1. Where you live; How well you sleep John Sonnega, Lee Bell University of Michigan – Flint Public Health and Health Sciences John Sonnega, Lee Bell University of Michigan – Flint Public Health and Health Sciences

2. Student Quote from yesterday FI am a person that needs sleep to study and by golly, I definitely dont get enough sleep, then my drive to school is almost an hour.

3. Questions How many of you got a good nights sleep? How many of you used your snooze alarm this morning? What is your sleep debt? (56 hours a week – actual hours of sleep). How many of you have sacrificed sleep for work? For play? How many of you make sleep a health priority?

4. Talk Outline FA public health focus on sleep FWhat is a good nights sleep? FHow do we compare? FThe Flint Sleep Project FSleep and place FDirections FA public health focus on sleep FWhat is a good nights sleep? FHow do we compare? FThe Flint Sleep Project FSleep and place FDirections

5. Sleep and public health FSleep is a fundamental human need. FPoor quality sleep is associated with adverse health outcomes, including mortalilty FSleep is an important public health goal, perhaps more than diet FSleep is a fundamental human need. FPoor quality sleep is associated with adverse health outcomes, including mortalilty FSleep is an important public health goal, perhaps more than diet

6. Allostatic Load- Wheres Sleep? 6

7. CDC MMWR March 3 rd FSleep is increasingly recognized as important to public health, with sleep insufficiency linked to motor vehicle crashes, industrial disasters, and medical and other occupational errors.

8. 12 state BRFSS data F35.3% reported <7 hours of sleep during a typical 24-hour period, F 48.0% reported snoring, F37.9% reported unintentionally falling asleep during the day at least once in the preceding month, Fand 4.7% reported nodding off or falling asleep while driving at least once in the preceding month. F35.3% reported <7 hours of sleep during a typical 24-hour period, F 48.0% reported snoring, F37.9% reported unintentionally falling asleep during the day at least once in the preceding month, Fand 4.7% reported nodding off or falling asleep while driving at least once in the preceding month. 8

9. 2009 Speak to your health data F44% of Genesse County reports less than 7 hours of sleep. F64 % are 7 hours or less. F44% of Genesse County reports less than 7 hours of sleep. F64 % are 7 hours or less. 9

10. Quality of Sleep in Genesee County How many hours do you sleep during a typical night? How many hours do you sleep during a typical night? 6.7 Hours How many nights a month do you have difficulty sleeping? How many nights a month do you have difficulty sleeping? 8 Nights a month During the past month have you taken sleep medicine to help you sleep? During the past month have you taken sleep medicine to help you sleep? 27% Yes During the PAST MONTH, how would you rate your sleep quality overall? One-Third said Fair or Poor 10

11. Summary F The majority of respondents do not get the recommended hours of sleep. F 1 out of 9 respondents have trouble sleeping every single night, report poor sleep quality, and take sleep medications three or more times a week. F The majority of respondents do not get the recommended hours of sleep. F 1 out of 9 respondents have trouble sleeping every single night, report poor sleep quality, and take sleep medications three or more times a week. 11

12. Stable Sleep trends

13. Hours of Sleep 13

14. Nights a month with difficulty sleeping 14

15. The Flint Sleep Project Community Based Participatory Research (CBPR) MICHR funded pilot. Community Partner Lee Bell Identify neighborhoods at risk of poor sleep with GIS Inform CBOP and Neighborhood rountable. Raise awareness. Conduct 7 focus groups in neighborhood. (N=71)

16. Percentage sleeping fewer than 7 hours by zip code 16

17. Sleep Disorders by city Have you ever been diagnosed with a sleep disorder? Fenton 5.6 % Linden 9.1 % Grand Blanc 11.2% Davison 12.4% Flushing 14.7 % Swartz Creek 16.7% Clio 17.3% Genesee County18.1% Mount Morris 18.6% Burton 20.3% Flint 20.8% 17

18. What accounts for sleep disparities by area? Proximal Environment. Noise. Lack of quality sleeping environment. Knowledge of sleep hygiene. Behavior and motivational factors for sleep hygiene. Social Determinants. Stress

19. 19

20. Sample sleep characteristics Participants (n=71) reported sleeping an average of 6.2 hours a night and gave themselves a median grade of C for sleep quality (A-E). Participants (n=71) reported sleeping an average of 6.2 hours a night and gave themselves a median grade of C for sleep quality (A-E).

