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To Sleep or Not to Sleep: Race, Gender, and Insomnia

February 28, 2022
by Margaret Hankins

I don’t have the best sleeping schedule. I often stay up to 3 a.m. — a habit that started because of schoolwork but I kept up so I could scroll endlessly on my phone. With every article I have read, I’ve learned more about how insufficient sleep increases my risk of cardiovascular issues and diabetes, decreases cognitive function, and weakens the immune system. At some point, I began to view this sleep schedule as an individual fault. It wasn’t one I was necessarily willing to address or even capable of fixing, but I started to believe that it was a flaw of mine.

And yet, research suggests that sleep is no less vulnerable to the same health disparities we find elsewhere. Perhaps there is something systemic occurring — in addition to my individual responsibility to get a good night’s sleep?

For example, a recent roundup of studies indicates that insomnia — a condition that may include trouble going to sleep or staying asleep or waking up early without being able to fall back asleep — is more prevalent among women.

Issues with sleep are both a cause and an effect of stress. Women are almost twice as likely to experience severe stress and/or anxiety as men. This discrepancy has persisted over time, in study after study, and is true across socioeconomic categories. And stress disrupts sleep. Stressful events have been shown to cause transient insomnia, which lasts about a month and resolves itself as the stressful event passes, as well as chronic trauma.

This discrepancy is exacerbated for Black women, as studies show Black people are more likely to deal with “short sleep,” defined as five hours or less of sleep, and — curiously — “long sleep,” or nine or more hours of sleep. Plus, although Black women generally get fewer hours of sleep than White women, we are also less likely to report difficulty sleeping to a physician or health professional. Meaning, we are struggling with issues of sleep more than White women but not asking for the medical help we need to deal with these issues.

This discrepancy is possibly the result of distrust in medical professionals among the Black community, and Black women specifically. And for good reason: the “Father of Gynecology” experimented on enslaved Black women without their consent; Henrietta Lacks’ cells were used to study cancers and many other diseases without her permission; and African Americans’ pain is still severely undertreated because of persistent, racist ideas about how we feel (or do not feel) pain.

Another factor to consider is the prevailing stereotype of the “Strong Black Woman.”

I’ve been considered a Strong Black Woman since before I was even an adult. I was called resilient, mature for my age, articulate, and self-reliant.

Research now suggests that this perception, both externally imposed and internally felt, can have negative health outcomes. According to the stereotype, strong Black women don’t need to ask for help, even when feeling miserable. At the same time, interviews with Black women reveal it’s possible that feelings of stress and symptoms of depression stem from this constant need to support others and the exhaustion that inevitably results.

The influence of the Strong Black Woman myth and Black people’s distrust of the medical community means Black women suffering from sleep disruption need a unique, holistic intervention. In other words, sleeping pills are not sufficient when Black women are responding to an environment that demands too much of us and then ignores the work necessary to meet these demands. Fortunately, Women’s Health Research at Yale is now conducting a study on a stress and insomnia intervention sensitive to the cultural needs of Black women. The project emphasizes mindfulness and an emotional vulnerability that would counter the Strong Black Woman myth.

Researching this topic made me realize that I also subscribe to these myths of the strong black woman. Maybe I stay up so late because I’ve taken on too many responsibilities between school, my internship, and my job. Or because I refuse to ask for help even when it’s impossible to do it all. Doing this research was eye-opening, allowing me to reframe my issues with sleep as part of a larger, structural issue. This is not to say that I don’t have power over it. Instead, I now know that I need to pay extra attention — not just to my sleep, but to how I consider my own vulnerability and responsibility to others.

Submitted by Rick Harrison on February 28, 2022