0142 Too tired to sleep: A social-ecological exploration of insomnia in Appalachian women

Abstract

Abstract Introduction Appalachian Kentucky contains numerous “hotspots” of insufficient sleep where 25-58% of adults report insufficient sleep 15+/30 nights. Insomnia, a leading cause of insufficient sleep, is present at higher-than-average rates among the NIH-designed health disparity population of Appalachian adults. Given the strong, bi-directional relationship between sleep and health, a better understanding of insomnia in this population is critical. This study focuses on the gender (women) and age group (45+) at highest risk of insomnia and builds on previous qualitative work exploring the intersections of gender and sleep. Methods Participants (N=46) were Appalachian females ages 45+ who self-reported difficulty falling/staying asleep ≥3 nights a week for ≥3 months and used prescription or over-the-counter sleep aids ≥3 months. Semi-structured telephone interviews were recorded with permission and professionally transcribed. The social-ecological model of sleep served as an interpretive framework. We used a multi-stage, inductive coding process informed by grounded theory and aided by NVIVO 12.0 software. Results Participants most commonly cited social-level issues as insomnia-initiating and perpetuating factors. Caregiving, loss of loved ones, and trauma were prevalent, and often experienced simultaneously. For instance, the death of a child resulted in several participants raising their grandchildren. Caregiving stress, and bed-sharing with, grandchildren perpetuated insomnia. Regional and societal norms (e.g., kinship and gender norms) exacerbated participants’ stressors. Secondarily, women cited a combination of individual-level (e.g., menopause) and/or societal-level (e.g., using technology before bed) insomnia factors. Conclusion Our findings illuminate social processes, social structures, and individual-level factors that contribute to the initiation and perpetuation of insomnia among middle-aged Appalachian women. Our data support previous findings that women in this region are more likely than their non-Appalachian peers to raise their grandchildren, while highlighting this kinship arrangement’s insomnia contributions. These insights may aid health care providers and policy makers aiming to address sleep disparities among the health disparity population of rural Appalachian women. Support (if any) Building Interdisciplinary Research Careers in Women's Health Program (NIDA K12DA035150); Igniting Research Collaborations Grant (University of Kentucky [UK] College of Pharmacy); UK Center for Clinical and Translational Sciences (UL1TROO1998).