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2011 Health Sleep Study

Survey Results, Observations & Recommendations

Date: January 1, 2011
Investigators: Richard R. Troxell & Hugh Simonich

House the Homeless 2011 Health Sleep StudyAccording to health authorities, people’s need for sleep varies from 5-10 hours per night. The key to the amount of sleep people need is based on two basic factors: quality of sleep and the requirements of the individual.

Neuroscientists believe that quality, uninterrupted sleep is not only critical for basic survival and brain development, but also in converting the day’s experiences into usable permanent memory. According to Dr. Michael J. Breus, a clinical psychologist and both a Diplomat of the American Board of Sleep Medicine and Fellow of the American Academy of Sleep Medicine, “Reducing your nighttime sleep by as little as one and a half hours for just one night can result in reduction of alertness by as much as 32%.”

Insomnia, a sleep disorder, can be caused by conditions such as painful arthritis, or by endocrine disturbances that include the introduction of certain drugs or the withdrawal of others such as alcohol. Other causes include psychological problems including anxiety or depression.

According to Professor Mack Mahowald at the University of Minnesota Medical School, “One complete night of sleep deprivation is as impairing in simulated driving tests as a legally intoxicating blood-alcohol level.” Furthermore, according to Dr. Eve Van Cauter with the University of Chicago School of Medicine, people who do not get enough sleep become “less sensitive to insulin.” Obviously, this increases their risk of diabetes and high blood pressure.

Dr. Cauter’s research indicates that, “Chronic sleep loss may not only hasten the onset but also increase the severity of age-related ailments such as diabetes, hypertension, obesity, and memory loss. Also, it is believed that people, especially men, who fail to get good quality sleep, often are more likely to experience depression.”

Additionally, the increased possibility of stroke has been shown to be related to snoring, sleep duration, and daytime drowsiness. Disordered breathing and disrupted sleep associated with snoring can lead to attention deficits and hyperactivity, as well as asthma, allergies, and aggression.

Finally, scientists, including F. Javier Nieto, M.D., Ph.D., at Johns Hopkins School of Hygiene and Public Health, in a study of 6,100 subjects found “a clear association between increasing frequency of (apnea) events and hypertension particularly among patients classified as obese.”

The following sleep study was conducted by House the Homeless, Inc. in Austin, Texas, on January 1, 2011, at the 10th Annual House the Homeless Thermal Underwear Drive. Of the several hundred participants, only those having experienced shelter stays were asked to participate in the survey. There were 204 respondents. Finally, only non-case-managed individuals were invited to answer the final question.

The question investigates the amount of time required to get through the mat/bed acquisition process. Anyone in case management was excluded from the survey as their bed is assured and their process time is truncated.

Survey Results

Shelter Sleepers ONLY
Respondents: 204

1. About how many hours of good, solid sleep do you get each night on average?

5.1 hours — the average for all 204 respondents.
93.1% responded they need more sleep.

2. About how many minutes does it usually take you to fall asleep?

25% responded that it takes them one or more hours.
50% responded that it takes one half hour or longer.

3. If you are awakened, how long does it take you to get back to sleep on average?

Over 30% responded that it takes them one or more hours.
Approximately 2.5% responded that they do not return to sleep at all.

4. What wakes you up?

64.0% Snoring
64.0% Loud talking
39.0% Doors slamming
27.5% Telephones
25.0% Alarm clocks
24.5% Traffic noise
21.6% Leg pain or twitching
18.1% Trash removal
11.3% Gasping for breath
08.0% Computer activity
10.3% Other.

5. Do people tell you that you snore?

Over 40% responded yes.

6. Where do you usually sleep?

Over 82% sleep at the ARCH — 40% on the first floor; 24% on the second floor; over 18% on the third floor.
Over 32% sleep at the Salvation Army.

7. What keeps you from sleeping?

Over 51% responded that their mind keeps racing.
Over 27% responded that they fear being hurt.
10% responded that they hear voices in their heads.

8. Do you dream?

Of the over 77% who responded yes — over 39% have violent dreams; 72% have dreams that wake them up.

9. When you wake in the morning, do you feel rested?

Over 68% responded no;
Over 71% say they are so tired, they cannot function normally during the day.
Over 50% say this feeling of fatigue lasts three or more days.

