Disparities in sleep duration and restedness among same- and different-sex couples: findings from the American Time Use Survey

Sexual minorities and sleep health: How does discrimination and stigma influence a sleep disorder diagnosis?

OBJECTIVES

Sleep difficulties are associated with many physical and mental health problems, such as diabetes, hypertension, and depressive symptoms. Sleep can be affected by stressors such as discrimination and stigma, which are disproportionately experienced by sexual and gender minority (SGM) individuals. This research assesses how different characteristics, including discrimination and stigma, sociodemographic characteristics, community connectedness, self-rated good health, and outness levels, influence a sleep disorder diagnosis among SGMs.

METHODS

We analyzed data from wave 3 of Generations: A Study of the Life and Health of LGB People in a Changing Society. We used bivariate analysis to document the distribution of key variables across SGM status. Next, we conducted logistic regression analyses to measure how each variable influences the likelihood of an SGM individual being diagnosed with a sleep disorder considering experiences of discrimination and stigma.

RESULTS

We found that feeling stigma was statistically significant in predicting a sleep disorder diagnosis among SGM individuals. However, after controlling for sociodemographic characteristics, community connectedness, self-rated good health, and outness levels, SGM individuals only had increased odds of a sleep disorder diagnosis if they reported higher scores on the Internalized Homophobia Scale.

CONCLUSIONS

Variation in having a sleep disorder diagnosis differs based on SGM status and could not be explained away with the inclusion of all covariates. Our findings support the need for more research to compare health outcomes between different sexual and gender identities, rather than comparing them with their nonminority counterparts.

Sleep and Socioemotional Outcomes Among Sexual and Gender Minority Adolescents: A Longitudinal Study

Sexual and gender minority adolescents face specific stressors associated with their minority status, leading to compromised socioemotional outcomes and sleep. Sleep patterns have, in turn, been found to predict socioemotional outcomes. As such, we aimed to investigate whether healthy sleep patterns prospectively predicted socioemotional outcomes, and whether associations varied as a function of sexual and gender minority status. We conducted a secondary data analysis among adolescents at age 14 to 17, from a nationally representative prospective cohort in the United Kingdom (N = 8923, mean age = 13.8), with 7021 cisgender heterosexual, 1801 sexual minority, and 101 gender minority adolescents. Indicators of socioemotional outcomes included self-esteem, emotional well-being, peer relationships, and relationship with parents. The results showed that gender minority adolescents reported the worst sleep patterns and socioemotional outcomes, followed by sexual minority and cisgender heterosexual adolescents. Results from multi-group path analyses showed that emotional well-being, self-esteem, and peer relationships at age 17 were prospectively predicted by sleep patterns and the associations were moderated by sexual and gender minority status. Influence of sleep patterns, particularly sleep initiation problems and frequent awakening, on socioemotional outcomes was greater among gender minority adolescents, when compared to cisgender heterosexual adolescents. In conclusion, positive socioemotional outcomes were predicted by healthy sleep patterns. The potential role of sleep health in optimizing socioemotional outcomes among sexual and gender minority adolescents might warrant further investigation in prevention or intervention studies.

Cyclical Links Between Daily Partner Interactions and Sleep Quality in Older Adult Couples: The Mediating Role of Perceived Partner Responsiveness and Negative Affect

Researchers have found significant associations between romantic relationship experiences and sleep quality. However, most existing studies are cross-sectional, few have focused on the aging population, and few have considered mechanisms underlying such associations. To address these gaps, 238 older adult couples completed 7-day daily diaries, reporting on their daily relationship, emotional, and sleep experiences. Multilevel structural equation modeling revealed that husbands' higher negative partner interactions and lower positive partner interactions were indirectly associated with their own and their wives' decreased sleep quality that night via lower perceived partner responsiveness and increased negative affect. Moreover, decreased sleep quality was associated with participants' and their partners' increased negative partner interactions and participants' decreased positive partner interactions the next day, with no significant gender differences. This research provides a foundation for future research on cyclical associations between romantic relationship experiences and sleep quality, with implications for relationship-based interventions to improve sleep quality.

The day-to-day impact of nighttime noise disturbances on college students' psychological functioning

ObjectiveTo understand environmental predictors (i.e., nighttime noise disturbance) of sleep health (i.e., restedness) in residential college students and its potential mental health consequences, this study examined daily variation in restedness upon awakening as a potential mediator between nightly environmental noise disturbances and daily fluctuations in depressive and anxiety symptoms. Participants: The sample was comprised of 283 college students (M_age = 19.9, SD = 1.9; 79% female). Methods: Multilevel structural equation modeling was conducted based on an initial self-report, online questionnaire and an online 7-day daily sleep (morning) and mood (evening) diary. Results: Daily fluctuations in college students' reports of restedness (morning diary) mediated the association between the nighttime presence of noise disturbances (morning diary) and depressive and anxiety symptoms (evening diary). Conclusions: Given the high prevalence of mental health problems in college students, creating more conducive sleep environments may help to prevent depressive and anxiety symptoms in this population.

