Covington awarded $25K to study sleep in socioeconomically disadvantaged families

Lauren Covington, a practicing pediatric intensive care unit nurse, has seen too many babies die from sudden unexpected infant death syndrome.

“These deaths were, at times, associated with avoidable, unsafe sleep environments,” she said. “It got me questioning the sleep environments in homes.”

These heartbreaking realities prompted Covington’s interest in researching sleep in toddlers and its relation to health outcomes. Poor sleep habits developed in early childhood can carry into adolescence and adulthood and have been linked to cardiovascular outcomes, morbidity, cognitive outcomes, and mental health.

“I’m really focused on disparities in sleep based on race, gender, ethnicity and other factors which contribute further to health disparities,” she said.  

Now, the assistant professor in the University of Delaware’s School of Nursing is one of just four nurses nationwide to be awarded the Heilbrunn Nurse Scholar Award through Rockefeller University’s Heilbrunn Family Center for Research Nursing. With so few nurses with doctorates, compared to other disciplines, Covington recognizes the magnitude of the scope of her work.

“I’m really honored to receive this fellowship. It’s validating because it speaks to the importance of my work not only from a world public health standpoint, but it’s now being validated as important for nursing, and people are understanding and realizing the necessity of improving sleep to improve health,” she said. “I also feel so lucky that I’m employed at an institution like UD that’s supportive of my research and is growing me as a nurse scientist. It’s one of the many reasons I chose UD five years ago.”

The $25,000 award will allow Covington, who's also affiliated with UD's Sleep and Circadian Health Research Program, to study the day-to-day associations between sleep and stress in socioeconomically disadvantaged families over two years. 

“I know from past studies that these families are facing so many different stressors daily, and I understand we can’t change or modify those stresses—that’s not a realistic intervention target. But perhaps, we can change how they cope and respond to that stress which could have positive implications for their sleep.”

Covington will measure sleep of biological parents or guardians and their toddlers using a wearable device known as an ActiGraph. The accelerometer measures movement or lack thereof and light. Adults wear the monitor on their wrist like a watch while toddlers can wear it on their waist or their ankle.

“I’m focusing on toddlers because during that time life-long sleep habits form. The routines that you establish in early childhood can really progress through adolescence and adulthood—it’s a foundational time of life,” she said.

Each morning and night, caregivers taking part in the study will receive a text message that contains a link to a survey.

“The survey gauges what stressors they faced that day and asks them to rate their degree of stress. They’ll also answer questions about how they coped with stress and whether their methods were effective along with questions about the child’s bedroom routine and its effectiveness,” she said. “In the morning, they’ll answer questions about how they and the child slept, when and where the child woke up, and their mood.”

Covington is hypothesizing that caregivers who face a lot of stress but cope well with that stress will sleep better than caregivers who don’t manage their stresses well, and because of that, the next day, they’ll be in a better mood and manage stresses better on an ongoing basis.

“I want to see these day-to-day relationships because I believe that to improve the child’s sleep, we need to improve the caregiver’s sleep,” she said.

Routine is at the center of healthy sleep habits.

“Try to go to bed within an hour of the time you normally go to bed nightly,” Covington urged. “Calming routines like reading, taking a bath, mindfulness-based practices, and avoiding technology, which isn’t always realistic, are standard methods that have shown to be effective in higher socioeconomic families.”

Her study seeks to determine not just whether these routines are effective in families of lower socioeconomic status, but whether they’re even feasible.

“In a single-parent household, where the caregiver is working multiple jobs and they’re not even home until 11 p.m., how can we expect them to get their child to bed by 9 p.m. if they’re not even home?” she asked. “Maybe, an older sibling or a neighbor can help with a child’s bedtime. But we need to focus on the caregiver too. What techniques can we advocate for them to decompress after a busy, stressful day?

While this study doesn’t seek to modify behaviors, Covington is already applying for funding for next steps in her community-engaged research. She’s working with Nemours and Stubbs Early Education Center and will continue to foster relationships with community organizations as vested partners in improving sleep health in underserved areas of Delaware.

“The whole purpose of the study is to identify what tools people are using that are working in real-life settings that we can integrate into a future intervention that will improve sleep, and in turn, improve overall health and health behaviors in families,” she said.