A good night’s sleep helps you be your best self: alert, attentive, in a positive mood and ready to function well. A comfortable mattress in a quiet, dark bedroom, a safe, relaxing, temperature-controlled environment and a consistent routine all contribute to healthy sleep.
People who are homeless experience the polar opposite of sleep hygiene: noise, discomfort, weather extremes, anxiety and fear. Sleep disruption undermines their efforts to improve their situations. Below, people who’ve been there talk about how it really feels to struggle to sleep while homeless.
Cars: Not for Sleeping
Even in a car, you still need to sleep with one eye open. One Saturday night several years ago, Paula B. was parked near a District of Columbia hotel, away from the light, as she and the younger of her two sons huddled under a blanket. Three teen boys began knocking on the car windows and trying the door handles. They didn’t realize she was gripping a knife, ready to use to protect herself and her child. Fortunately, the locks held.
Paula became homeless through a series of difficult circumstances beyond her control. She faced multiple challenges while trying to work her way back into a place to call home.
Being crammed inside a car each night didn’t help. “That affects your sleep,” Paula says. “It affects you standing up in line, waiting to go to a clothing closet because you need an extra pair of boots; you need a jacket. It affects you standing in line at a job fair, because you were too exhausted because your back hurts. Your legs hurt. Because you didn’t get much sleep. No matter the size of a vehicle, it is not made to be a shelter.”
Paula knew things could still be worse. “When I was driving my son to the bus stop, I saw people on the street,” she says. “I never laid my head on the ground. I never laid my head on a grate. So I realized this vehicle was not only a safety net — it was a blessing.”
In 2016, Paula arrived at the Patricia Handy Place for Women, an emergency shelter in the District’s Chinatown, run by N Street Village. Through the organization, she now lives in transitional housing, while both of her sons stay with friends nearby. She completed coursework on job-seeking and computer skills and learned jewelry-making while healing from the trauma of homelessness. She intends to find permanent housing and start her own business.
[See: 13 Ways Social Determinants Affect Health.]
Crowded Nights
In 2016, an estimated 550,000 people were homeless in the U.S. Of these, about 374,000 had shelter, while 176,000 were unsheltered, according to figures from the Department of Housing and Urban Development, which sets the criteria for “literal homelessness.”
“Most of the people who are ‘literally homeless’ are not on the street,” says Schroeder Stribling, CEO of N Street Village, which provides temporary shelter, permanent housing and other services to homeless and low-income women in the nation’s capital. “You’re either on the street, in a shelter, living somewhere not meant for human habitation, or doubled- or tripled-up with family or friends.”
Each night, Stribling says, 213 women sleep in the emergency shelter, which is always filled to the point of overflow. The majority of women are over 50.
“More than 85 percent of our population have some history of substance use disorder, mental health issue or both,” Stribling says. “A lot of folks have chronic health conditions. And because they’re older women, all of these things are compounding.”
Bunk beds help accommodate as many people as allowed by the fire codes, Stribling says, although she notes that’s not ideal for restful sleep.
“You can imagine: You’re in a dormitory,” Stribling says. “You’re in the top or bottom bunk. There are all kinds of reasons your sleep would be interrupted, even if you actually manage to be in your bed for a full eight hours.”
[See: How Social Workers Help Your Health.]
Time to Move Along
It’s called “sleeping rough” for good reason. Finding somewhere dry, where you don’t get kicked as soon as you settle in, is challenging, says Jay, who has lived out on the street in rainy Portland, Oregon. He’s rolled out his sleeping bag in parks and other public spaces.
Fragmented sleep is the norm. “You’ll find somewhere to sleep but then you’ll be wakened up in like an hour by a security guard telling you to leave,” he says. Sympathy only goes so far. “They might give you advice of some other place to try. But then another security guard will tell you to leave.”
