Does Poor Sleep Lead to Poverty?

A recent segment on NPR’s All Things Considered came on and caught my interest when I heard the terms “sleep quality” and “sleep deprivation”. I was even more interested when I heard that the interviewee was conducting research in India on the relationship between poor sleep quality and poverty.

We’re constantly revisiting reasons why sleep is important to health on our blog, our website, etc., so drawing a connection between poor sleep and poverty sounded pretty compelling. Read on! 

Current research on the relationship between sleep and poverty in India

Heather Schofield, an economist at the University of Pennsylvania, has been working in Chinnai, a city of nearly 5 million people in Southern India. For the past five years, she has been examining poverty and wondered if one of the root causes of poverty could be lack of sleep. She poses the following questions and has designed experiments to test whether better quality sleep can improve these factors that influence poverty:

  • If you’re at the level where you are that exhausted, how can you possibly function to be productive, to make good choices?
  • Does it [poor sleep quality] change your preference over having stuff now versus having things in the future?
  • Does it [poor sleep quality] change how risk-averse you are?

The experiments will require recruiting poor people form the neighborhood for tests. How quickly can they do a computer task? Will they agree to give up payment today in exchange for higher pay tomorrow? Will they join a savings program? And most important, does the outcome change if the participants get more sleep?

If Heather Schofield can answer some of these questions, perhaps improving the sleep of those facing poverty can be a solution to this massive problem.

Effects of poor quality sleep

The Centers for Disease Control and Prevention (CDC) has identified insufficient sleep as a public health problem and has even called it a public health epidemic. Many studies have clearly identified the effects of poor sleep. We know that lack of sleep reduces cognitive performance, even when those suffering from the effects are unaware of the effects. A 2003 study in SLEEP concluded:

Since chronic restriction of sleep to 6 h or less per night produced cognitive performance deficits equivalent to up to 2 nights of total sleep deprivation, it appears that even relatively moderate sleep restriction can seriously impair waking neurobehavioral functions in healthy adults. Sleepiness ratings suggest that subjects were largely unaware of these increasing cognitive deficits, which may explain why the impact of chronic sleep restriction on waking cognitive functions is often assumed to be benign. Physiological sleep responses to chronic restriction did not mirror waking neurobehavioral responses, but cumulative wakefulness in excess of a 15.84 h predicted performance lapses across all four experimental conditions. This suggests that sleep debt is perhaps best understood as resulting in additional wakefulness that has a neurobiological “cost” which accumulates over time.

Additionally, chronic sleep loss can put individuals at risk for:

Poor sleep leading to poverty

behavioral-risk-factor-surveillance-system-survey-resultsWe know that lack of sleep has cognitive implications that the sufferer may not even be aware of. Knowing that, the following findings from The Behavioral Risk Factor Surveillance System (BRFSS) survey (2008) are even more startling. Participants self-reported the following sleep-related difficulties:

  • Concentrating on things
  • Remembering things
  • Working on hobbies
  • Driving or taking public transportation
  • Taking care of financial affairs
  • Performing employed or volunteer work

Keep in mind, these are the self-reported sleep-related difficulties. Actual incidence of sleep-related difficulties may be much higher.

Similar to Heather Schofield’s work in India, these results (on a massive scale) show that the effects of lack of sleep could have a great impact on one’s ability to perform well at work, manage personal finances such as saving and planning, and make sound decisions. These are essential skills.

Sleep consequences by age and ethnicity

We can even take it a step further and look at the incidence of self-reported sleep problems (unintentionally falling asleep and falling asleep while driving) by age and ethnicity.

The National Health and Nutrition Examination Survey (NHANES) introduced the Sleep Disorders Questionnaire in 2005 for participants 16 years of age and older. The analysis summarized in the graphic below includes 10,896 respondents aged ≥20 years. A short sleep duration was found to be more common among adults ages 20–39 years (37.0%) or 40–59 years (40.3%) than among adults aged ≥60 years (32.0%), and among non-Hispanic blacks (53.0%) compared to non-Hispanic whites (34.5%), Mexican-Americans (35.2%), or those of other race/ethnicity (41.7%). Adults who reported sleeping less than the recommended 7–9 hours per night were more likely to have difficulty performing many daily tasks.

Black non-Hispanic (6.5%), Hispanic (6.3%) and other non-Hispanic (7.2%) participants reported that they had nodded of or actually fell asleep while driving in the past month compared to White non-Hispanic (3.2%). Drowsy driving is estimated to result in 100,000 police-reported crashes and 1550 deaths each year (see our blog post Driving Drowsy vs. Driving Drunk: the Fatal Mistake Most People Make for more stats from the National Sleep Foundation and National Highway Traffic Safety Administration).

behavioral-risk-factor-surveillance-system-results-2009

Poverty in America

In 2010, the poverty threshold was $22,314 for a family of four and 15.1%, just over 46 million Americans, were officially in poverty in 2010.Among racial and ethnic groups, African Americans had the highest poverty rate, 27.4 %, followed by Hispanics at 26.6 percent and Whites at 9.9 percent.

Populations that are at the highest risk of facing poverty also suffer more from sleep deprivation.

What can be done? 

Untreated sleep apnea causes poor sleep quality

We know that untreated sleep apnea causes poor sleep quality. Sleep apnea is a common sleep disorder defined as the cessation of breath during sleep. It is estimated to affect approximately 18 million Americans.

When oxygen levels dip during sleep apnea, the brain signals the body to partially wake up. The person’s sleep is disturbed and he is never allowed to sink into deep, restorative sleep stages. People with severe sleep apnea can go through this process hundreds of times each night. Often, people do not remember this happening and think that they have slept normally; however, they wake up feeling exhausted, groggy, and unrested. They are suffering sleep deprivation.

Once diagnosed, sleep apnea can be treated with weight loss, positive airway pressure (PAP) therapy, surgery or oral appliances. 

While we look forward to the results of Heather Schofield’s experiments on treating sleep loss in India, there are actions we can take here and now. Treating sleep apnea is one way to impact the sleep deprivation epidemic and potentially improve the financial situations of those in America and across the world. Talking about the implications of sleep loss is an important first step.

Do you or a loved one suffer from untreated sleep apnea? Take our sleepiness quiz and share your results with your doctor.

Sleepiness Quiz

Sources:
Centers for Disease Control http://www.cdc.gov/Features/dsSleep/
Dongen et al, The Cumulative Cost of Additional Wakefulness. Van SLEEP, Vol. 26, No. 2, 2003
Economic Policy Institute http://stateofworkingamerica.org/fact-sheets/poverty/#sthash.PR5XdR2h.dpuf
Harvey R. Colten and Bruce M. Altevogt, eds., for the Institute of Medicine (U.S.) Committee on Sleep Medicine and Research, Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem (Washington, DC: National Academies Press, 2006).
Kessler, Ronald C, PhD, et al. “Insomnia and the Performance of US Workers: Results from the America Insomnia Survey.” Sleep Journal.
National Public Radio, A Bad Night’s Sleep Might Do More Harm Than You Think http://www.npr.org/sections/goatsandsoda/2015/12/02/458059941/a-bad-nights-sleep-might-do-more-harm-than-you-think

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