know what this is.
  • 19:41My hold on. OK, hold on a second I'm gonna.
  • 19:45I do know how to do this.
  • 19:47Share computer sound I'm sorry for
  • 19:49that awkwardness we were here.
  • 19:50You're hearing it but I think
  • 19:52we're hearing out of your speakers.
  • 19:53So which would be junkie?
  • 19:54And I'm being quiet.
  • 19:56So let me just start it back.
  • 19:57Will just lose a minute hold up
  • 19:59is not a. Replace that,
  • 20:01everything is not all equal.
  • 20:02That justice has not happened
  • 20:04yet for everyone, and that there
  • 20:05is a lot of work to be done.
  • 20:11Your eyes are wide opening.
  • 20:13You're paying attention and you're
  • 20:14reaching out and speaking to people
  • 20:16along the way and bringing them on.
  • 20:18And to increase the amount of Wokeness
  • 20:20in your community being woke is like
  • 20:23as wide open everything is clear.
  • 20:24You can always see things that other
  • 20:27people can just ignore or they just
  • 20:29don't know well for me is just being
  • 20:31outraged all the time and being able
  • 20:33to stay human and feel outraged about
  • 20:36injustice that is happening around me.
  • 20:37It's being uncomfortable all the time.
  • 20:39And making sure that I'm speaking on behalf
  • 20:41of those that can't speak up for themselves.
  • 20:44Some people know what's happening around
  • 20:45them, but they're not doing anything there,
  • 20:47just like, well, it is what it is.
  • 20:49Yeah, that's not what woke means that you
  • 20:51actually take it upon yourself to be like.
  • 20:53This is something I need to
  • 20:55fix any part of the solution.
  • 20:56I mean, The thing is to do that,
  • 20:58knowing that you can fix it
  • 21:00whatever your level or platform is,
  • 21:02because there's always an opportunity
  • 21:03for you to do just a little
  • 21:05something to support them.
  • 21:06I also think about what words actually
  • 21:08mean and how we give them power,
  • 21:09right?
  • 21:10Are you just going to wear it across
  • 21:12your chest but actually not live it out?
  • 21:14Or are you going to give this word a meaning
  • 21:16with your actions with your daily commitment?
  • 21:19And I think in order for
  • 21:20us to really progress,
  • 21:21we're going to need people to really
  • 21:23step out of their comfort zones and
  • 21:25have those uncomfortable conversations
  • 21:26and not just live in a space where they
  • 21:29get to preach to the people who already
  • 21:30understands what it means can agree more.
  • 21:32I think to be woke means that you are aware
  • 21:35of the issues and the world around you.
  • 21:37I believe it means that you
  • 21:39are engaged in the work.
  • 21:41Just as this is a time where we just,
  • 21:43we can't afford to be asleep,
  • 21:45we have to be all the way alert without
  • 21:48action on the knowledge that we have now.
  • 21:50Our world will never change and
  • 21:52we need that more than ever.
  • 21:58OK, thank you for bearing with me and
  • 22:00I'm sorry for the technical difficulties.
  • 22:02Can you hear me now?
  • 22:05Yes, that's perfect. Thank you.
  • 22:07OK great, so that was really my first
  • 22:10time in bedding at YouTube in a video
  • 22:14and especially video about being woke,
  • 22:17but I think.
  • 22:19It's relevant and especially interesting.
  • 22:22You know this expression.
  • 22:24Is asleep term being away?
  • 22:27I mean, it's it's not the term we might use,
  • 22:32but being awake means it kind of or
  • 22:36being well recognizes that everyday
  • 22:39racism and structural racism.
  • 22:41Affects sleep health,
  • 22:42they're saying in order to be present.
  • 22:45An engaged in the injustice of the world.
  • 22:48You cannot be asleep.
  • 22:50You can afford to be asleep and I mean,
  • 22:53I think that's that's really powerful.
  • 22:56I've until recently.
  • 22:57I've never really thought about how.
  • 23:00Sleep disparities was like embed
  • 23:04or implicated in that expression,
  • 23:07and I think there's more
  • 23:10more to think about there.
  • 23:16As we try to tease apart how to make
  • 23:19the world a better place so we don't.
  • 23:22So it's not that we.
  • 23:26So we don't have to wake up to disparities or
  • 23:29be be chronically vigilant to disparities.
  • 23:33We can or discrimination.
  • 23:34We can all sleep better in a better world,
  • 23:38and that would ultimately be my goal.
  • 23:42I know I'm a bit of an Optimist, But.
  • 23:46But there I am. Did anybody?
  • 23:48It's a It's about halfway through it.
  • 23:50Does anybody have any thoughts or any type?
  • 23:52I can't see the chat,
  • 23:54but if anybody wants to say something about.
  • 23:57That expression I'd love to hear more.
