New study reveals socioeconomic ties to sleep disorders in rural Appalachia
Researchers at the University of Kentucky, in partnership with colleagues at the University of Miami and the University of Arizona, discovered that adults living in rural Appalachian communities face a significantly higher burden of sleep disorders than previously understood.
This confirms something many living in the region already see and feel every day — bad sleep leads to hardship, and hardship leads to bad sleep. Sleep disorders are part of a stark gap in healthcare outcomes shaped by economic and social factors.
The ongoing research project, Researching Sleep Time in Kentucky Communities (REST-KY), found that 64.9% of participants suffered from clinically significant insomnia. This rate is more than six times higher than the 10% national average.
“It’s not just, ‘I cannot sleep.’ There’s a significant impact of mental health driving these high rates,” said Daniela Moga, co-lead on the study, assistant dean for research and the Larry H. Spears Endowed Chair in Pharmacogenetics at the UK College of Pharmacy.
To capture these data, the UK team recruited 327 participants from 12 economically distressed Eastern Kentucky counties: Adair, Bell, Estill, Jackson, Knott, Letcher, Lincoln, Perry, Pike, Rockcastle, Russell and Whitley. The researchers then followed the participants for two years, with detailed surveys and two-week intensive tracking periods every six months.
The socioeconomic gradient of insomnia
The study, recently published in JAMA Network Open, highlights how social determinants of health fundamentally shape sleep quality in underserved regions. The research team identified a “steep socioeconomic gradient” regarding insomnia.
According to the data, the prevalence of insomnia reached 82.9% among participants earning less than $20,000 annually. In contrast, the rate dropped to 44.4% for those earning more than $100,000. Beyond income, the study found that insomnia was significantly associated with being female, living alone, cigarette use, poor diet quality and trauma history.
Although insomnia was the most prevalent issue, the study also looked at several other sleep deficiencies and found that about 51.3% of the participants faced an elevated risk of obstructive sleep apnea (OSA), compared with a national average of roughly 38%. Additionally, 44.8% of those surveyed reported insufficient sleep duration, which is defined as getting less than seven hours of sleep per night.
The data also revealed that 37.1% of participants suffered from moderate to severe anxiety or depression and 62.1% reported moderate to high stress.
Additional data from REST-KY, published last year in the Journal of Affective Disorders, found that greater social support was associated with lower insomnia severity, and this relationship was mediated by depressive symptoms (69%), anxiety symptoms (64%) and perceived stress (78%).
“One of the most meaningful findings is how closely sleep is connected to broader life circumstances, such as financial stability, overall health and social support. That gives us clearer direction for how to support better sleep in ways that are realistic and community-informed,” said Emily Slade, associate professor at the UK College of Public Health and one of the study’s authors.
What’s next?
Because healthcare access, cost and travel time are significant barriers in rural Appalachia, the researchers are focusing on interventions that do not require a visit to a physical clinic.
In a previous study funded by the Building Interdisciplinary Research Careers in Women’s Health program, Moloney and Moga tested a cognitive behavioral therapy intervention delivered via an app to women aged 45 and older in Eastern Kentucky.
“We were able to show that not only did they improve their sleep outcomes, they also reduced the use of medications to help with treating insomnia,” Moga said.
The team has since submitted a grant to bring a similar app-based intervention, called Somryst, to the counties involved in the REST-KY study. These digital tools are designed to address both sleep and mental health while overcoming the stigma and transportation burden sometimes associated with seeking traditional care.