SCIENCE science.org 29 OCTOBER 2021 • VOL 374 ISSUE 6567 555can get that sleep.” Recommendations
have to be applicable to everyone, even a
single mom who works two jobs and has
two kids, he says.
For a study published last year, Jean-
Louis and his team created a website that
features Black people sharing their expe-
riences with sleep apnea. “They can see
themselves through those stories,” Jean-
Louis says. “If your brochures only depict
white men and women ... [Black people]
don’t relate to this, they don’t
even open it up.” In a ran-
domized trial, the researchers
found that participants who
used the website reported feel-
ing more able to seek sleep
apnea evaluation and adhere
to treatment, which involves a
machine that delivers pressur-
ized air through a face mask to
keep the airway open.
Jean-Louis says Black pa-
tients sometimes don’t feel
welcome in sleep clinics and
mistrust medicine and physi-
cians, so he advocates testing
these patients at home. Seixas
is developing a kit with sev-
eral wearable devices to screen
patients of color for sleep dis-
orders, upload their data, and
then provide tailored sleep
health advice.
Alcántara, meanwhile, is
working to improve access to
insomnia therapy for Hispanic
people. Therapy for Spanish
speakers “is virtually non-
existent,” she says. In a review
published earlier this year,
Alcántara and her colleagues
found that of 8182 randomized
clinical trials of behavioral in-
terventions to improve sleep,
only 7% targeted underserved
groups, and only one included
Spanish in the treatment.
Cognitive behavioral ther-
apy for insomnia (CBT-I) is the
gold-standard treatment for
this sleep disorder. It involves
a therapist who helps the patient identify
thoughts, feelings, and behaviors that in-
terfere with sleep, and suggests ways to
mitigate them. At Columbia, Alcántara
is currently adapting a digital version of
CBT-I approved last year by the U.S. Food
and Drug Administration—the first of its
kind—for Spanish-speaking Hispanic peo-
ple. “Adaptation is more than translation,”
she says. It involves understanding cul-
tural details and family dynamics, such as
which family members Hispanics are mostlikely to trust on medical matters, she says.
Next month, she and her team will begin to
enroll participants with insomnia in a trial
of the culturally adapted CBT-I therapy.TWO MONTHS AGO, Jean-Louis moved to Mi-
ami to launch a Translational Sleep and
Circadian Sciences Center at the Univer-
sity of Miami. His new lab aims to probe
one factor that could make Black people
more vulnerable to poor sleep: There issome evidence that compared with white
people, Black people have shorter daily
sleep-wake cycles, more readily disrupted
by shift work, light pollution, and other
factors. “I’ve been puzzled by this for about
20 years,” Jean-Louis says. “We want to get
to the bottom of this.” He’s also building a
new network of pastors and barbers in the
area for his outreach work.
But engaging with communities of color
is only a small part of what’s needed, he
and others say. Physicians must also play arole, for example. “The training that physi-
cians receive in medical school about sleep
is very, very limited,” Brown says. And al-
though the number of sleep specialists has
been increasing, “there’s not enough [of
them] treating the people that need to be
treated,” Johnson adds. “We need more in
the right places.”
For the first time, the Department of
Health and Human Services earlier this
year included improving sleep as one of
the main disease prevention
goals for the next decade.
Brown, who chaired the work-
ing group that came up with
sleep objectives for the project,
called Healthy People 2030, is
elated that improving sleep is
now a national health priority.
She is disappointed, however,
that tackling sleep disparities
wasn’t ultimately included, de-
spite all the evidence she and
others presented to decision-
makers. But she’s not deterred.
“I am an eternal optimist,”
she says. “It may take us until
Healthy People 2040, but, you
know, we’re pushing.”
Sleep research is starting to
influence policy. In 2019, Cali-
fornia became the first state to
mandate later school times to
accommodate children’s and
teenagers’ circadian rhythms.
And research on shift work
has informed guidelines in
the aviation industry and for
health care workers, aimed at
mitigating the negative health
effects of sleep disruption.
These policy wins don’t
tackle sleep health disparities
specifically, but Johnson is
quick to point out steps that
could. Raising the minimum
wage so people don’t have
to work multiple jobs and
do shift work, implementing
noise and light pollution regu-
lations, and improving health
care access to people of color
through telemedicine are among the ideas
Johnson and a colleague proposed in an
editorial published last year.
For Alcántara, changing policy to im-
prove the sleep of Black, Hispanic, and
other people of color in the country is at
the core of fighting structural racism. “If
we’re thinking about addressing sleep as a
social justice issue, then yes, you have to
focus on the policies that are driving who
has the luxury of sleeping well and who
PHOTOS: TOP TO BOTTOM GIRARDIN JEAN-LOUIS; MIKE YAMIN AND AZIZI SEIXAS doesn’t,” she says. j
Sleep researcher Girardin Jean-Louis recently visited Trinity Baptist Church in North
Miami, Florida, to speak with churchgoers about the importance of sleep for overall
health and wellness (top). At New York University, Azizi Seixas (bottom, center) uses
digital tools to screen people in the Black community for potential sleep health issues.