  • 24:00Maybe in the end,
  • 24:01because to me it's kind of a new direction
  • 24:04for thinking about sleep disparities.
  • 24:09So my last comment on kind of mechanisms
  • 24:13and pathways through which we see
  • 24:16differences in sleep among adults, is.
  • 24:20Through the these key kind of
  • 24:24socially social demographic.
  • 24:26Categories that really end behaviors.
  • 24:28The first is social and
  • 24:30marital relationships.
  • 24:31Many of you may know Wendy Troxel's work,
  • 24:35showing that being married is
  • 24:37associated with better sleep.
  • 24:38There comes a lot of economic
  • 24:41security and emotional security,
  • 24:42but it's gotta be a good relationship.
  • 24:45Employment matters again.
  • 24:47Economic securities very helpful
  • 24:49for being able to sleep at night.
  • 24:51But 15% of people have
  • 24:53irregular hours or night shifts,
  • 24:55and those are obviously.
  • 24:58Stressful and disruptive.
  • 24:59The work on American lifestyle
  • 25:02and sleep is fascinating.
  • 25:04It fits right in line with the work of
  • 25:07sociologists on negative acculturation,
  • 25:10immigrants to the US tend
  • 25:12to have the best sleep,
  • 25:15and then they and their offspring as
  • 25:18they assimilate to take an American
  • 25:20behaviors tend to deteriorate in terms
  • 25:23of Bedtimes and other sleep outcomes.
  • 25:26And then of course the close links.
  • 25:30Between sleep and mental health,
  • 25:32which many of you know about.
  • 25:35And of course how we're spending
  • 25:38our time screen, social media,
  • 25:41sedentary behavior,
  • 25:42all interrelated with sleep outcomes.
  • 25:46So I'm going to move on because of
  • 25:48course I only have 15 or so minutes
  • 25:51left to describe my life's work.
  • 25:54Not really to describe this project
  • 25:56that I am so engaged with the
  • 25:59fragile families study and it's.
  • 26:01Consistent with the theme of
  • 26:03thinking about racial disparities,
  • 26:05because what we've identified our
  • 26:07pediatric disparities in sleep starting
  • 26:09at an early age and then of course,
  • 26:12moving into active graphic
  • 26:13disparities in sleep among teenagers.
  • 26:15And then I go into some other stuff on
  • 26:19sleep in teens that are kind of key.
  • 26:22Findings of our study.
  • 26:25So as I mentioned,
  • 26:27the beginning of my research
  • 26:28on sleep disparities,
  • 26:30I was primarily looking at
  • 26:31adults and I I was asking the
  • 26:34question whether the mechanisms?
  • 26:36How do we get there,
  • 26:38why or black men sleeping an hour
  • 26:41point for less than white women?
  • 26:44What's going on?
  • 26:45He said, well,
  • 26:46we have to figure out what
  • 26:48happens across the life course.
  • 26:50What's the trajectory of
  • 26:51these sleep disparities?
  • 26:53When do they begin?
  • 26:54And that's when I got
  • 26:56involved with the study,
  • 26:57called the fragile families
  • 26:59and child well being study.
  • 27:01It's an excellent resource for many social
  • 27:03scientists and in more recent years,
  • 27:06sleep researchers too.
  • 27:08Longitudinal birth cohort where they've
  • 27:10been following individuals who,
  • 27:12since they were they,
  • 27:13were enrolled in the hospital.
  • 27:15Their mothers were enrolled
  • 27:16when they were born.
  • 27:18The kids were born,
  • 27:19and they've been followed at ages.
  • 27:21Of course,
  • 27:22at birth,
  • 27:231359 and 15 were about to next
  • 27:25month about to go back into the
  • 27:27field and collect information
  • 27:29on them as young adults.
  • 27:31The young adult age 22 study and
  • 27:33the study was designed to have
  • 27:36enough power to look at disparities.
  • 27:38By income and race and parents
  • 27:41with low levels of Education.
  • 27:43So it's really well suited
  • 27:45to address some of the
  • 27:47concerns that I have.
  • 27:49I won't spend time here,
  • 27:51but these are some of our aims to look
  • 27:54at trajectory's multiple levels of.
  • 27:57Predictors and determinants of sleep
  • 27:59and then of course the outcomes of
  • 28:02obesity and depression, which I'll just.
  • 28:04Touch on slightly today.
  • 28:07So we had about 3500 teens in the
  • 28:10full survey in the full study,
  • 28:12but in terms of who we actually
  • 28:14got into the homes of,
  • 28:16there was a random subset
  • 28:18of about 1000 teens,
  • 28:19800 of whom we were able to get actigraphy,
  • 28:22and anybody who we got actigraphy on.
  • 28:25We also collected a daily diary where they
  • 28:27were asked questions about their behaviors,
  • 28:30their screen use,
  • 28:31their diet, etc that day,
  • 28:32so this was the timing already.