Socio-Ecological Context of Sleep: Gender Differences and Couples' Relationships as Exemplars

PURPOSE OF REVIEW

We summarized recent findings on insufficient sleep and insomnia, two prominent sleep issues that impact public health. We demonstrate the socio-ecologial impact of sleep health with findings on gender and couples' relationships as exemplars.

RECENT FINDINGS

Robust gender differences in sleep duration and insomnia are due to biological and socio-ecological factors. Gender differences in insufficient sleep vary by country of origin and age whereas gender differences in insomnia reflect minoritized identities (e.g., sexual, gender). Co-sleeping with a partner is associated with longer sleep and more awakenings. Gender differences and couples' sleep were affected by intersecting social and societal influences, which supports a socio-ecological approach to sleep. Recent and seminal contributions to sleep health highlight the importance of observing individual sleep outcomes in a socio-ecological context. Novel methodology, such as global measures of sleep health, can inform efforts to improve sleep and, ultimately, public health.

Sleep problems among sexual minorities: a longitudinal study on the influence of the family of origin and chosen family

BACKGROUND

There is growing evidence that lesbian, gay, and bisexual (LGB) adults experience more sleep problems than the general population. As LGB individuals experience a significantly greater risk of family rejection and low family support, our study investigates the role of family support as a potential determinant of LGB sleep problems over a prolonged period, and whether friend support (i.e. chosen family) can mitigate the effect of low family support. Given the importance of sleep on mental and physical health, study results may help shed light on persistent health disparities across sexual orientations.

METHODS

Our sample included 1703 LGB individuals from the UK Household Longitudinal Study (UKHLS). Mixed-effect logistic regressions were used to estimate the effect of family and friend support on the development of sleep problems after 24 months while controlling for potential confounders. A modified Pittsburgh Sleep Quality Index was used to measure 1) presence of any sleep problems, 2) short sleep duration, and 3) poor sleep quality.

RESULTS

Family support at baseline was independently associated with all sleep problems in our study after 24-months: 1 SD increase in family support was associated with a 0.94 times lower risk of sleep problems (95% C.I = 0.90-0.98), a 0.88 times lower risk of short sleep duration (95% C.I = 0.81-0.95), and a 0.92 times lower risk of sleep quality (95% C.I = 0.93-0.98). Support from one's chosen family (proxied by friend support) did not mitigate the effects of low family support on sleep problems.

CONCLUSIONS

Our study found a consistent effect of family support across all sleep outcomes along with evidence of a persistent effect after 24 months. Our findings point to the importance of targeting family support in designing interventions aimed at reducing LGB sleep problems.

A Research Note Describing a More Inclusive Approach to Identifying Same-Sex Cohabiters in the American Time Use Survey

Identification of individuals in same-sex relationships in the American Time Use Survey (ATUS) is of increasing interest to the research community. While the ATUS interviews one person per household, by using information about who else lives in the household, researchers can easily identify respondents in coresident same-sex couple arrangements. Previous research has outlined two approaches to identifying individuals in same-sex relationships in the ATUS that use information on the sex of household members. We extend that work in this research note by using additional information collected from a direct question to identify unmarried cohabiting partners in the Current Population Survey (CPS). We identify 23% more individuals in cohabiting same-sex relationships when we use the CPS direct question information than when we use information from the ATUS alone. We argue that this identification strategy is more inclusive of individuals in same-sex cohabiting relationships.

Self-Continuity Moderates the Association Between Sexual-Minority Status Based Discrimination and Depressive Symptoms

Self-continuity, or how an individual understands their sense of self as persisting from past to present and present to future, is an important aspect of the self-concept that is linked to mental health outcomes. This self-concept construct may be particularly pertinent for sexual minority populations, as living in a heterosexist environment may prove detrimental for the development of self-continuity. The current study examined self-continuity among sexual minority and heterosexual community college and university students (N = 292). Compared to their heterosexual peers, sexual minority participants reported lower levels of self-continuity. Self-continuity moderated the associations between victimization due to gender nonconformity and victimization due to sexual minority status and depressive symptoms, such that higher levels of self-continuity were protective among individuals who were experiencing higher levels of victimization due to gender nonconformity or sexual minority status. Findings will be discussed in terms of their implications for identity development among emerging adults.

