By James R. Jolin
U.S. incarcerated populations have long dealt with chronic sleep deprivation, often with little to no reprieve. This disturbing health crisis is insidiously ingrained in the culture of corrections and surprisingly neglected in American public health scholarship.
Estimates for the incidence of such sleep deprivation in correctional facilities are admittedly varied (likely a consequence of little epidemiological sleep research in the U.S. correctional systems on the whole), but some scholars have reported insomnia rates as high as 81%. Results from correctional facilities outside the U.S., while not exactly comparable to those of the U.S., paint an equally grim picture: one cross-sectional study of three English prisons saw 88.2% of respondents reporting subjective poor sleep quality.
Even without precise estimates, however, it takes little stretching of the imagination to see how the correctional setting is uniquely adverse to sleep. Increasingly crowded living spaces, poor lighting, inadequate bedding, and intense environmental stressors are just some of the risk factors associated with decreased sleep quality.
What is more, the kind of chronic sleep deprivation that flows from such abject sleeping conditions appears to be baked into the punitive U.S. correctional system. For corrections professionals, the quality of sleep is rarely top-of-mind. For scholars, the heightened ethical risks associated with research among such a vulnerable population dissuades investigation of reform. And even if sleep makes its way onto the corrections policy agenda, some policymakers will undoubtedly perceive catering to the needs of convicted felons with some skepticism, arguing instead that the punishment fits the crime.
But the health consequences of such chronic sleep deprivation can be vast — far beyond what even the most ardent advocate of punitive justice might think comports with a committed crime. A wide body of epidemiological sleep research affirms the threat chronic sleep disorders pose to cardiovascular, diabetes, depression, anxiety, suicide, and even recovery from substance use disorders. People who are incarcerated already exhibit elevated rates of morbidity, and it is likely that the sleep deprivation associated with corrections only depresses health outcomes.
Crucially, the crisis of sleep deprivation among incarcerated populations is not wholly divorced from the present COVID-19 threat facing correctional systems. Cases and deaths due to COVID-19 remain “consistently higher” in correctional settings than the general U.S. population, a troubling reality not only for COVID-19 mitigation efforts, but also health equity writ large. And in 2021, researchers furnished evidence from a study of over 40,000 participants in the general population, indicating that those with “moderate” to “significant sleep burdens” experienced elevated COVID-19 mortality. Poor sleep, therefore, likely places inmates at greater risk for COVID-19-related death. So while typical mitigation strategies including correctional vaccination campaigns and social distancing remain necessary, effective correctional pandemic mitigations strategies must also account for poor sleep.
With all the risks of poor correctional sleep — not only for incarcerated populations, but also the broader public — what has been done to augment the quality of sleep in correctional facilities? In short, not enough.
Practically, litigation has served as the primary source of any respite for sleep-deprived inmates. A smattering of low-profile cases have cropped up in recent years, some of which have been successful in providing relief. In Walker v. Schult, for instance, a District Court awarded an inmate $20,000 after finding their sleeping conditions to be so abject as to constitute unconstitutional punishment. The real triumph from Walker, however, was the Court’s explicit recognition that “sleep is critical to human existence.” Upshaw et al v. Alameda County et al saw a similar outcome. In this case, a California judge ordered the Alameda County, CA, correctional facility to end early morning pill calls for female inmates as a remedy for sleep deprivation.
Still, these and other rulings only represent modest victories; courts by no means have been a consistently effective source of relief for sleep deprived inmates. Decisions in other cases regarding sleep deprivation have diverged from those like Walker and Upshaw. Other judges evade dealing with weighing in on the quality of sleep in jails altogether by dismissing cases on procedural grounds. And most notably, no Supreme Court precedent deals directly with the Eighth Amendment implications of correctional sleep deprivation, leaving some lower courts confused with how to deal with such issues.
The judicial system itself also has important limitations when dealing with correctional sleep issues. Litigation is, of course, already costly and time consuming — and even more so for indigent prisoners. Additionally, correctional settings are diverse not only in the infrastructure they possess, but also in the challenges they face, a reality that counsels against a panel of far-off judges ordering all facilities to meet a universal, court-defined sleep quality standard. To be sure, enforcement through litigation must remain available, but the real work of crafting national, state and local policies regarding correctional sleep standards might be better done by legislators in consultation with health care experts.
This presents researchers and policymakers with an opportunity. To address the paucity of sleep research in U.S. correctional settings, public health and sleep medicine scholars alike ought to use their robust epidemiological tools to provide a more comprehensive account of the challenges to adequate correctional sleep. Legal and policy scholars must then use this research to inform policy proposals, which can be subsequently tested in correctional settings. These studies will naturally require careful attention to the ethical risks associated with research in jails and prisons, but the value they stand to provide in improving correctional sleep is immeasurable. Indeed, legislators must heed this scholarship, not only for its potential benefit to inmates, but also for the welfare of the broader American public health. In a moment when correctional and non-correctional health systems are in desperate search of ways to improve health outcomes, we must recognize that sleep matters.
James R. Jolin is an A.B. Degree Candidate in Government and Global Health and Health Policy at Harvard College and a student intern at the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. His academic interests lie at the intersection of criminal justice and public health.