  • 28:34It's been almost five years since.
  • 28:37Or more than that,
  • 28:38for the early waves you know.
  • 28:40Soon these data will be outdated,
  • 28:42but we're having the ability to
  • 28:44track them overtime where where their
  • 28:46sleep patterns at age 15 predictive
  • 28:48of their outcomes at age 22.
  • 28:50I'll ask me in a few years.
  • 28:54Here's the distribution of
  • 28:55for whom we got actigraphy on.
  • 28:57I would say they were pretty
  • 28:59good at following directions.
  • 29:00We said may lack the devices in seven days.
  • 29:03Almost all of them did it in six,
  • 29:067 or 8 besides the group who decided not to.
  • 29:11And they were scored at or fail
  • 29:15Buxtons Actigraphy lab in Penn State.
  • 29:19So the key variables we look at,
  • 29:22our sleep duration, sleep quality,
  • 29:23and sleep timing.
  • 29:24There are other things we might be
  • 29:27looking at regularity and beyond,
  • 29:29but it's it goes on and on.
  • 29:31We are enjoying the richness of these data.
  • 29:34This is a cartoon of what the
  • 29:36actigraph output looks like.
  • 29:37We used builds respironics watch
  • 29:39is and we use the actigraph device
  • 29:41on the hip to also simultaneously
  • 29:43measure physical activity.
  • 29:45Not going to go into all of the
  • 29:47rest of the study, but.
  • 29:49For the topic we are discussing,
  • 29:52or so when did this study show
  • 29:55about racial differences in sleep?
  • 29:57First thing they showed in the age 9?
  • 30:00Data when it was parent reported data
  • 30:03is that there were disparities early in life.
  • 30:06At age 9 or measure asleep was where
  • 30:10they getting sufficient sleep at age 9.
  • 30:13Recommended at least nine hours
  • 30:15and there's about 60% fewer odds
  • 30:18of black kids getting nine or more
  • 30:21hours per night than white kids.
  • 30:24An also reduced odds of Hispanic
  • 30:27children getting sufficient sleep,
  • 30:29so this is to me quite telling.
  • 30:32I have some ideas in the next slide on.
  • 30:36On what's happening,
  • 30:37but at age 9 even we see differences
  • 30:40in sleep.
  • 30:41These were self reported that
  • 30:43self reported parent reported.
  • 30:44When we get to the age 15 data.
  • 30:48We see much bigger differences and
  • 30:50we have it reported in minutes
  • 30:53from Acta graphic sleep we see a
  • 30:5532 minute difference between black
  • 30:58and white sleep between black and
  • 31:01white teens on weeknights,
  • 31:03and 41 minutes on weekends.
  • 31:05Now, uh,
  • 31:06two other studies,
  • 31:07one in Pitts Burg by Karen
  • 31:10Matthews and the other one in
  • 31:12Cleveland that use actix graphics.
  • 31:14Lee also show black white differences
  • 31:16in sleep among teenagers.
  • 31:18Ours is a national study.
  • 31:20We had 20 cities involved in our study,
  • 31:23but those other two community
  • 31:25studies also showed about 20 minutes
  • 31:28different per per night for the kids.
  • 31:31What I think is really interesting
  • 31:33is we were able to code for napping.
  • 31:36And what we found is that.
  • 31:38There was competitior E napping between
  • 31:42black and white children in that.
  • 31:45Night time sleep was shorter for black teens,
  • 31:48but they often made up for
  • 31:51it during a daytime nap.
  • 31:53So if you look at 24 hours sleep,
  • 31:56you don't get the same racial
  • 31:58differences in sleep and what's
  • 32:00particularly interesting is there's
  • 32:02work in preschoolers showing
  • 32:04the same thing that night time
  • 32:07sleep among black preschoolers is
  • 32:09shorter than white preschoolers,
  • 32:11but there's Compens Atory,
  • 32:13and happening, so this may not.
  • 32:15Translate to the same outcomes that we
  • 32:18see in adults where there may not be.
  • 32:20This can pensa Tori napping,
  • 32:22but it is interesting that these
  • 32:24disparities exist early in life.
  • 32:26At ages 9 and 15.
  • 32:29Here's some more results from the age 9,
  • 32:33just highlighting that caregiver
  • 32:36routines are extremely important for.
  • 32:39Predicting sufficient sleep duration
  • 32:41almost these are odds ratios.
  • 32:42You almost never see odds ratios
  • 32:45it sevenfold 7 times higher odds
  • 32:478 times higher odds.
  • 32:49If you have an early bedtime
  • 32:519:00 PM or earlier,
  • 32:53an regularly enforced for a night
  • 32:55for more nights per week compared
  • 32:58to know better huge difference
  • 33:00is huge importance of having
  • 33:02and enforcing bedtime routines.
  • 33:04And in the same data same population.
