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Perchance to Dream: UK Appalachian Study Offers Opportunities to Understand ‘Hot Spots’ for Lack of Sleep Even as Flooding Affects Target Communities 

By Richard LeComte 

LEXINGTON, Ky. -- Abbey Loar, a University of Kentucky junior psychology major, wants to help people in rural communities, and her major offers her the chance to do just that: She’s going to be working on a project to study why people in Appalachia don’t get enough sleep. 

"I want to do research to help improve the mental health of communities, especially like those in Eastern Kentucky,” said Loar, who’s from Hebron, Maryland. "Rural communities don't necessarily have that help available, and I’d like to help communities like that in the future.” 

Loar, is a psychology major, is joining  Mairead Moloney and Christal Badour, associate professors in UK’s Departments of Sociology and Psychology in the College of Arts & Sciences, in “Researching Equitable Sleep Time in Kentucky Communities (REST-KY)." The effort, funded with a $3.5 million grant from the National Institutes of Health, will send researchers into Appalachia for a five-year study to assess why people there have some of the worst sleep in the nation and how it affects their health.  

“We discovered that other researchers had analyzed time use data nationwide and found that the largest hotspots of insufficient sleep are located in Appalachia, and specifically in eastern Kentucky," Moloney said.  

Moloney and Badour’s earlier intervention in the region had revealed high rates of insomnia and other sleep issues, but they decided that further research was needed to better understand the contributing factors.  

The team will track the sleep of 400 adults from 12 Appalachian Kentucky counties along with health information such as heart rate, physical activity, blood sugar levels, and measures of immune function. Moloney said the study will include some sleep studies performed in people’s homes.  

“We're also going to ask people to do things like measure their neck circumference, because that can be a predictive factor when it comes to obstructive sleep apnea,” Moloney said. “We’re using a number of ways to measure people’s sleep, both self-reported, which are more subjective, and more objective factors as well.” 

Participants will also report their daily experiences including stress and substance use. A team of researchers Moloney and Badour have gathered will garner the data for the team.  

“We already have a fabulous team assembled,” Moloney said. “We have Candy Fields, who is our project coordinator, who’s our point of contact out there. She's very well integrated in the community, and she will be helping lead the recruitment in eastern Kentucky. Then we also have a team of graduate and undergraduate folks here at the university who also are helping us out.” 

In addition to Badour and Moloney, the study will draw upon the expertise of: 

  • Suzanne Segerstrom, professor of clinical psychology in A&S. 

  • Lauren Whitehurst, an assistant psychology professor with expertise in cognitive neuroscience in A&S. 

  • Daniela Moga, associate dean for research in the UK College of Pharmacy. 

  • Nancy Schoenberg, UK associate vice president for research and health disparities in the College of Medicine. 

  • Emily Slade, assistant professor in the Department of Biostatistics in the College of Public Health.  

Planning to start the study this fall, Moloney and Badour recruited people with boots on the ground in Eastern Kentucky. They established an office in Whitesburg, but this summer it fell victim to the region’s catastrophic floods. Badour and Moloney have helped with flood relief and are working to get the study back on track. 

"We actually were pleased to head into the field in August with resource dissemination, and we met with our project coordinator who’s based out there,” Moloney said. “But the office that we were getting set up for her is a complete loss structurally, so we are having to pivot.” 

So, what are the factors that are inhibiting sleep in Appalachian Kentucky?  

“The short answer is, we don't entirely know yet,” Badour said. “But we have some hypotheses that we've gathered from our pilot work and existing research.” 

For one thing, Moloney and Badour said lack of sleep is particularly acute among middle-aged and older women.  

“We’ve started interviewing women in Appalachia who have had sleep problems, and we’re identifying some common themes,” Badour said. "Then we also looked at some other national data to compare this geographical area where we've seen the sleep disparities to other places, both other places in Appalachia and other places in Kentucky and nationally, to try to understand what some of the differences might be. Some of the things that came out in our interviews with women were a lot of things related to ongoing stressors that people are encountering in their life.” 

Grandparents particularly seem to be encountering such stressors, especially when they’re taking care of grandchildren. 

“Grandparents are more likely than anywhere else in the United States to be raising grandchildren," Badour said. “So if you think about parenting stress and then grandparenting stress, we have some unique features there.” 

And, of course, domestic violence, economic hardship and a lack of resources add to these stressors. But Eastern Kentucky counties show even more sleep deprivation than other counties with similar economic trends, possibly because of the retreat of coal mining and higher rates of disabilities.   

“These counties happened to be more likely to have a large coal industry presence before the decline of coal and have seen a big drop in their economic opportunity,” Badour said. “It doesn't necessarily mean overall economic opportunity changed, but one might guess that that may be the case. We've also seen that in these areas there's a higher rate of disability than in other counties, and so one hypothesis that people who are staying are people who are perhaps are less healthy.” 

All of these factors could eventually figure into their research, but because they’re just starting, it’s too soon to tell.  

As the study adds to social scientists’ understanding of these hot spots for sleep deprivation, the students involved are picking up key skills and getting to serve communities in need — showing what’s wildly possible in A&S. 

“I’ve learned a lot about time management working on research projects,” Loar said. "In a research project like this, you have deadlines to meet, and you have to be able to reach out to other people and be comfortable communicating with people you don’t know and don’t have a strong connection to.”