Homelessness—both sheltered and unsheltered—is associated with poor sleep quality and insufficient duration. Insomnia, which refers to dissatisfaction with sleep quantity or quality, can both contribute to and be a consequence of disproportionately high rates of disease found among adults experiencing homelessness, including obesity, hypertension, cancer, and depression; it can also contribute to early mortality that is well documented in this population. Permanent supportive housing (PSH) using a housing-first approach is regarded as an evidence-based intervention to end homelessness by providing low-barrier affordable housing paired with flexible health and social services. Although PSH has been credited with a decline in the number of chronically homeless adults in the United States since 2007, a recent consensus study re-port from the National Academies of Sciences, Engineering, and Medicine concluded that current evidence that PSH improves health in general—and sleep in particular—is lacking. The primary objective of the current study was to examine longitudinal change in insomnia as adults transition from homelessness to PSH and whether additional factors may moderate the relationship between housing and insomnia for persons who have experienced homelessness. Specifically, we hypothesized that screening positive for insomnia would be mitigated upon entry to PSH and that the relationship between housing status and insomnia would be moderated by mental health symptoms, physical health conditions (eg, hypertension), and alcohol and tobacco consumption, all of which are experienced at disproportionately high rates among homeless and recently housed adults.
Longitudinal effects of permanent supportive housing on insomnia for homeless adults
Sleep Health: Journal of the National Sleep Foundation