Sleepless in Appalachia

By D.M. Mackey

There is a point where, deep in the blue Appalachian , Tennessee, Kentucky, and the Virginias meet. The region is known for its sweeping vistas and the folksy Appalachian Blues music born there. But this place is also the home of the highest concentration of chronically -deprived people in the U.S., a team of scientists recently discovered. There are important lessons for us all in both the cause and the effects of Appalachia’s sleeplessness.

The study, authored by six scientists and published in August 2015 in the journal , analyzed the geography of American . Various “hot spots” surfaced, and yet a particularly clear and surprising cluster appeared at the Appalachian intersection of the four states – 17 counties that constitute the highest concentration of sleep-deprived people living in one area in the United States.

How to explain this surprising finding? It turns out that it’s not so surprising after all. Appalachia is a microcosm of our national health problems; most everything we struggle with nationwide is present there, with relative abundance. That includes cancer, diabetes, heart disease, trauma, and substance abuse, among other maladies.) Local experts believe multiple factors led the region to this situation. The coal trade, poor water quality, a healthcare system too far from the reality of the communities, and habits like smoking and a sedentary lifestyle all contribute, they say. “The Appalachian region is just like the rest of the U.S. — only more,” Tom Frieden, the U.S. Centers for Disease Control and Prevention Director told USA Today last year.

Much of this boils down to : few options, excess stress. Appalachian regions have higher-than-average poverty even within their own states; that’s to say, the Virginian part of Appalachia has more concentrated poverty than Virginia does as a whole, and so forth. And the link between poverty and insufficient sleep is a well known one. “It is relatively well-established that people in poverty don’t sleep as well as people not in poverty,” says Dr. Michael Grandner, the study’s lead author and a researcher at the University of Arizona. “This should be no surprise, as they have so many constraints that can impinge on sleep.”

It’s a logical domino effect, says Dr. Susan Redline of Harvard Medical School. “Poverty is associated with neighborhood disadvantage. Neighborhood disadvantage is associated with high pollution levels and exposures to indoor allergens and irritants, which can exacerbate and sleep quality. Poverty is also associated with high rates of chronic lifetime stresses, which contribute to inadequate sleep,” Dr. Redline says, adding that “chronic health conditions and obesity” also often accompany poverty and are known to interrupt sleep health.

Sleep scientists note that insufficient rest often functions as both a cause and an effect within a cycle. The conditions that sleeplessness causes are in turn exacerbated by it. This cycle is likely present in Appalachia, the study’s authors say. “It seems like that region is prone to many health and behavioral risk factors, and these all often overlap with each other,” says Dr. Grandner. “It may be the case that poor sleep quality may be mixed up in that, and is either helping to cause these problems or being caused by them.”

Dr. Grandner says that, whether in Appalachia or New York, the same tips can help stop this cycle. “Remember that sleep is essential for health. Make time for sleep, and if you are having trouble sleeping, talk to your healthcare provider, and maybe even a sleep specialist,” he says. “In the meantime, try to set up your schedule so that you have adequate time for sleep.”


Tags:  Mountains Poverty Sleep sleep apnea Sleep deprivation Sleep Health sleep science





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