Religiosity and Spirituality as Stressors or Stress Relievers in relation to Sleep Health among African American Women

Objective: To investigate associations between religiosity/spirituality and sleep and potential modification by stress among Black/African American (AA) women. Methods: Using data from the Study of Environment, Lifestyle, & Fibroids at enrollment (2010–2012) and three follow-up periods (2012–2018), we estimated prevalence ratios (PRs), risk ratios, and 95% confidence intervals (CIs) for the following sleep dimensions: short sleep duration (<7 hours), nonrestorative sleep (NRS, waking rested <4 days/week), and insomnia symptoms (difficulty falling/staying asleep). At baseline, participants reported: importance of faith, religion/spirituality as a source of strength/comfort ('very-to-somewhat' vs. 'not at all'), and prayer/meditation frequency ('everyday,' 'every week,' or '≥once/month' vs. '<once/month'). Day-to-day stress was dichotomized as 'very high/moderate' vs. 'mild/not at all.' PRs were estimated using adjusted Poisson regression with robust variance, and longitudinal models used generalized estimating equations. Interactions between religiosity/spirituality and stress were tested. Results: Among 1,693 Black/AA women (mean age ± SD 29.2 ± 3.4 years), 69.3% reported faith as important, 55.6% perceived religion/spirituality as a source of strength/comfort, 58.8% prayed/meditated daily, and 43.8% reported high/moderate stress. Short sleep affected 58.4% of participants, NRS 9.5%, and insomnia symptoms 17.9%. Everyday vs. <once/month prayer/meditation was associated with NRS (aPR=3.16 [95% CI:1.16–8.56]). Among women experiencing daily life stress vs. no daily life stress, those who reported religion/spirituality as 'very much' a source of strength/comfort had significantly lower prevalence of NRS compared to those who did not (aPR = 0.37, 95% CI: 0.14–0.98, p = 0.05). Religiosity/spirituality was not longitudinally associated with sleep. Conclusion: Daily prayer/meditation was associated with NRS. Religion/spirituality as a source of strength was associated with restorative sleep among highly stressed women. Future research should address potential reverse causation for both negative and positive effects.