A woman suffers from insomnia.
For much of history, humans probably got pretty lousy sleep. Prior to the Industrial Revolution, many people slept in the same bed alongside their family in dwellings lacking any temperature control beyond a fire or air ventilation. Those homes were littered with bed bugs, fleas, and lice that not only feasted on their hosts at night but also spread diseases, which — in the absence of modern medicine — kept the infirm awake and suffering. The noises of cities and rural life alike also made sleep difficult, thanks to the all-hours bustling of laborers, horse-drawn carriages, and livestock with whom farmers might’ve shared a home. “Because in the winter they generated warmth,” says A. Roger Ekirch, a history professor at Virginia Tech and author of At Day’s Close: Night in Times Past.
Nighttime itself was a risk. Slumber left people vulnerable to crime or death from fire or other natural disasters. Some prayers throughout history sought God’s protection from the litany of threats adherents encountered in the dark, says Ekirch.
For those who are lucky enough to have access, modern marvels like central heating and air conditioning, comfortable beds, and even Tylenol have all but eliminated many of these barriers to sleep. “We don’t have to worry about the myriad perils to sound slumber and our physical well-being that people did 300, 400 years ago,” Ekirch says.
“We don’t have to worry about the myriad perils to sound slumber and our physical well-being that people did 300, 400 years ago.”
Still, sleep doesn’t come easily to millions of Americans. Over 14 percent of adults had trouble falling asleep most days in 2020, according to the National Health Interview Survey. Nearly just as many people — 12 percent — have been diagnosed with chronic insomnia, according to an American Academy of Sleep Medicine survey. Among the 33 percent of US adults who get less than seven hours of sleep a night, native Hawaiian or Pacific Islander and Black adults are the most likely to get shorter durations of shut-eye. Those with an annual household income of less than $15,000 are also likely to be sleep-deprived.
Despite seemingly prime conditions for sleep, why do so many suffer from restless nights? The most comfortable bed in the darkest room might not be enough to overcome a mix of environmental, systemic, and behavioral forces preventing quality slumber.
Modern lifestyles aren’t ideal for sleep
American sleep culture is marked by contradictions.
Anyone who’s endured a night of terrible sleep can attest to its importance in cognitive functioning, mood, hunger, and overall health. Yet, many people act in ways that sabotage their hope for a good night’s sleep. We stay up later than we should to catch up on work or news or precious free time — what is sometimes called revenge bedtime procrastination. We consume content on our phones so upsetting or attention-grabbing as to prevent our falling asleep, although many of us know by now that screen use an hour before bed results in delayed bedtime and less sleep overall. We settle into bed and realize that late-afternoon coffee or nightcap too close to bedtime has come to collect its vengeance.
Some people innately need more sleep than others, and these so-called long sleepers simply cannot find the time in their busy schedules to devote to 10 hours of slumber. Try as we might to have it all, optimizing our waking hours might come at the detriment of our sleep. “We’re trying to have our cake and eat it, too,” Ekirch says. “The less time we accord to sleep, the more perfect we want it to be for when we do nod off.”
Ironically, a population of people with no notable sleep issues has turned sleep into a competitive sport, leveraging mouth tape, expensive mattresses, and sleep trackers like the Oura Ring in pursuit of the perfect night’s sleep. This fixation on enhancing sleep may actually do more to promote insomnia than peaceful slumber, experts say.
Most disruptions to sleep cannot be blamed on personal choices, though. Parents and other caregivers are among the most sleep-deprived, often contending with their children’s inconsistent sleep schedules. And the sleep patterns of shift workers — which account for 20 percent of the US workforce — are dictated by their employers.
The ill effects of poor sleep can negatively impact mental health. The opposite is true, too: Mental distress has consequences for sleep. “Stress, anxiety, weird work schedules,” says Jessi Pettigrew, a clinical social worker who focuses on sleep disorders, “can lead to the development of sleep disorders like insomnia or circadian rhythm disorders, which basically means being misaligned with your biological sleep schedule because of social reasons.”
Environmental and systemic barriers can disrupt sleep
Outside of individual behavior, where we live has a role in sleep.
Not having the ability to control the temperature in your bedroom because you lack effective heating or air conditioning can be a barrier to sleep, Pettigrew says. If you feel unsafe in your environment, you’re less likely to get restful slumber, too, she adds. This tends to impact people with housing insecurity, refugees, and those who are incarcerated.
Beyond the bedroom, noise and light pollution from bright street lights and traffic have been shown to interrupt sleep and contribute to insomnia — and those in low-income neighborhoods are more susceptible to these conditions.
“People who live in places with good natural light, green spaces, the ability to control the temperature and light and noise in their environment,” Pettigrew says, “helps them to sleep better and better regulate their circadian rhythm during the day and sleep at night.”
All of our waking experiences impact our ability to sleep, says Anita Shelgikar, a neurology professor at the University of Michigan Medical School and the president of the American Academy of Sleep Medicine board of directors. And some of those waking experiences may be colored by racism and discrimination. Stress associated with racial discrimination has been linked to poor sleep. Among shift workers, people of color are more likely to work alternating day/night schedules, resulting in disrupted circadian rhythms. “If that disrupts your sleep enough, that technically qualifies as shift-work sleep disorder,” says Jade Wu, a behavioral sleep medicine psychologist and author of Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications. This disorder is marked by excessive sleepiness, insomnia, or both.
The knock-on effects of altered sleep-wake schedules are profound, ranging from cardiovascular disease and obesity to mood and immune disorders. “Sleep health disparities disproportionately affect the same populations who suffer from overall health disparities,” Shelgikar says.
Those in rural or low-income areas who generally lack access to healthcare, let alone specialized sleep medicine, may continue to suffer from poor sleep, in addition to any number of physical and mental health conditions. Without individualized care, Shelgikar says, the disparities may only widen.
How to overcome these sleep obstacles
If you work odd hours or have a fussy baby, hearing the common advice of keeping your room cool and dark and only retreating to bed when you’re sleepy can seem trite. Wu suggests identifying the environmental or circumstantial reason you aren’t getting restful sleep and doing whatever you can to mitigate it. For those who live in spaces that aren’t conducive to sleep — hot bedrooms or the constant wail of sirens all night — there are few things people can do beyond getting a fan or earplugs, Wu says. People with means and flexibility can seek out a doctor specializing in sleep medicine to diagnose potential disorders like insomnia or sleep apnea.
If you work odd hours or have a fussy baby, hearing the common advice of keeping your room cool and dark and only retreating to bed when you’re sleepy can seem trite.
But if your conditions for sleep are pretty good and you still struggle to get shut-eye, the key, according to Wu, may be to not obsess over it as much. “What you see in people with insomnia is that they’re trying too hard,” she says. “They’re tracking their sleep too closely. They are perfectionistic about their sleep hygiene and doing things like going to bed too early or trying to take too many naps, trying to achieve a certain number of hours of sleep, or a certain score on their sleep tracker.”
The human body was meant to sleep. And despite all the constructs and complications society throws our way, we still require sleep. Ironically, though, the more we fret over it, the more elusive it can become. As difficult as it seems, the best advice may be to surrender to the circadian rhythm. “One thing that can help with sleep,” Pettigrew says, “is just saying, I’m going to trust my body to take care of this.”