  • 33:08We showed that bedtime routines are
  • 33:11disproportionately not enforced among
  • 33:13my children of minority mothers,
  • 33:15and we also show that the benefit
  • 33:19of bedtime routines,
  • 33:20especially language based bedtime routines.
  • 33:24Pay off in terms of better
  • 33:26cognitive outcomes.
  • 33:27This specifically that Pvt test of
  • 33:29verbal skills goes up so there there
  • 33:32may be structural reasons behind that.
  • 33:34If if mom or dad is working in multiple
  • 33:37second job and working at night,
  • 33:40it's harder to enforce routines
  • 33:41and have that,
  • 33:42but that may be part of what's explaining
  • 33:45some of these early disparities.
  • 33:47We also found that respect to the
  • 33:50age 15 and I should have clarified
  • 33:53that in the age 15 data.
  • 33:55Remember,
  • 33:55the field investigators went into
  • 33:58these peoples homes to give them the
  • 34:00devices and they took notes they recorded.
  • 34:03If they if when they were doing
  • 34:05their one hour long interview.
  • 34:07If they were interrupted and
  • 34:09interruption could be allowed.
  • 34:11Television was on,
  • 34:12dog was barking,
  • 34:13the phone kept ringing and if they
  • 34:16if they reported that they were
  • 34:18interrupted at least three times that
  • 34:21was associated with an increased.
  • 34:24Decrement decrement asleep by
  • 34:26about 21 minutes.
  • 34:28We didn't see that household
  • 34:30chaos was more common,
  • 34:31or this interviewer interruption was
  • 34:33more common among minority families,
  • 34:35so it probably doesn't,
  • 34:37or it doesn't attenuate racial disparities
  • 34:40in sleep, but it is another dimension
  • 34:42of what could be going on in some
  • 34:45households to affect negatively
  • 34:47affect sleep quality. Interesting Lee.
  • 34:49So no Association between bedroom sharing
  • 34:52or a self reported in measure of chaos.
  • 34:56So what else is going on
  • 34:59with teenagers, of course.
  • 35:00Here's this beautiful graphic of an school.
  • 35:03Start times. This is using data
  • 35:05from 20 cities worth of schools.
  • 35:08Active graphic measures of sleep.
  • 35:10The only kids who were in bed enough time
  • 35:13to get the minimum 8 hours overnight.
  • 35:16'cause these are 15 year olds.
  • 35:19The minimum recommended amount
  • 35:20of time in bed were those whose
  • 35:23high schools start after 8:30 AM.
  • 35:25And there's just this beautiful
  • 35:28dose response.
  • 35:29Of course,
  • 35:30actor graphics sleep in the square
  • 35:32is shorter than time in bed.
  • 35:34That makes perfect sense,
  • 35:36but if your school starts later you get
  • 35:39more time in bed and more time asleep,
  • 35:42so that's the structural factor.
  • 35:44Of course,
  • 35:45we all know about the physiological
  • 35:47phase delay that occurs during puberty.
  • 35:49Pushing kids to stay up later and
  • 35:51then there are all these other factors
  • 35:54that happened during adolescence,
  • 35:56specially screentime caffeine
  • 35:57consumption and a whole range of other.
  • 36:00High school pressures.
  • 36:03I'm going to show here some results from
  • 36:07our study on neighborhood disadvantage,
  • 36:10showing that more disadvantaged neighborhoods
  • 36:13have more waso and lower sleep efficiency.
  • 36:16Not huge effects, but there's something and
  • 36:20also we have data showing that kids who
  • 36:25had consistent enforced routines early in
  • 36:29life ages 5 and nine were more likely to.
  • 36:33Have lower body mass index.
  • 36:35That's Group One group.
  • 36:37The green group is Group 4 is the reference
  • 36:42group and the people who had no bedtime
  • 36:46routine had shorter sleep duration by
  • 36:50about .3 hours and higher body mass index.
  • 36:56I don't really have a huge amount of time,
  • 37:00but I I do want to touch on a few of
  • 37:03my data points about screens because
  • 37:06I think that's such a key issue,
  • 37:09especially during the pandemic when
  • 37:11we are relying on screens to basically
  • 37:14get all of our social interactions
  • 37:16and our schooling interactions.
  • 37:18Here's a figure of this is from Jenn Twinkies
  • 37:21work looking at short sleep among teenagers.
  • 37:24How it's gone up.
  • 37:26Since to that between 2009 and
  • 37:282015 you may say that's old news,
  • 37:31why are you telling me that the
  • 37:34reason is because there is a kink
  • 37:37up in 2012 and 20's work nicely?
  • 37:39Medicine shows the only thing that changed.
  • 37:42Basically between 2000 eleven 2013 is
  • 37:45the pervasiveness of smartphone use.
