A systematic review of 66 studies found that 43% of adult refugees and asylum seekers experience clinically significant sleep disturbances, with mean insomnia scores bordering on moderate clinical severity. The finding underscores that sleep assessment should be standard in refugee health protocols, not optional.
Researchers conducted a comprehensive meta-analysis examining sleep quality across 66 studies involving 42,956 refugees and asylum seekers. Using standardized measurement tools, the pooled analysis revealed two striking findings: mean Insomnia Severity Index (ISI) scores of 13.76 (placing participants at the upper boundary of subthreshold insomnia, approaching moderate clinical severity) and Pittsburgh Sleep Quality Index (PSQI) scores of 8.59 (exceeding the clinical threshold for poor sleep quality, where scores above 5 indicate clinical concern).
The prevalence figures were sobering. Nearly 43% of adults in the included studies met criteria for sleep adversities, with 36% of children showing similar patterns. These are substantially higher rates than general population estimates, indicating that displacement and the asylum-seeking process create elevated risk for sleep disturbance. The research also identified specific sleep architecture problems: prolonged sleep latency (difficulty falling asleep) and frequent nightmares were commonly reported secondary findings across the studies.
The meta-analysis acknowledged significant heterogeneity across included studies, meaning the populations, assessment methods, and contexts varied widely. Subgroup analyses suggested trends might exist across different refugee populations and measurement approaches, but statistical power was limited by this variation. The authors note this limitation transparently: while directionality appears consistent, confidence in population-specific estimates requires more standardized research designs.
Notably, the review did not identify specific interventions tested in refugee populations with high-quality evidence. This gap highlights that while the problem is well-documented, evidence-based solutions tailored to displaced populations remain underdeveloped. The authors call for integration of standardized sleep assessment into refugee health protocols as a prerequisite for identifying who needs intervention, and for targeted research on what actually works for this population.
If you work in refugee health services or policy, the message is direct: sleep screening belongs in intake assessments. Current protocols often prioritize infectious disease screening and acute mental health crisis assessment, leaving sleep disturbance undetected despite its impact on recovery and functioning.
For individuals experiencing displacement or asylum processes, recognition that sleep problems are common and understandable may reduce self-blame. Sleep disturbance in this context is not a personal failing but a predictable response to trauma, uncertainty, and disrupted circadian rhythms.
General sleep hygiene practices documented in other populations may provide some support while waiting for refugee-specific research. Establishing regular sleep duration, maintaining a dark room environment, limiting social media exposure before bed, and practicing deep work or journaling during the day represent low-risk approaches. However, standard interventions developed for insomnia in stable populations should not be assumed equally effective in displacement settings, where uncertainty about housing, legal status, and family separation may dominate sleep-related anxiety.
The research also signals a need for health systems to move beyond assuming sleep problems will resolve once material circumstances improve. Even after resettlement, sleep disturbances can persist and benefit from targeted attention rather than passive waiting.
| Attribute | Details |
|---|---|
| Study type | Systematic review and meta-analysis |
| Databases searched | Cochrane, Embase, PubMed (inception to December 2024) |
| Studies included | 66 |
| Total participants | 42,956 |
| Primary outcome measures | Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI) |
| Pooled ISI score | 13.76 (95% CI 10.39-17.13) |
| Pooled PSQI score | 8.59 (95% CI 2.11-15.07) |
| Prevalence of sleep adversities (adults) | 43.2% |
| Prevalence of sleep adversities (children) | 36.4% |
| Secondary findings | Prolonged sleep latency, frequent nightmares |
| Key limitation | High heterogeneity across studies; limited power for population-specific estimates |
| Journal | PLOS One |
| PubMed ID | 42391198 |
Insomnia and poor sleep quality in refugee and asylum-seeking populations: A systematic review and meta-analysis. PLOS One. PubMed: 42391198
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