For people living on the streets or in shelters, sleep deprivation can lead to a host of other problems.
“Joe,” a man who has been homeless several times, knows how difficult it can be to get enough sleep without permanent housing.
“Where and how you sleep is often a matter of discipline when residentially challenged,” said Joe, who recently moved to Seattle from the Bay Area. “If you're sleeping in a car or RV, shelter or friend's couch, you have the issue of finding a place to sleep and being up and about before the rest of the world is. Usually in a shelter, you have to be up and out by a certain time. If [you’re sleeping in] a vehicle, you have to have it moved by a certain time. If you're working you have to find ways to make the job fit your situation or vice versa. You're on others’ schedules. And this is where sleep deprivation hits the hardest. It adds up.”
Scientists often chide middle-class workers about the dangers of sleep deprivation and poor sleep hygiene. Don’t take your iPad into bed with you; don’t watch that last episode of 30 Rock (guilty and guilty).
Sleeplessness contributes, popular science preaches, to obesity, diabetes, poor diet, and unproductiveness. And yet, even those of us who should have no problem logging a solid eight hours often struggle to get enough.
But for those who don’t have access to a bed, a locked door, and an iPhone alarm, sleep deprivation is caused by more than just the frivolous decision to eat more ice cream at 11:30 p.m.
“Without a doubt, sleep is the biggest issue for homeless people,” writes San Diego-based blogger and self-proclaimed “chronic homeless man” Kevin Barbieux, who writes under the name The Homeless Guy. Barbieux, who has alternated between transitional housing and no housing at all, updates his blog either through his donated laptop or by using the computers at his local library.
“Homeless advocates are always focused on what are believed to be the root causes of homelessness, and providing the basics of food shelter and clothing to those who do without,” he continues. “And although those things are important in their own way, they don't affect homeless people with the intensity that sleep does (or the lack thereof).”
For individuals without permanent housing, sleep is difficult to come by. When there’s no way to secure your personal belongings, it’s dangerous and frightening to be as vulnerable as we are when we’re in a truly restful sleep.
As a result, sleep becomes a matter of when you can, where you can. And often, you just can’t, leading to a host of other mental and physical ailments.
Sleep deprivation has also been linked to an increase in mental illness, drug abuse among teenagers, and higher rates of violence and aggression. Schizophrenia-like symptoms may also start to develop, which is problematic in a population that already experiences a higher-than-average likelihood of suffering from the disease.
The dangers of the elements (in colder climates, even nodding off in the winter may be a death sentence), the possibility of attack, and the physical maladies that arise from perpetual dampness and grime make achieving good sleep an impossible feat.
Even finding enough ground to stake out can be difficult. The discomfort of homelessness has driven businesses to extreme measures. In London, some buildings have erected “anti-homeless spikes.”
There are also potential legal ramifications. The National Law Center on Homelessness and Poverty has found that “of 234 American cities, 40 percent make it a crime to sleep in public spaces.”
Barbiuex notes that shelters, which are often considered to be the safest, best option by those who aren’t homeless, come with their own set of problems. As he writes in his blog:
You check in to a homeless shelter and hope for the best. But the ‘best’ is not offered at shelters ... After a long period of processing and standing in lines... you'll finally be assigned a bed. You'll find this bed is located in a large warehouse type room with many other beds—more than likely they will be bunk beds, or army cots, (ever try to sleep on an army cot?) You will be in a room with anywhere from 25 to 150 other homeless people, and not all of them will be ready to go to sleep. They will be talking, laughing or yelling, getting into fights (verbal and physical) making noises, the mentally ill will be trying to wind down from their constant hallucinations. As is practiced in many shelters, you'll be required to undress, give your clothes over to shelter personnel to be placed in a closet, you'll have to wear hospital scrubs. You'll be given one thin blanket, regardless of the temperature, you may, or may not be issued a pillow. If you like the cold, you'll sleep well, if not, you could have problems ... After a couple hours, most everyone has settled in to sleep, and you'll get some sleep. But then you'll be awakened, sometimes rudely, at 5 a.m. at most shelters. 5 a.m. every single morning.
Most shelters make it a practice to eject guests long before white-collar workers rise in the morning. By 6 a.m., homeless men and women are wandering the streets, trying to find an open Starbucks or a bus to hop on to catch an extra few moments of shut-eye. By the 8 a.m. commute, they are hidden in plain sight, either in day shelters, or in the doorways and alleys where you’ve probably seen them nodding off.
When the shelters are full, those without full-time housing take refuge in other spaces, which offer varying degrees of safety. Cars provide some measure of privacy but are far from ideal. Storage units, motels, and tent cities are other options.
“I haven’t slept in days,” says a vendor for Real Change, a weekly Seattle paper sold by those in extreme poverty. He requested that I not use his name, and he says he isn’t homeless—he lives in transitional housing—but nonetheless fears for his safety at night.
“It’s better than when I was living on the streets, I guess, but not by a lot. You don’t get a lock on your door. I don’t worry about them stealing my stuff while I’m out here working because I don’t have a lot of stuff, but I worry about, you know ... other stuff. At night. Sometimes, when I make enough out here, I check into a hotel just to sleep in a room by myself.”
New York City is currently debating whether or not housing costs should be considered a matter of healthcare. Common Ground director Brenda Rosen noted in an NPR report that the cost for providing transitional housing services was less than the cost of paying for the three places where homeless individuals usually end up: shelters, jails, and the emergency room.
And yet, says Eowyn Rieke, a physician with Outside In in Portland, Oregon, the problem of insufficient sleep is “an unrecognized” one. Even within the medical community that deals directly with the homeless, “we don’t talk enough about these concerns with our patients.”
Steve Berg, Vice President for Programs and Policy at the National Alliance to End Homelessness admits that sleep, specifically, wasn’t a factor of health that he had necessarily considered. However, the healthcare community has been helping secure funding to get chronically homeless populations into housing.
“The thing we know from research is that housing people in that situation improves their health and reduces cost,” he said. “There are striking reductions in the use of hospitals and emergency rooms. Mainly who it saves money for is the healthcare system. And I think people in the healthcare system have started to understand this.”
The Obama administration is currently pushing to increase funding to the Department of Housing and Urban Development by about $300 million, which would fund rent subsidies for as many as 37,000 chronically homeless people—a number that, Berg says, “would be enough to finally end chronic homeless by the end of 2016.”
“The process of Congress deciding how much money to spend on things is very bogged down right now,” he says, “but eventually they’re going to have to make a decision.”
In the meantime, though, there remain huge gaps in the care of those who sleep outside.
When the weather turns cold, cities open warming shelters. When populations are hungry, food banks and soup kitchens provide nourishment. There are resources for assistance paying utility bills, applying for jobs, even getting to and from work.
But aside from low-income housing, which is often in high demand and still often unaffordable, there is no sleep resource. And without a sleep resource, there seems to be little chance for solving the myriad problems associated with sleeplessness.
“Suffering from a lack of sleep, just how is a homeless person supposed to do all the things necessary for overcoming their homelessness?” asks Barbieux.
This post originally appeared on The Atlantic.