Pauline Anderson

April 13, 2017

For women, but not men, having children in the home affects how much sleep they get, and the more children, the more their sleep is affected.

Gathering information on what contributes to insufficient sleep could help target approaches to achieve optimum sleep, which in turn can improve overall health, said researcher Kelly Sullivan, PhD, Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro.

"Our 'go, go, go' kind of push to do more, do more, do more, and the influence of electronics, is making us chronically sleep deprived," said Dr Sullivan.

Dr Kelly Sullivan

"I wanted to focus on what factors are associated with getting insufficient sleep so we can figure out how to best approach this to offer solutions."

Their findings were released February 26 and will be presented at the upcoming American Academy of Neurology (AAN) 2017 Annual Meeting.

The researchers used data from the 2012 Behavioral Risk Factor Surveillance System, an annual nationwide telephone survey conducted by the Centers for Disease Control and Prevention.

The survey, which Dr Sullivan described as "the largest continuously conducted health survey system in the world," queries respondents on their health-related behaviors: for example, on screening for breast or prostate cancer or their approach to diabetes management.

Included in the survey are questions about sleep, including how many hours of sleep respondents get per day. Researchers categorized this as an optimum amount of sleep, defined by the National Sleep Foundation as 7 to 9 hours per day, or insufficient sleep, less than 6 hours per day.

As well, survey participants provided information on the number of days in the past month that they felt unrested.

The survey provided data on participants' body mass index, age, race, education, marital status, exercise, number of children in the household, employment status, income, and snoring. Researchers adjusted for these predictors and stratified them by sex.

The study included information on 2897 men and 2908 women.

In the entire study, 23% of men reported less than 7 hours of sleep per day and 77% reported 7 or more hours of sleep a day. Among women, 21% reported less than 7 hours and 79%, 7 or more hours of sleep.

In men, longer sleep was associated with higher education (P = .0002) and snoring (P = .02). Among women, having children was inversely associated with sleep duration (P = .002), while being unemployed (P = .009) and having a higher household income (P = .03) were associated with longer duration.

Younger Participants

The analysis also looked at the amount of daily sleep among younger participants. In men under age 45 years, 30% reported less than 7 hours and 70% reported 7 or more hours, while in women in this age category, 25% reported less than 7 hours and 75% reported 7 or more hours.

In younger women, 48% of those with children reported getting optimal sleep compared with 62% of those without children.

Looking at factors associated with sleep among those younger participants, researchers found that men with less than a high school education were more likely to report insufficient sleep compared with college graduates (odds ratio [OR], 10.00; 95% confidence interval [CI], 1.87 - 53.42). As well, snoring was inversely associated with insufficient sleep (OR, 0.31; 95% CI, 0.11 - 0.87).

"The snoring finding does contradict what has been widely established about snoring as a risk factor for poor sleep," said Dr Sullivan. But because of the limitations of the data on snoring — it was self-reported and relatively few men reported on it — it's probably not that insightful, she said.

In younger women, the only variable associated with insufficient sleep was having children. Each child increased the odds by nearly 50% (OR, 1.46; 95% CI, 1.14 - 1.87).

Dr Sullivan said she wasn't expecting children to come up as the only factor associated with insufficient sleep in younger women or that there would be "no association at all for men."

"I actually was surprised because I was thinking along the lines that some of the other typical things, like employment or income or exercise, would be a main factor" in these younger women.

It's unclear what exactly is causing the disparity, said Dr Sullivan. "As amazing as the data set and survey are, we don't have any insight into family dynamics. That's a major limitation in trying to figure out the meaning or reasons behind the findings."

Research shows that a woman's brain is different than a man's brain, as are her sleep cycles, said Dr Sullivan. And there are biological differences in women to consider, such as hormonal changes in pregnancy, menopause, and throughout the menstrual cycle, and the demands of breast feeding, she said.

Dr Sullivan noted that other studies have shown that women need more sleep than men to feel adequately rested.

In this study, having children in the home was associated with feeling unrested among younger women (P = .001) Those with children reported feeling unrested 14 days in a month compared with 11 days for those without children. Again, this was not true for younger men (P = .10).

Dr Sullivan stressed that the relationships respondents had with the children in the household wasn't clear. They may not be biologically related, or they could be older siblings of children in the home.

Sleep a Priority

The study results highlight the importance of "prioritizing sleep," said Dr Sullivan. Traditional sleep hygiene techniques (eg, no electronics in the bedroom, no caffeine before bed) may help as might stress management.

The study findings were also not surprising to sleep medicine specialist Donn Dexter, MD, vice chief medical officer, Northwest Wisconsin Region, Mayo Clinic Health System, Eau Claire; assistant professor, neurology, Mayo Clinic College of Medicine; and fellow of the AAN.

Asked to comment on the research, Dr Dexter noted that because the information came from a phone survey, there may not be enough data collected to "support any strong theory" as to why younger women with children in the home are falling behind in their sleep

He reflected on his own experience of having three young children at home. "Even though I tried to be a responsible dad, I think most of child-rearing chores, and certainly getting up at night for a kid who was sick or crying or teething, fell to my wife." He estimated that when it came to child-related duties, the split between him and his wife was probably "close to 70-30(%)."

He stressed that he hasn't done "exhaustive research" on the topic but has the impression that despite the sexes being more equal in many respects, "chores at home and household duties still fall disproportionately to women."

He questioned whether much progress has been made in this area. "It would be interesting to look back, say, to the 1930s or 1960s and compare it to now. I wonder if there would be any change."

In commenting on the findings of snoring among men, Dr Dexter agreed that "you can't relate quality of sleep with quantity of sleep"

"People who snore may sleep more hours but may not be getting good sleep, so you have to be really careful about using time as a marker for quality."

AAmerican Academy of Neurology 2017 Annual Meeting (AAN). Abstract P3.060. Presented April 25, 2017.

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