Issues

What is healthy sleep? “Healthy sleep requires adequate duration, good quality, appropriate timing and regularity, and the absence of sleep disturbances or disorders.

As a result of socioeconomic status and environmental factors, underserved populations are disproportionally impacted by health disparities. Undiagnosed sleep disorders and insufficient sleep have an influence on those disparities. The result is higher disease burden, earlier mortality, lower quality of life, and contributing to financial medical debt.

Sleep Equity Project seeks to identify and refine issue which can be addressed on a variety of levels (Individual, Family, Community, Societal). Dr. Paula Braveman, et al cited that "effective public policy requires clear and contextually relevant operational definitions to support the development of objectives and specific targets, determine priorities for use of limited resources, and assess progress." (16) This will be a guiding concept of Sleep Equity Project as we go through our process of identifying, refining and prioritizing our core issues.

Core Issues

Access, Affordability, Health Equity, and Patient Safety

Next Steps

1. Identify and refine issues which impacts sleep equity

2. Determine if developing programing or an advocacy agenda is appropriate

3. Seek partners to collaborate (patients, organizations, practitioners, caregiver, industry)

4. Explore funding sources to support the development of programing

Patient Safety

Patients are less aware of the immediate impact of sleep apnea which can have various physiological states such as nightly blood pressure; pre and post surgical considerations; and variation of pulse oxygen saturation.

The presence of sleep disorders can have a wide ranging impact on blood pressure, amount of anesthesia needed for a surgical procedure as well as safety factors post surgery, and effectiveness of monitoring of arterial oxygen saturation. The awareness of these issues is critical when faced with either an emerging health issue or managing an ongoing chronic health issue which can impact a sleep patietn's quality of life and ead to less optimal health outcomes

Access

Sleep disorders can affect different people in different ways

Signs, symptoms, and prevalence for sleep disorders (sleep apnea, insomnia, restless leg syndrome) differ for woman and a lack of knowledge and gender bias among medical professionals contributes to less women being assessed and properly treated. Furthermore, societal myths about sleep disorders and gender plays a role in minimizing the prevalence of sleep disorders among women. Sleep disorders are a lifespan issue for all, and in particular for women who experience hormonal shifts during the onset of puberty, menstrual cycles, pregnancy, and menopause which can alter sleep architecture. This bias in medicine and societal myths combine to put women at undue health risk for complications from chronic health conditions and can impact quality of life and mortality

Sleep disorders and occurring major chronic health conditions have a disproportionate impact on underserved populations. Sleep disorders are under recognized as a co-occuring health condition with many major chronic health issues such as cardiovascular disease, diabetes, liver disease, and eye conditions due to socioeconomic and environmental factors.

Cultural stereotypes and medical bias hamper access to assessment and treatment for sleep disorders for underserved communities. Implicit bias in medical care shows up in the belief that treatments developed in clinical studies involving primarily white subjects is effective for all others. This shows up in a variety of manners-pulse oxygen sensors are not as effective in reading people who have darkened skin (18); Racial and ethnic disparities exist in the utilization of tonsillectomy and adenoid surgery (T&A) for children with Sleep Disordered Breathing enrolled in Medicaid

Affordability

Underserved people in the U.S have barriers to affordability of sleep treatments

Sleep assessment, diagnosis, and treatment is not attainable for many people in the U.S because of cost and silos of access. The testing process can be costly for someone without knowing if they need treatment until the sleep study is read by the sleep physician. Medical debt is an issue for millions in the United States.

For some the thought of going to a physician brings up the issue of incurring more medical debt. Also, if someone wants to track their sleep quality the commercially available sleep trackers are costly and more attainable for those with more financial resource's. Sleep is not a luxury and access to healthy sleep should be provided across the life span without the addition of medical debt.