Natural Disasters and Sleep
Evidence of the negative downstream psychological consequences of disturbed sleep caused by climate change is highlighted in a 2020 study by Betty S. Lai, PhD, the Buehler Sesquicentennial Assistant Professor of Counseling, Development & Educational Psychology in the Carolyn A. and Peter S. Lynch School of Education and Human Development at Boston College, Chestnut Hill, Mass., and colleagues. They conducted a bi-directional assessment of sleep problems and posttraumatic stress symptoms (PTSS) in 269 children after they were exposed to Hurricane Ike in Texas in 2008. Assessments were taken at eight months and 15 months post-hurricane (J Pediatr Psychol. 2020;45:1016-1026).
Explore This IssueMarch 2021
The study was undertaken to fill a gap in the literature on the effect of natural disasters on sleep in children. “This is a problem because our work and that of others is showing that children may have trouble with sleep after disasters,” said Dr. Lai, who’s the senior author of the study. “Sleep is important in helping children cope with stress.”
I would argue that our role as physicians is to speak about public health issues and be a voice behind public health policy to raise awareness with our legislators. —Neelima Tummala, MD
Overall, the study found that a “sizable minority” of children reported sleep problems at eight months following Hurricane Ike that persisted up to 15 months after the hurricane. Younger-age children and those with higher levels of sleep problems at eight months were at higher risk of having sleep problems at 15 months.
In the study’s main assessment, the investigators found that while PTSS did predict sleep problems, sleep problems did not predict later PTSS. “Post-traumatic stress symptoms seem to contribute to and worsen sleep problems for children,” said Dr. Lai.
Why This Matters to Clinicians
“All healthcare providers need to recognize that climate change will have the greatest healthcare impact, even greater than the COVID-19 pandemic, in the coming decades,” said Dr. Rifkin. “It’s something we all need to start to recognize and realize what we as clinicians can to do help address it, regardless of the area of practice.”
Neelima Tummala, MD, an otolaryngologist and clinical assistant professor of surgery at George Washington University School of Medicine and Health Sciences, Washington, D.C., has a special interest in the effects of climate change on population health. She emphasized that otolaryngologists play a key role in speaking out about public health issues like the effects of climate change on health, both as educators of their patients in the clinic and as spokespersons to help affect policy.
“I would argue that our role as physicians is to speak about public health issues and be a voice behind public health policy to raise awareness with our legislators,” she said. “It starts in the clinic with recognizing that there’s a real risk factor [of the effect of climate change on health] and that we need to do something about it.”
Beyond the larger advocacy role, clinicians also play a role in addressing health issues such as sleep problems related to climate change in their daily clinical practice. Dr. Rifkin urges clinicians to focus more on sleep in terms of health prevention, similar to a focus on exercise and diet. “We spend a third of our lives sleeping, but we focus our health prevention on waking hours,” he said.
To shift the focus to include sleep, Dr. Rifkin and his colleagues have developed a “Restcue Kit” in their clinic for patients who need help with sleep disorders. The kit includes a sleep mask, earphones, a small pen and notebook to record thoughts prior to bedtime, and a lavender-scented stick.
Dr. Tummala also noted that clinicians play a critical role in educating patients about how climate change can affect their health by, for example, providing advice on how to keep their core body temperature cooler when exposed to higher ambient temperature. “This is particularly important for children, who are less able to regulate their own body temperature as compared to adults,” she said.
Dr. Lai also underscored the importance of talking to children who have been exposed to natural disasters to ask how they are doing. “Asking a child whether they are experiencing problems doesn’t make the problem worse,” she said. “Most children report relief that an adult gave them an opportunity to talk about what they’re experiencing.” Dr. Lai noted, however, that before asking children questions, clinicians should be sure to have referrals ready so the child and family can receive help.
Dr. Rifkin highlighted the need for more attention and research on sleep in humanitarian settings. Dr. Rifkin and his colleagues plan to study how their “Restcue Kits” impact sleep in displaced persons, particularly given the high rates of displacement caused by the COVID-19 pandemic that have led to increased homelessness. “People displaced from their homes have a hard time sleeping outside of their normal home environment,” he said. “If they were just given simple things like a sleep kit, it might help.”