21. Sleep as a community topic FDo you talk about sleep with family and friends? FRarely FIn a Negative context FWe only talk about sleep when we dont get a good nights rest. Kinda like giving folks a warning. F FDo you talk about sleep with family and friends? FRarely FIn a Negative context FWe only talk about sleep when we dont get a good nights rest. Kinda like giving folks a warning. F

22. What is a good nights sleep? Consistent: When I dont wake up. Deep: One where you fall asleep whe your head hit the pillow and dont even know you are sleeping. Restful: Where I wake up in the morning feeling good.

23. What is a bad nights sleep? Trouble failing asleep: I cant get to sleep no matter what I do. Night wakenings: When I keep tossing and turning all night. Early awakening: When I wake up after a few hours and cant get back to sleep. Bedtime rumination: When thoughts just keep going through my mind and I cant tell if Im sleeping.

24. What are the effects of poor sleep? Poor health Irritability Lack of focus Most folks dont really think about what sleep means for their health. I dont think were aware of all that it means. Participants thought that awareness of sleep issues were not as widespread as other health behaviors

25. Reasons for a poor nights sleep Poor health or pain, Hormones, Substance use Sleep hygiene: Temperature, light, comfort, time of day, activity, Media, crowding Stress was the most common cited reason for poor sleep.

26. Stress Themes Economic or employment Safety or crime Sleep itself : I cant sleep because I cant sleep. Sleep itself : I cant sleep because I cant sleep. Neighborhood or community

27. Apprehension Sometimes I get up just to make sure my car is okay. If it was gone Id probably sleep. Sometimes I get up just to make sure my car is okay. If it was gone Id probably sleep. The sirens make me worry. The noise doesnt really keep me awake – its wondering what s happening that does. I wonder where Flint is going. I dont like to think about the future. I wonder where Flint is going. I dont like to think about the future. Im sleeping better now that I dont have a job. It was the work that was keeping me awake. Im sleeping better now that I dont have a job. It was the work that was keeping me awake. I worry about everyone. All my friends and family. I worry about everyone. All my friends and family. 27

28. Apprehension and Insecurity FAnxiety, uneasiness, worry, dread, concern, nervousness, fear. Flack of confidence. Things arent going to get better. FAnxiety, uneasiness, worry, dread, concern, nervousness, fear. Flack of confidence. Things arent going to get better.

29. Quantitative correlations Correlations for sample neighborhoods only (n=409) Sleep Quality Sleep Quality Safety Insecurity.149** Financial Insecurity.123* 29

30. Community Suggestions Exercise and improved sleep hygiene as individual remedies to sleep difficulties. Addressing financial and safety insecurities was a community- based suggestion. Exercise and improved sleep hygiene as individual remedies to sleep difficulties. Addressing financial and safety insecurities was a community- based suggestion. 30

31. Sleep hygiene tips Simple education regarding sleep hygiene alone does not have proven efficacy for the treatment of insomnia. (S. Schutte-Rodin, Broch, Buysse et al, 2008). Respondent: That Sh*t dont work. Everybody has their own way to do it. 31

32. Faith based interventions Im so close to the edge sometime. Just juggling so much that I worry about crashing. When I cant sleep I turn to my faith. Faith and forgiveness. Respondents suggested engaging the faith community in sleep programs.

33. I have trouble sleeping because of my financial problems? Financial problems and sleep