  • 37:47So more and more teens,
  • 37:49especially as we're bringing our
  • 37:51devices not just to our bedrooms,
  • 37:54but into our beds with us,
  • 37:57using them as alarm clocks and
  • 37:59goodnight pillows and all of that
  • 38:02is affecting our ability to sleep.
  • 38:04I won't go into great detail on this,
  • 38:08but I'm fascinated by the literature
  • 38:10and work showing that our reliance on
  • 38:14screens is interfering with our sleep,
  • 38:16especially among teenagers.
  • 38:17Over 90% of studies that look at screens
  • 38:20and sleep show this adverse Association
  • 38:22and the remaining 8% shown a neutral.
  • 38:24Nobody's saying screens are
  • 38:26good for your sleep.
  • 38:27Maybe if you're doing a meditation app,
  • 38:29but that's not really why
  • 38:31people are using them.
  • 38:32And as I said,
  • 38:34people are using these devices.
  • 38:35Not only is alarm clocks,
  • 38:37but they check them in
  • 38:39the middle of the night.
  • 38:41Is pervasive and our data from the age
  • 38:4415 show that screen use is associated
  • 38:47with worse problems falling asleep,
  • 38:50staying asleep in shorter sleep duration?
  • 38:54Above and beyond depressed
  • 38:55depressive symptoms.
  • 38:56So I know I'm going off the topic
  • 38:58of fragile families, but this is.
  • 39:01This is the fun one for your.
  • 39:04Your Thanksgiving,
  • 39:05whatever form it may be in this year.
  • 39:08If somebody says to you, you know.
  • 39:10Why should I care about sleep?
  • 39:12Why should I get off of my screens,
  • 39:15especially on thinking of your nephew?
  • 39:17What your high school age and after he says,
  • 39:21say,
  • 39:21do you know that professional
  • 39:23athletes do better when they put
  • 39:25their phones away and they're off
  • 39:27Twitter at night and this is proven.
  • 39:29This is published in sleep health.
  • 39:31We looked my colleague Jason
  • 39:33Jones who is a sociologist.
  • 39:35Stony Brook looked at two public datasets.
  • 39:37We merged the Twitter records
  • 39:39of 112 verified NBA players.
  • 39:41And we merged 30,000 tweets with
  • 39:44their performance on next days
  • 39:47games an what we are able to show.
  • 39:50It's kind of amazing is that if they were
  • 39:54up late at night tweeting after 11:00 PM.
  • 39:58They performed worse the next day.
  • 40:00By about one point and they don't.
  • 40:03If you add up all the players
  • 40:06on team for everybody's.
  • 40:08Staying up late,
  • 40:10they're going to have.
  • 40:12Fewer points scored an also
  • 40:14fewer minutes on the court,
  • 40:16so and I would say the most powerful effect
  • 40:19that we saw was a drop in shooting accuracy.
  • 40:23The amount of shots that they got.
  • 40:25Here's I think Mrs points per game
  • 40:28from about 10 1/2 points per game down
  • 40:30to nine and a half with some slight
  • 40:33variation between home and away games.
  • 40:36Actually there are similar.
  • 40:38But here's the one for shooting accuracy.
  • 40:42If you were a late night Twitter,
  • 40:45which means tweeting after 11:00 PM,
  • 40:48your shooting accuracy dropped
  • 40:50from about 45% down to 43 1/2%.
  • 40:53So that's a pretty significant drop.
  • 40:55And if you are infrequent,
  • 40:58late night Twitter tweeting
  • 40:59headed even bigger effect on you.
  • 41:02And it also had a big effect on you.
  • 41:06If it was an away game.
  • 41:08So this is the message that I say.
  • 41:13Speak to your audience.
  • 41:15Figure out how how you can meet them
  • 41:18with something they care about.
  • 41:20Teenage boys don't care about
  • 41:22the effects on metabolism,
  • 41:24but they might care about if they're going
  • 41:27to do better in their basketball game.
  • 41:30And so that's that's my message on
  • 41:33using big data to help understand
  • 41:36the power of sleep.
  • 41:38I have one other follow up.
  • 41:41We're still in the process
  • 41:43of collecting some data.
  • 41:44What's happened to sleep
  • 41:46among teenagers since covid?
  • 41:47I'm involved in the study down and
  • 41:50Elana suburbs schools that actually
  • 41:52opened and closed within one week.
  • 41:54But we collected data from them before
  • 41:57the lock down and then in the month
  • 42:00after the lockdown so March and May,
  • 42:03and in both of these counties are
  • 42:05two SIM County to high schools.
  • 42:08We saw an increase in sleep duration,
  • 42:10which is pretty cool.
  • 42:12They were going to going to bed later,
  • 42:14but also waking up later so
  • 42:16there's a shift in timing,
  • 42:18which is consistent with
  • 42:20what we would expect.
  • 42:21But unfortunately we also saw increases in
  • 42:23insomnia symptoms and napping behaviors,
  • 42:25which I don't have as much of a problem with.