Gender Dysphoria, Mental Health, and Poor Sleep Health Among Transgender and Gender Nonbinary Individuals: A Qualitative Study in New York City

Background: A vast amount of research has demonstrated the numerous adverse health risks of short sleep duration and poor sleep health among the general population, and increasing studies have been conducted among lesbian, gay, and bisexual individuals. However, although poor sleep health is disproportionately experienced by sexual and gender minority populations, little research has examined sleep quality and associated factors among transgender and gender nonbinary (TGNB) individuals. This study qualitatively explored the relationship that factors such as gender identity, mental health, and substance use have with sleep health among a sample of TGNB individuals in New York City. Methods: Forty in-depth interviews were conducted among an ethnically diverse sample who identified as transgender male, transgender female, and gender nonbinary from July to August 2017. All interviews were transcribed, coded, and thematically analyzed for domains affecting overall sleep, including mental health, gender identity, and various coping mechanisms to improve overall sleep. Results: TGNB interview participants frequently described one or more problems with sleeping. Some (15%) participants suggested that mental health issues caused them to have difficulty falling asleep, but that psychiatric medication was effective in reducing mental health issues and allowing them to sleep. An even larger number (35%) told us that their gender identity negatively impacted their sleep. Specifically, participants described that the presence of breasts, breast binding, stress and anxiety about their identity, and concerns about hormonal therapy and gender-affirming surgery were all reported as contributing to sleep problems. Given these sleep challenges, it is not surprising that most (60%) participants used various strategies to cope with and manage their sleep problems, including prescription and over-the-counter sleep medications (33%) and marijuana (18%). Conclusions: Our findings document that sleep health is frequently an issue for TGNB individuals, and they also offer insight into the various ways that TGNB individuals attempt to cope with these sleep problems. Sleep health promotion interventions should be developed for TGNB people, which would promote positive mental health, reduce the risk of pharmaceutical adverse events, and help alleviate psychosocial stress in this target population.

The relationship between minority stress and biological outcomes: A systematic review

Sexual minority (non-heterosexual) individuals experience higher rates of physical health problems. Minority stress has been the primary explanatory model to account for this disparity. The purpose of this study was to identify in published research empirically established relationships between minority stress processes and biological outcomes and identify avenues for future research. The PubMed database was queried with search terms relevant to minority stress and a comprehensive list of physical and biological outcomes. To be included in the analysis, studies had to examine the relationship between minority stress and a biological outcome among sexual minority individuals. Those meeting inclusion criteria were coded for key variables including methodology used, positive and null results, participant characteristics, and specific minority stress processes and biological outcomes considered. In total, 26 studies met inclusion criteria. Studies tested relationships between specific minority stress processes including prejudice, expectations of prejudice, concealment of sexual orientation, and internalized stigma and multiple biological outcomes, such as overall physical health, immune response, HIV specific outcomes, cardiovascular outcomes, metabolic outcomes, cancer related outcomes, and hormonal outcomes. Studies included both analyses that detected this relationship (42% of analyses) and analyses that did not detect this relationship (58%). There is substantial evidence to support the relationship between minority stress and biological outcomes, yet additional research is needed to identify the measurements and outcomes that have the most rigorous and replicable results.

Sexual orientation and sleep difficulties: a review of research

Is sexual orientation associated with sleep difficulties? In this article, we review empirical evidence that addresses this question. Stress is associated with sleep difficulties such as insomnia and, because members of sexual minorities experience greater stress, on average, than do others, lesbian, gay, and bisexual (LGB) individuals can be expected to report more sleep difficulties than their heterosexual peers. We reviewed 17 studies published since 1990, with data gathered from more than 600,000 individuals; some included data on both quantity and quality of sleep. In nine of 12 relevant studies, at least some sexual minority individuals reported shorter sleep duration than did heterosexual individuals, on average. In nine of 10 relevant studies, sexual minority individuals reported lower quality sleep, on average. Few data were available about other aspects of sleep as a function of sexual orientation. No investigators found LGB people to have fewer sleep difficulties than did heterosexual individuals. We conclude that, although research in this area is new and still limited in some respects, sleep difficulties are more common among LGB than heterosexual people. Our conclusion suggests the possibility that sleep difficulties may underlie known health disparities among members of sexual minorities. Further research is needed to evaluate differences in sleep difficulties among members of sexual minorities, and to explore treatment options for LGB individuals suffering from sleep difficulties.