Two things we all have in common: we’re human and we need sleep. But depending on ethnicity, our bedtime routines and sleep health can vary significantly. For the first time, the National Sleep Foundation (NSF) polled Asians, Blacks/African Americans, Hispanics, and Whites for its 2010 Sleep in America survey to uncover the similarities and differences among the four ethnic groups’ attitudes, habits, and problems related to sleep.

Over the years, researchers have conducted a few smaller studies—but few large epidemiological studies—that suggested differences in sleep among different ethnic groups. “We thought it would be important to learn more about whether these differences really exist. And the reason it is important is that we can use this information to help clinicians understand how to approach patients and how important it is to ask about and treat sleep-related issues,” says Sonia Ancoli-Israel, PhD, professor of psychiatry at the University of California at San Diego (UCSD) School of Medicine and chair of the study.

WHAT’S KEEPING AMERICANS AWAKE?

All Americans spend about a third of their lives in bed. But from how they get ready for bed, to what keeps them awake once in bed, to how much sleep they get each night while there, the poll uncovered significant differences among the four ethnic groups surveyed.

Blacks/African Americans reported having the busiest bedtime routines of all the groups. In the hour before going to bed, almost three-fourths either watch TV (75%) and/or pray or perform another religious practice (71%). By comparison, only half of Asians polled (52%) report watching TV, and only 18% of Asians, 32% of Whites, and 45% of Hispanics report praying in the hour before bed. Asians, however, are twice as likely (51%) to be found online or on the computer every night or almost every night in the hour before bed than the other ethnic groups (20%-22%).

Once in bed, falling or staying asleep can be a struggle as the economy and personal concerns keep Americans of all ethnic groups lying awake. Overall, at least one-third of Hispanics (38%) and Blacks/African Americans (33%) report that financial, employment, personal relationship, and/or health concerns disturb their sleep at least a few nights a week. By comparison, about one-fourth of Whites (28%) and Asians (25%) find themselves kept awake.

WHAT’S THE IMPACT OF THIS LACK OF SLEEP?

Although all this activity and worry cut into everyone’s sleep, the poll found that one group is getting significantly less sleep than all the others. Whether on weekdays/workdays or weekends/non-workdays, Blacks/African Americans spend more time in bed without sleeping than the other ethnic groups—54 minutes on weekdays/workdays and 71 minutes on non-workdays/weekends.

Additionally, the poll found that, of all the groups, Blacks/African Americans are getting the least amount of sleep on workdays/weekdays (6 hours and 14 minutes)—that’s 34 minutes less sleep on a work night/weeknight than Asians and 38 minutes less than Whites. Interestingly, Blacks/African Americans also say that they need only 7 hours and 5 minutes of sleep each night to perform at their best during the day, significantly less sleep than the 7 hours and 29 minutes both Asians and Hispanics say they need.

Overall, when comparing the hours of sleep each group says it needs to the hours of sleep it is actually getting on workdays or weekdays, roughly one-third report not getting enough sleep.

“We know from different polls that the NSF has done, and from different studies, that in general people are sleeping less than they should. And often they realize that it affects them,” says Ancoli-Israel. “The fact that Blacks/African Americans sleep less, but feel that’s enough, to me that’s the most surprising [finding]. And the question that arises from that, is it really enough or [is their perception] of the impact it’s having on them [different].”

Still, this lack of sleep is impacting the four ethnic groups similarly. All the respondents reported disturbingly similar experiences missing work or family functions because they were too sleepy (19%-24%). And among married people or couples living together, one in five respondents reported that their intimate or sexual relationship was affected because they were too sleepy (17%-23%). More than one-half of those surveyed among each ethnic group agreed that lack of sufficient sleep can impact or affect their job performance; their relationships with family or friends; and their ability to carry out household duties, to care for their family, and to do everyday activities.

