Volume 3, Issue 1, Summer 2014
SLEEPING WITH ONE EYE OPEN
By Maryellen Hess Cameron
Managing Editor: Matt Kaku, M.S.
Sleeping under a bridge. Sleeping on a park bench. Sleeping in a car.
These images spring to mind when someone talks about homelessness because these are common places for the homeless. The misnomer is in the word “sleeping.” While homeless people may catch a couple of hours of sleep here and there, it is neither restful nor sufficient for good health.
Personal wellness depends on at least seven or more hours of restful sleep per night. There is laboratory evidence that short sleep durations of 4-5 hours have negative physiological and neurobehavioral consequences. Homeless people have little opportunity to obtain even this level of good sleep for many obvious reasons:
Safety is compromised by homelessness. Robbery and assault are constant threats.
Police interrupt people sleeping outside. Sometimes they will wake people up just to tell them to move along, as if they have anywhere else to go.
In some communities, homelessness is now a crime and the police have to arrest homeless people.
Other homeless people may wake a sleeping person for more innocent reasons. It could be just to bum a cigarette. It could be a person in the throes of a manic episode, characterized by rambling, and rapid speech.
Something as universal as the urge to go to the bathroom can be a big interruption to sleep. Unlike a housed person, a homeless person must find a public bathroom open all night. Before they can even do that, they have to gather up all their belongings so they won’t get stolen. There is no chance they will easily return to sleep.
Weather conditions are a huge factor. Do we really think a person can sleep well in the rain or cold? Excessive heat can be equally disruptive to a person's sleep. Think of tossing and turning during a heat wave.
Shelters are stretched to capacity. In my community we have waiting lists for the shelters.
Even shelters are not particularly restful places. They resolve the obvious issue of exposure to the elements. People have at least a cot and a pillow. But shelter residents are mixed in with others who talk at night, pace or snore loudly enough to drown out a train.
It is intuitive that severely mentally ill people are at risk of homelessness. They struggle to maintain steady income. They are often estranged from family or friends, leaving them without any support systems. Their symptoms and related behaviors interfere with lease compliance, leading to eviction.
On the other hand, there have always been people who experience homelessness due to other reasons. They lost their jobs. Medical bills pushed them into bankruptcy. The housing foreclosure crisis forced them out of their homes and ruined their credit. Such individuals may have enjoyed reasonably good mental health all their lives until the trauma of homelessness hit.
The effect of sleep deprivation on homeless people is profound. Studies are showing that sleep deprivation can bring on psychosis. In fact, sleep deprivation creates so much misery, it is used as an “enhanced interrogation technique” in hostile situations. There are well documented correlations between insufficient sleep and deterioration of physical and emotional health.
The latest research findings add to the growing body of scientific knowledge indicating that sleep problems cause dysfunction in the brain. Those dysfunctions may contribute to emotional difficulties and psychiatric conditions.
According to research conducted at the University of California at Berkeley, sleep deprivation compromised participants’ ability to judge emotion in human faces. Consider how debilitating this can be for a person who is already suffering from paranoia.
Just one night without sleep can lower inhibition and increase impulsive reactions to negative stimuli. Negative stimuli are everywhere for the homeless.
Lack of sleep makes most of us cranky and short tempered. Our stress levels increase. High stress can make it more difficult to sleep, and people may fall into a vicious cycle.
A study co-authored by Dr. D. F. Dinges of the Perelman School of Medicine reported a progressive increase in emotional disturbance across a seven-day period. In addition, subjective descriptions in participants' daily journals indicated increasing complaints of emotional difficulties.
Many mental disorders have a side effect of sleep problems, particularly among those with depression and bipolar disorder. Sleep problems and schizophrenia may have common roots. This means researchers may be able to mitigate this devastating disorder by helping patients overcome insomnia. Treatment for insomnia could backfire on people who cannot sleep safely.
Identifying the number of homeless people with mental illness is a moving target. Homeless people are transient. Yet actual street counts tell us that anywhere from 25 to 35% of the homeless population have a severe mental illness.
If 25 to 35% of homeless people have an existing mental illness, are we actually fostering mental illness among the remaining 65 to 75%? The possibility that we are doing that is real. Evidence shows persistent sleep deprivation will ravage one's mental health. Until we provide homes for people who do not have them, we are magnifying economic damage and human suffering.
Homelessness and mental illness often go hand in hand, one perpetuating the other. Housing provides a safe and private place for homeless people to relax and sleep and thus helps prevent the psychosis sleep deprivation can cause. For those already coping with mental illness, housing is an effective treatment for the positive symptom of insomnia. This means housing is both inexpensive and efficacious health care.
Homeless people must sleep with one eye open as part of their survival. Only housing can break this cycle.
Maryellen Hess Cameron is Executive Director of ICAN Housing in Canton, Ohio, an agency that serves over 1,000 homeless people per year with street outreach, emergency housing, permanent housing and housing case management. She is also the author of Come and Get Me, a fictionalized account of one woman’s desperate escape from domestic violence.
1. “How Much Sleep Do We Really Need?” (retrieved June 5, 2014) National Sleep Foundation. http://sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need
2. Coren, Stanley. “Sleep Deprivation, Psychosis and Mental Efficiency.” Psychiatric Times (March 01, 1998). http://www.psychiatrictimes.com/articles/sleep-deprivation-psychosis-and-mental-efficiency?pageNumber=1
3. Miller, Greg. “Memos shed light on CIA use of sleep deprivation.” Los Angeles Times. (May 10, 2009). http://articles.latimes.com/2009/may/10/nation/na-interrogate10
4. Breus, Michael J. “Sleep Habits: More Important Than You Think, Chronic Sleep Deprivation May Harm Health.” (retrieved June 5, 2014) http://www.webmd.com/sleep-disorders/features/important-sleep-habits
5. van der Helm, Els; Gujar, Ninad; Walker, Matthew P. “Sleep Deprivation And Recognition Of Human Emotions.” Sleep. Volume 33, Issue 03. http://www.journalsleep.org/ViewAbstract.aspx?pid=27729
6. Dinges, D.F.; Pack, F.; Williams, K.; Gillen, K.A.; et al. “Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5 hours per night.” Sleep. 1997 Apr; 20(4):267-77. http://www.ncbi.nlm.nih.gov/pubmed/9231952
7. Breus, Michael J. “Sleep Habits: More Important Than You Think, Chronic Sleep Deprivation May Harm Health.” (retrieved June 5, 2014) http://www.webmd.com/sleep-disorders/features/important-sleep-habits