  • 42:29But this this is actually paralleled
  • 42:31in some studies in adults too,
  • 42:33but these are kind of hot off the
  • 42:36presses from our study in Georgia, so.
  • 42:39I know I'm running a little long,
  • 42:41I'm just going to end on with some
  • 42:44summary in future directions to get
  • 42:46back to this topic about racial disparities.
  • 42:49We know that they begin early in life.
  • 42:52Do they begin in infancy?
  • 42:54Maybe,
  • 42:54but they definitely persist in
  • 42:56preschool school age years.
  • 42:57An adolescence through adulthood,
  • 42:59and we know that they are
  • 43:01linked to sleep, is linked,
  • 43:03or inadequate sleep is linked
  • 43:05to depression and obesity.
  • 43:07Among youth, I think the most important
  • 43:10modifiable behavior is focusing on bedtimes,
  • 43:12bedtime routines, and cutting out screen use.
  • 43:15I think this place somewhat of a
  • 43:17role in explaining disparities.
  • 43:19Not all of it, and some of it's beyond
  • 43:22the scope of what's addressable.
  • 43:24If it's a structural reason for heart,
  • 43:27difficult to enforce bedtime routines,
  • 43:29but it is an important one because
  • 43:31it's kind of a low hanging fruit.
  • 43:34And then there are some more
  • 43:36complicated structural problems with.
  • 43:38Insufficient sleep among younger people,
  • 43:40such as household chaos in school start
  • 43:43times, these are not easy to change.
  • 43:46They may.
  • 43:46They probably play less of
  • 43:48a role in disparities,
  • 43:50but they're still very important.
  • 43:52And then I'll just kind of conclude
  • 43:55with what I think are some really
  • 43:59key areas for thinking about.
  • 44:01Disparities and sleep.
  • 44:03As I said,
  • 44:05We need to embrace this idea of
  • 44:08understanding how discrimination affect
  • 44:10sleep and what we can do about it.
  • 44:13We need to think about causal and
  • 44:15modifiable mechanisms through doing
  • 44:17experimental work with in person
  • 44:19work and then thinking more about the
  • 44:22consequences of sleep disparities.
  • 44:24I think we have a pretty good grasp
  • 44:27of the consequences for health.
  • 44:31But less work has focused on kind of
  • 44:33socioeconomic and performance outcomes,
  • 44:35and I'd love to see more on that.
  • 44:38And then finally,
  • 44:39the big work is translating
  • 44:40all of this to the public.
  • 44:42How can we develop, implement, evaluate,
  • 44:44culturally tailored interventions,
  • 44:45and that's kind of the long term goal.
  • 44:48I hope for all of us.
  • 44:50Here's a figure that Dan Buysse
  • 44:52beautifully put together for a review
  • 44:54article of here in the layers and levels
  • 44:57in the sociological model of sleep.
  • 44:59And each of these levels
  • 45:01carries with it kind of.
  • 45:03A set of opportunities for
  • 45:06intervention and we should.
  • 45:09Be considering and thinking at all
  • 45:11these levels as much as we can,
  • 45:13because these are big, complicated problems,
  • 45:15and that's that's the plan.
  • 45:17So thank you all. I'd love to hear from you.
  • 45:20I one thing I don't like about this
  • 45:23format is I don't get to see all your faces,
  • 45:26but at least mayor kept his on so
  • 45:29I could see his most of the time.
  • 45:32So let's open it up.
  • 45:33I don't know how this works,
  • 45:35but Lauren you can lead us.
  • 45:39Yes,
  • 45:39thank you so much for a really
  • 45:41fantastic talk or and we can open it
  • 45:44up to questions and anyone is welcome
  • 45:47to unmute themselves an ask away there.
  • 45:50I don't think there are any
  • 45:52questions in the chat just yet,
  • 45:54OK.
  • 45:55So
  • 45:55I'd like to make a comment warn that
  • 45:59that I got a communication about a month
  • 46:03and a half ago from a professor at MIT.
  • 46:07Covid Anne was using an oximeter,
  • 46:10and she asked me a very simple question.
  • 46:15Are oximeters accurate in black people?
  • 46:19And when you think about an oximeter,
  • 46:22you know it fits on the finger.
  • 46:25It shines a light through the finger,
  • 46:28and yeah. And so I didn't know I didn't
  • 46:31know the answer to the question.
  • 46:34Fascinating, so so I contacted two
  • 46:37engineers working for companies
  • 46:39that actually build these things,
  • 46:41and I said are they accurate in
  • 46:44black people and they said, well,
  • 46:46the standards.
  • 46:47These are called ISO standards,
  • 46:50you only have to get data on 12 people.
  • 46:54Four of whom have to be dark skinned.
  • 46:58So there are millions of people
  • 47:00out there that are that are using
  • 47:03oximeters and we don't really know
  • 47:05how accurate they are in people with
  • 47:08different amounts of pigmentation,
  • 47:10both in you know, both in their finger.