NOT TOO MUCH, NOT TOO LITTLE

Source: National Sleep Foundation 2010 Sleep in America Poll

So, how many hours of sleep should everyone be getting? According to Jose Loredo, MD, MS, MPH, FCCP, professor of medicine and medical director at UCSD’s Sleep Medicine Center, Americans should be getting between 7 and 8 hours of sleep per night every night, otherwise they risk their health. “Sleep duration is turning out to be a very strong and important health risk factor, and it appears that we need just the right amount of sleep to maintain health,” says Loredo. And although respondents may not be getting those precious 7 to 8 hours every night, three-fourths agree with Loredo and health care professionals that poor sleep is associated with health problems (76%-83%).

“If you sleep less than 6 [hours] on a chronic basis or more than 9 [hours] on a chronic basis, that factor is associated with having worse health, whether it’s cancer, heart disease, obesity, [or] psychiatric disorders,” says Loredo. He adds that Blacks/African Americans’ total sleep time and attitudes regarding sleep may be associated with the increased prevalence of sleep apnea, hypertension, and diabetes in that population.

The good news is that sleep duration is one factor on which sleep professionals can intervene with patients. Awareness and education about the importance of sleep duration and its relationship to overall health could go a long way in improving sleep health.

“There are three major factors to getting a good night’s sleep. Sleep quality—so we have to sleep well. Sleep duration—you have to sleep enough. Not too much, not too little. Just like the Goldilocks story. And number three is schedule—when do you sleep,” says Loredo.

TIME TO TALK ABOUT SLEEP

But before sleep professionals can make these recommendations, patients need to walk into their offices. Many Americans, regardless of ethnicity, still do nothing (12%-16%) or assume their sleep problems will go away in time (19%-37%), according to the NSF poll. And even if they finally sit down face-to-face with a health care professional, they might not get the help they need.

The poll found that Asians are least likely to have been asked about (28%) or to have discussed sleep (14%) with a health care professional. In contrast, four in 10 Whites, Blacks/African Americans, and Hispanics (40%-48%) say they have been asked about sleep, and 38% of Whites, 30% of Hispanics, and 26% of Blacks/African Americans have discussed sleep with a health care professional.

“I think every single patient, when they show up to their doctor, should be asked about sleep,” says Loredo. He also argues that such simple questions as do you snore or does your partner think you snore should be a part of every patient’s medical workup.

Getting the conversation about sleep started with patients could significantly improve diagnosis and treatment of sleep disorders. Although specific sleep disorders occur at different frequency among the four groups, they continue to be very common among all the groups. Whites (20%), Blacks/African Americans (19%), and Hispanics (19%) were all twice as likely as Asians (10%) to have been diagnosed with a sleep disorder. Whites report the highest rate of diagnosis for insomnia (10%), while Blacks/African Americans have the highest rate of diagnosed sleep apnea (14%) among the four ethnic groups.

Check Sleep Review‘s home page for results of other sleep-related polls.

And even though certain sleep disorders are more prevalent among certain ethnic groups, Ancoli-Israel contends that all patients, regardless of ethnicity or race, should be asked about them. “Many Asian patients are slender. Don’t assume that because a patient is slender sleep apnea is not an issue. Don’t base it on the race. Don’t base it on what you are seeing in front of you. Base it on the answers to the questions that you should be asking,” she advises sleep professionals.

And Loredo adds that because sleep is not the same in all ethnic groups, clinicians’ approach toward solving sleep problems needs to be more individualized. “Ethnicity and race need to be taken into account in our approach toward solving or improving sleep quality in the population in the United States,” he says.

“The bottom line,” says Ancoli-Israel, “is that everybody, no matter what their race or ethnicity, has issues with sleep. There are some differences clearly. People in different ethnic and racial groups approach sleep differently. They have different beliefs about what is good for sleep and what isn’t good for sleep. They have different habits, some of which promote sleep, some of which don’t. [But] everybody needs to be asked so they have the opportunity to talk about their sleep, to be educated about their sleep, and to have an opportunity to improve their sleep, so they can have a better quality of life.”

Alison Werner is associate editor of Sleep Review. She can be reached at [email protected].