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Penn Medicine Researchers Find Sleep Beliefs Vary Along Racial Lines in Philadelphia

Empty-bedWhen it comes to sleep, Penn Medicine researchers arefinding out that some things really are black and white. A new study focusingon the sleep beliefs and behaviors of older women in the Philadelphia areafound that older black women in the City of Brotherly Love may be more likelyto support certain unhealthy practices, beliefs and attitudes about sleep thantheir white counterparts.  The findings, published in the Journal ofthe National Medical Association, also point to differences among black andwhite women in reported snoring, napping, methods for coping with sleepdifficulties, and non-sleep behaviors in bed.

“This study represents one of the first attempts tounderstand everyday sleep practices and beliefs in the community. Also, this isone of the first opportunities to look at how differences in these practices inbeliefs may explain black-white differences in healthy sleep,” said lead studyauthor Michael Grandner, PhD, instructor in Psychiatry and member of theCenter for Sleep and Circadian Neurobiology at Penn.  “Our resultssuggests that older black women in our community may be less likely to engagein helpful coping strategies to address sleep problems and more likely toendorse beliefs and attitudes about sleep that may reflect a lack ofunderstanding about the importance of sleep.”

The study included 65 participants recruited from fourworkshops, held at various community centers in West Philadelphia. All of thesubjects were female -- 36 black and 29 white -- with an average age of 69years.  The women participated in focus groups in which sleep and healthwere discussed. As part of this, all participants were given a questionnaire toevaluate their beliefs, attitudes, and practices regarding sleep as well asinformation about sleep complaints.

Overall, the research team found no significant differencesbetween the two groups for overall sleep quality and daytimesleepiness.  This finding corroborated earlier research by Grandnerand colleagues at Penn that found that general sleep complaints are notdifferentially reported in black and white study participants.  In this2010 study published in the journal Sleep Medicine, researchers found that rates ofsleep complaints in African-American, Hispanic/Latino and Asian/Other groupswere similar to Whites.

However, in the current study, when asked how they wouldcope with daytime sleepiness, black participants were more likely to nap duringthe day.  The two groups also differed in strategies for coping withdifficulties falling asleep, in that black participants were more likely todrink alcohol (which is more likely to exacerbate problems rather thanameliorate them) and engage in activities in bed other than sleep (which is acommon coping strategy but may lead to more sleep difficulties later). Theseactivities included reading or watching television, eating or drinking,worrying or thinking, and arguing or being angry.

The black participants were also more likely to reportsnoring, which is consistent with prior research that has shown that blackindividuals are at greater risk for developing obstructive sleep apnea.

The researchers also found that black respondents were lesslikely to report motivation to make time for sleep. Also, there was a trend forblack participants to be more likely to believe that sleepiness is due tolaziness and bad habits, though daytime sleepiness is an important symptom fora number of important health conditions and is usually caused by poor sleepquality at night.

One universally concerning finding was that both groups didnot endorse the belief that sleep is related to health outcomes, includingobesity, cardiovascular disease, diabetes, and depression, reflecting a generallack of understanding across racial groups about the importance of sleep.

Both groups also reported that they rarely discussed sleepproblems with their health care provider, though research suggests that blackindividuals are more likely to discuss health issues with elders, clergy, andhealers in the community.

“Despite several differences, we were not surprised thatboth groups share issues with understanding the overall value and need forsleep,” said Dr. Grandner. “While they may be of different races, these womenwere of a common age and socioeconomic group, and live in the same neighborhoodand may share many commonalities that would influence the ‘culture’ of sleepfrom their generation.”

Based on their findings, the authors hope this research willbe helpful in developing effective sleep education programs that includeconsideration of cultural and demographic differences in sleep patterns andbeliefs. “Sleep is an important part of health and functioning,” says Dr.Grandner, “and this research will help us better understand how to improvesleep in the real world.”

To further study the social, cultural and demographicpatterns of sleep in the Philadelphia area, Dr. Grandner and his team haverecently launched the Sleep and Healthy Activity, Diet, Environment andSocialization (SHADES) study. A first-of-its-kind study of a major metropolitanarea, SHADES aims to collect data on a variety of health, behavioral, social,and environmental factors that play into sleep patterns of residents across thecity. To learn more, or to take part in this study, visit






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