As it would for anyone, disrupted sleep takes its toll. “Typically, I’m just me working under worse conditions,” Jay says. “Like, I’m not operating at my peak. When I don’t get enough sleep it’s not that I’ll instantly be snappy, or such — it’s just that things that typically make me snappy will do it a whole lot easier.”
A couple of weeks ago, Jay entered transitional housing. He has his own bedroom, while sharing a kitchenette and bathroom with three others. “It’s gone pretty good,” he says. “I’m definitely getting more sleep and better sleep.”
Housing insecurity — and all the related stressors, including poor sleep quantity and quality — is an important social determinant of health, says Dr. Brian Little, medical director of Outside In located in Portland. Outside In provides housing to homeless youth — anywhere from their mid-teens to 25 — throughout the city of Portland and Multnomah County.
Chronic physical conditions like diabetes and heart disease have been correlated with insufficient sleep syndrome, Little says. “Then there’s the psychological piece,” he adds. “People have difficulty concentrating, especially when insufficient sleep becomes chronic. They have psychological manifestations. People become irritable; they don’t necessarily think clearly; their judgment becomes altered as well.”
Out on the streets, people are at the mercy of changing weather. “Luckily, our winters are not that severe,” Little says. “But when we do have cold snaps, we have a couple of deaths a year from hypothermia.”
Homeless shelters aren’t permanent solutions, emphasizes Mirra, a young Portland woman. “It’s an improvement for certain needs,” she says. “For me, I couldn’t handle sleeping outside. I’m small; I have bad vision. And generally, it isn’t safe for me to sleep outside. Being in a shelter gives me a roof over my head. But the rules are suffocating. It’s very noisy at night. It’s very bright.”
In the shelter, Mirra managed by putting hard headphones on top of earplugs and placing a scarf over her eyes. “Then I could sleep,” she says. “But sometimes the bed would creak, or actually make a banging noise, when someone was asleep above it.” Roommates were sometimes dangerous or bullying, she adds.
Homelessness represents a humanitarian issue, Mirra says. “Putting a band-aid on like giving people somewhere to sleep for a night doesn’t solve it,” she says. “People should speak up politically and try to get change that way.”
[See: 10 Reasons You Might Be Feeling Fatigued.]
Homelessness Risks
The life span for a homeless person is between 42 and 52 years on average, according to an April 2014 study in the journal American Family Physician. Homelessness affects too many U.S. veterans, says study co-author Dr. David Maness, a family practice specialist in Jackson, Tennessee, and a professor of family medicine at the University of Tennessee.
“Soldiers are near and dear to my heart,” says Maness, a former commander of military hospitals including Womack Army Medical Center at Fort Bragg and 115th Combat Support Hospital at Fort Polk, Louisiana. But he’s concerned about everyone who’s homeless: men, women and children.
Sleep deprivation affects memory and attention, Maness says. And it exacerbates symptoms of existing mental health conditions, such as anxiety, depression and schizophrenia, often complicated by substance use disorders.
Sleeplessness and fight-or-flight stress go hand in hand. “Women who are on the streets have often been victims of physical or sexual assault,” says John Maceri, CEO of The People Concern, a housing and social services organization based in Los Angeles. “So we hear very frequently from our female clients that often at night they will keep moving. They will ride the buses until the buses stop running.” Fear of violence is not unique to women, he adds.
With scorching LA summers, Maceri says, they sometimes see cases of people overcome by heat stroke or dehydration. More often, though, people tend to suffer from the chronic wear and tear of trying to sleep on hard surfaces.
“Just imagine what it’s like to sleep outside, on concrete, in an alleyway; on the sidewalk; on a bench,” Maceri says. “Just imagine how uncomfortable that would be for one night — and this is people’s reality, often for months, sometimes years, at a time — and how that would impact any of us. You can understand why people aren’t at their best.”
If you want to help by donating, local organizations can always use sleeping bags and many other supplies to distribute to homeless people in need. You can go online to group websites for wish lists and links to order items and send them directly.
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Sleepless on the Sidewalk originally appeared on usnews.com