10. By computing the weight and height of each of the 197 responding individuals, and using the Body Mass Index, or BMI, we calculated that:

66% are overweight;
Over 50% of those are considered to be obese.

11. Demographics:

88% of respondents were male; 12% were female.

12. Medications taken for following conditions:

21.0% Depression
13.0% High Blood Pressure
16.0% Sleep
06.0% Diabetes.

13. Have you been diagnosed with:

Please check or circle all that apply:

51 High Blood Pressure
23 Memory Problems
20 Anger Issues
19 Diabetes
14 Restless Leg Syndrome
13 Schizophrenia
12 Sleep Apnea
11 ADHD
08 Chronic Fatigue Syndrome
06 Chronic Snorer
06 Seizures
05 The Shakes (feelings of instability)
03 Bi-Polar Disorder
02 Schizoaffective Disorder

123 Depression:
43 Mild
51 Moderate
29 Severe

34 Eat way too much
61 Eat way too little
13 Sleep way too much
103 Sleep way too little
58 None.

14. Non-Case Management people ONLY:

On average, how many hours a day does it take you to get approved or denied for a mat or bed?

11 1 hour
15 1.5 hours
35 2 hours
19 2.5 hours
47 3 hours

85 On case management or non-responsive.

Findings and Observations

1) With people receiving only 5.06 hours of good solid sleep on average, this is at the very low end of minimally satisfactory sleep requirements. This leaves the vast majority (190 out of 204) stating that the amount of sleep they need is less than the amount they receive.

2) Only about 1/3 of the shelter consumers, upon waking in the morning, felt rested.

3) 143 out of 204 shelter users OR 70% reported that they occasionally felt so tired that they could not function normally during the day.

4) 103 or half of the shelter consumers interviewed (204) woke feeling that they could not function normally during the day and this feeling lasted three days or more.

5) 180 people surveyed (88%) take 15 minutes or longer (beyond an hour) to fall asleep.

6) 158 people (77%) required 15 minutes or longer to return to sleep once awakened.

7) 130 people (64%) said that loud talking alone was a significant factor involved in waking them up. Other controllable noise factors included ringing telephones (56), alarm clocks (51), doors slamming (79), computer activity (16), traffic noise (16), and trash removal (37).

8) 82 people in the study have been told by others that they snore, but only six people reported to have been diagnosed as being a “chronic snorer.”

9) Only about half (27) of the people diagnosed with high blood pressure (51) are being treated for that condition.

10) 47 out of 127 people not on case management said that it took them three hours or more to get approval or denial for a mat or bed. At the same time, 35 out of 127 said the same process took them two hours or more.

Recommendations

1) Further study is required to explore the relationship between sleep deprivation and the health condition of people sleeping at city shelters.

2) Individual sleep study research should be conducted on site at shelters.

3) Specific steps should immediately be taken to reduce or eliminate controllable noise factors:

a) Ringing telephones should be replaced with flashing light telephones.
b) All alarms should be silenced.
c) Slamming doors should be muted.
d) Isolate or end all computer activity.
e) Install sound deadening materials in the ceiling and walls.
f) Delay trash removal until waking hours.
g) Stop all unnecessary loud talking.

4) Encourage all smokers to enter a smokers cessation program in an effort to help address snoring.

5) Coordinate with the Community Care Health Clinic to ensure that people with unmet health needs begin to be addressed.

6) Expedite the application process for securing a mat or bed so that it does not exceed one hour in length for non-case-managed applicants.

7) Coordinate dietitians and shelter food providers to create healthful, nutritional, and balanced meals incorporating the findings of this report.

8) Involve people experiencing homelessness in designing and running non-contact exercise/sports programs.

9) Explore the possibility of shelter-wide “White-Noise” remediation application to mask ambient shelter sounds.

Additional House the Homeless Research & Commentary

The following documents [MS Word format] can be downloaded by clicking the links below:

HtH Health Questionnaire Austin 2010
Connecting the Dots, Austin
Health Survey: No Sitting Ordinance Responses
Health Survey Testimony
Health Survey: Request for Sitting Permits
Confidential Health Survey Questionnaire
Health & Work Surveys