  • 47:13On their ring finger there some
  • 47:15now that are on the rings.
  • 47:18An Apple just came out with
  • 47:20one that's on their watch.
  • 47:22I read about that and so this is an example
  • 47:25where the data just isn't available.
  • 47:28But there must be some indication if
  • 47:31if oximeters aren't working in darker
  • 47:33skinned people, that this is, uh, I.
  • 47:36I mean, I've never thought of
  • 47:39this before, but it seems like,
  • 47:41wouldn't somebody who's a clinician
  • 47:43have noticed something before?
  • 47:45If it wasn't working well, I
  • 47:48mean, this is The thing is.
  • 47:52We don't know, and since covid you'll
  • 47:54remember that with kovid there are
  • 47:56all these things in the media about
  • 47:58oxygen saturation's going into
  • 48:00the 50s and how terrible it was.
  • 48:02It turns out that the standards
  • 48:04are such that nobody has any
  • 48:06data for these things below 70%.
  • 48:09Well so anyway so,
  • 48:11but the the fact that they there's
  • 48:15almost no data published in darker
  • 48:17skin people to me is like mindboggling.
  • 48:23It is an I hope somebody on this call
  • 48:26comes up with the study design for it
  • 48:29to test that out. I mean 12 people.
  • 48:31That mean that is way too small sample size
  • 48:35you would think, or 444. That's not.
  • 48:37Yeah, thank you for illuminating that for me.
  • 48:45Any other comments or thoughts?
  • 48:51I know we're all tired of zoom is tough.
  • 48:57Or I'll just
  • 48:58comment about your question awhile
  • 49:00ago about the woke comment.
  • 49:02You know the bulk idea and I do really,
  • 49:06really like that.
  • 49:07My connection and the video,
  • 49:09but I'm also, you know,
  • 49:11increasingly fascinating,
  • 49:11fascinated with like this sort of.
  • 49:15Community idea and late people at
  • 49:18persons idea sleep duration that we
  • 49:21you know that we're behind and talking
  • 49:24about sleep as a multidimensional.
  • 49:27Aspect in it,
  • 49:28so so far in in my research with toddlers,
  • 49:31the variability is where I'm really
  • 49:34seeing that the race ethnicity
  • 49:36differences and makes me very
  • 49:38concerned that you know how much
  • 49:41variability we're seeing and that
  • 49:42works like a missed opportunity.
  • 49:44Having worked in primary care for years,
  • 49:47you know I don't.
  • 49:49I don't think I ever asked before
  • 49:51I became a sleep researcher.
  • 49:54You know how regular is the bedtime?
  • 49:57Alright, and what influences that?
  • 49:58And so it's a. It's a really.
  • 50:00In terms of sleep health,
  • 50:02especially in young children and
  • 50:04setting up habits, and you know.
  • 50:07Yeah, I guess so.
  • 50:09I love the idea of Oak and I,
  • 50:11but I I challenges all to
  • 50:13be talking about sleep.
  • 50:14Health and that would you mentioned.
  • 50:16And I mean obviously everybody
  • 50:18on this call knows that.
  • 50:20But I I try not to miss any
  • 50:22opportunity I can to tell to say
  • 50:24to somebody you know we need to
  • 50:27do more than ask about duration.
  • 50:29You know 'cause it said I did
  • 50:31term woke is like just the
  • 50:33simplicity of sleep, right?
  • 50:34Absolutely? And I'm sure many
  • 50:36of you if you aren't already.
  • 50:38Check out damn bicis work on are you
  • 50:40stated it's and also of new research on
  • 50:43the sleep regularity index, that regularity.
  • 50:45Is extremely important,
  • 50:47and it's harder to measure.
  • 50:49First of all, it's.
  • 50:50It's not easy, but I think that may be
  • 50:54going on in in our racial differences.
  • 50:57In adolescents data,
  • 50:58we're seeing that 24 hours sleep
  • 51:01doesn't vary by race ethnicity,
  • 51:03but night time sleep does, which means.
  • 51:06Probably you know I'm not in the room,
  • 51:09but probably there's a a
  • 51:11nap at the first chance.
  • 51:13The team can get it, you know,
  • 51:15like Oh, I got home from school.
  • 51:17Now I can take a nap.
  • 51:18Oh I got home from my after school job.
  • 51:20Now I can take a nap.
  • 51:22They're catching up and it might.
  • 51:24Be extremely irregular,
  • 51:25or it might be in the middle of
  • 51:29school that's hard to measure,
  • 51:32but if it's micro nap.
  • 51:34But yes,
  • 51:35I think we need to embrace the
  • 51:38multidimensionality aspect completely.
  • 51:43And with that pair connection
  • 51:45that teens would I just in sleep
  • 51:48clinic what I hear a lot is that.
