By Michael Breus, PhD, ABSM
In the past few years there’s been much attention paid to obesity as an emerging worldwide health crisis. Among the other global health problems that have rightly received notice in recent years are HIV, malnutrition, and chronic diseases that are on the rise around the world.
But what about sleep?
The truth is, we don’t know very much about sleep problems on a global level, particularly among developing nations. A new study addressed this gap in research, and returned some striking and sobering results, estimating that as many as 150 million people worldwide are currently suffering from sleep problems.
Researchers at the UK’s University of Warwick Medical School conducted a large-scale, multi-national study of sleep problems among eight countries in Asia and Africa. The goal? To assess the frequency of sleep problems in these areas of the world where sleep issues have been under-examined.
Their results showed an overall rate of nearly 17% of the populations in these developing nations suffering problems with sleep. This is a figure not too far from the average 20% of the populations of the developed world that is believed to struggle with sleep problems of one form or another. But in studying the prevalence of sleep problems in these mostly rural areas of developing nations on two continents, researchers found a great deal of variation in the frequency of sleep difficulties. Some areas experienced very low levels of sleep problems and other areas met and in some cases exceeded the levels of sleep difficulties experienced in developed nations.
Researchers did find some consistency in results among these different areas of Africa and Asia:
- Sleep problems are more common among women and older adults
- Sleep problems are more often found among people with lower education, people who are not living with a partner, and those who report lower self-rated quality of life
- Sleep problems are strongly linked to rates of anxiety and depression
Several of these associations—particularly the link between poor sleep and depression and anxiety—are similar to those associations that have been found with sleep problems in developed countries.
Overall, researchers said their findings show rates of sleep problems in these developing nations are higher than what they expected to find.
The study included nearly 50,000 participants—24,434 women and 19,501 men—age 50 and older. The scope of the study included rural populations in Ghana, Tanzania, South Africa, India, Bangladesh, Vietnam, and Indonesia, and an urban population in Kenya. Researchers assessed the quality of sleep among participants over a 30-day period and analyzed this information with social demographic data, including income, education levels, and partnership status. They also looked at physical and mental health and a self-reported measurement of quality of life.
Here are some results from the study that show the range and disparity of sleep problems among these different populations:
- India and Indonesia reported the lowest rates of sleep problems—6.5% of Indian women and 4.3% of Indian men reported difficulty with sleep, and 4.6% of Indonesian women and 3.9% of Indonesian men reported sleep problems.
- Rates in Vietnam were significantly higher: 37.6% of Vietnamese women reported sleep problems, compared to 28.5% of Vietnamese men.
- In South Africa, 31.3% of women and 27.2% of men reported difficulty with sleep. These rates are substantially higher than other African countries included in the study. Overall rates of sleep problems in the remaining African nations of Tanzania, Ghana and Kenya ranged between 8.3% and 12.7%.
- Bangladesh has the highest rates of overall sleep problems among the nations included in this study, driven largely by its exceptionally high rate of sleep difficulty among women. More than 40% of Bangladeshi women reported having problems sleeping, compared to 23.6% of Bangladeshi men.
Researchers point to a number of factors that create particular public health challenges in many of these developing nations. In addition to high rates of poverty among populations in many of these countries, governments and medical communities face pressure to stretch limited financial resources to treat infectious diseases such as HIV and malaria, as well as widespread and growing chronic health problems.
We know what many of the consequences are if widespread sleep problems are left untreated, or poorly managed: populations are at greater risk for a number of chronic diseases and mental health disorders, as well as challenges to daily life and relationships. These are dangerous and expensive problems. And what about solutions? We need to know a whole lot more about the sleep problems facing the developing world. As these results indicate, there’s not likely to be a one-size-fits-all treatment plan for populations facing a range of sleep difficulties. Acknowledging sleep as a serious global health concern, and directing research towards understanding the problems and developing targeted treatments, is a good place to start.
Michael J. Breus, PhD
The Sleep Doctor™