  • 51:50Depending on work schedules
  • 51:52such as shift work,
  • 51:53alot of adolescents are self regulating
  • 51:55themselves at night and so you know
  • 51:58there's that perhaps more variability.
  • 52:00My work is not in teams,
  • 52:02but I would imagine that among
  • 52:04those who are who are who are self
  • 52:08regulating home alone at night.
  • 52:11There's going to be more variability.
  • 52:13Absolutely thank you.
  • 52:17David. You're on mute.
  • 52:25You're still here with David.
  • 52:31I can't hear you. Can you type it in?
  • 52:39Let's see.
  • 52:47While he's doing that,
  • 52:48I I have an obligatory hat to put on.
  • 52:50My husband was like you're going
  • 52:52to speak at Yale, so I got.
  • 52:54I got my baseball cap.
  • 52:56It's really nice.
  • 52:57Where'd you get that hat?
  • 52:58He went there is class tonight.
  • 53:03I like I won't do it for the talk,
  • 53:06but I'll put it on during the question
  • 53:09and answer, so David's question is,
  • 53:11has there been a move given zoom
  • 53:13to postpone school start times?
  • 53:16Out schools in the US or such a
  • 53:20decentralized process I I cannot speak
  • 53:23for all of schools or all of zoom,
  • 53:26but what an opportunity root Gruber
  • 53:28wrote an article just last week
  • 53:31or two saying yes, now we should.
  • 53:34Now we should have school
  • 53:36starting at 10:00 AM on zoom.
  • 53:38Absolutely, I can say anecdotally.
  • 53:42I don't think that's happening.
  • 53:43I think the default position is.
  • 53:45Have them signed on at.
  • 53:48At 8:05 or whatever time
  • 53:49there school typically starts,
  • 53:51because that's what's known as the work day.
  • 53:53On the other hand,
  • 53:55there's not the morning commute.
  • 53:57My kids got up and did
  • 53:59virtual school this morning,
  • 54:00and we didn't have to hustle and
  • 54:02bustle to get them out the door.
  • 54:05They were no shoes.
  • 54:06My kids are not in high school.
  • 54:09It's a little bit of a different thing,
  • 54:11but the elimination route.
  • 54:13Sorry, Gruber,
  • 54:13Gruber.
  • 54:16The elimination of commute time
  • 54:18may also be reducing disparities,
  • 54:21because in some communities,
  • 54:23particularly rural communities,
  • 54:24maybe the poorest students living furthest
  • 54:27away and having to wake up just even a tiny.
  • 54:32You know 20 minutes earlier every night could
  • 54:36could lead to a clinically significant.
  • 54:40Difference in sleep duration
  • 54:42so that may be a benefit.
  • 54:44I would say a slight benefit of
  • 54:46the zoom schooling academically.
  • 54:49I am not a fan, but at least sleep
  • 54:53wise we may have some some perks.
  • 54:56Oh, more and yeah,
  • 54:58you can read David's comment
  • 54:59in the chat.
  • 55:02American Academy of Pediatrics
  • 55:04recommendations for school reopening or tried
  • 55:06to insert a recommendation about it,
  • 55:08but it was not well received.
  • 55:11It sounds like I'm so disappointed
  • 55:13to hear that, but how fantastic that
  • 55:16you were fighting the good fight.
  • 55:19That's crazy, AP should
  • 55:21totally be on board with that.
  • 55:24They already have a position statement on it,
  • 55:27so I don't know why they wouldn't so.
  • 55:31That stinks, I can say I
  • 55:34helped fight for the.
  • 55:36AP's position statement on screen use
  • 55:38in children to advocate that don't
  • 55:41use screens in the hour before bed,
  • 55:43and they did accept that even though really
  • 55:46the science and that's a little fuzzy,
  • 55:49but it's just generally good advice.
  • 55:53On the weather, it's one hour or two hours,
  • 55:55or what the right duration is.
  • 55:57But one hours, so that's a bummer.
  • 55:59So let me read the ship.
  • 56:00Probably wrap up 'cause it.
  • 56:03Hey Mr second question,
  • 56:05David David tried to text me.
  • 56:07If you are email me if you want.
  • 56:09Thank you so much and thanks to
  • 56:11everybody who's been a conference
  • 56:13today and I want to just let people
  • 56:16know about our speaker for next week.
  • 56:18We're going to be hearing from Fatima,
  • 56:20Cody Stanford who is at Harvard and
  • 56:23she's going to be giving a talk
  • 56:25relevant to many of our patients.
  • 56:27It's going to be entitled obesity
  • 56:28and its management.
  • 56:30What you need to know is a Sleep
  • 56:32Medicine physician and provider.
  • 56:34So please join us for that,
  • 56:35then have a great week take care.
  • 56:40I wrote to your response to me. I.
  • 56:47Thanks all bye.