How The World Forgot To Sleep
We're getting less shuteye than ever before, and it's ruining our health, happiness and prosperity.
BY Joanna Fuertes | Nov 24, 2017 | Fitness & Health
Both sides of the pillow have become irritatingly warm. It's now light outside as your mind races with thoughts of work, thinking about thinking and replaying that one time you called your boss "mum". In the daytime you feel and look like your face is melting. You are jealous of babies and cats smug in their slumber, while you cling to your third coffee of the day. But by night time you're five episodes deep on a new series on Netflix and writing to do lists, as if you didn't just spend the entire day exhausted and wanting to be in bed.
According to the World Health Organisation you are likely part of the 'sleep loss epidemic', with two-thirds of adults in developed nations not getting the recommended 8 hours of sleep a night. There has been a global rise in sleep disorders such as insomnia and sleep apnea, but also, put simply, those who have the capacity to sleep well just aren't sleeping enough. In Japan, where the epidemic is at its most absurd, the average time spent asleep is just 6 hours and 22 minutes, with phrases for both falling asleep in public (inemuri) and dying from overworking (karōshi). And the UK isn't far behind, averaging just 6 hours and 49 mins a night, meaning that since a study in 1942 found under 8% of the population was trying to survive on six or less hours, it's now rocketed to almost one in two of us.
Professor Matthew Walker, a British neuroscientist and now director of the Center for Human Sleep Science at the University of California, Berkeley, recently released book Why We Sleep which is, in his own words, a "manifesto of sleep science". The book both collates and dispels a number of sleep myths while calmly linking the "pernicious erosion of our sleep in developed nations" to pretty much every major modern illness, from cancer to diabetes to heart disease to Alzheimer's. In my own sleep-deprived state, Walker is disarmingly chirpy to talk to, but resolute about the message of the book: "I think sleep is still a missing piece in the puzzle of people's health. It's not something people are necessarily recognising as a critical issue when comes to fighting disease and sickness. And that's partly the fault of people like me: the science has not been communicated well enough."
So why aren't we sleeping? Both our commutes and our work hours are longer, the latter becasue hyper connectivity means we're never truly away from the office. On top of nurturing the relationships outside of our jobs with our friends and family, we have online lives to maintain and Twitter arguments with strangers to get into. We are perpetually drenched in the light from our TVs, phones and laptops, and frustrated by cities that dare to sleep. When we get home from work, it's easy for rest to take a backseat when there are Reddit threads of deep sea creatures to get lost in.
All of that said, it's too easy to blame our en masse sleep poverty on technology and modernity alone, when, arguably, it's technology that has also made us more aware, as Walker puts it, of "quantified self improvement" and keeping an eye on our own health. But embracing the concept of wellness and the self-care apps it has produced doesn't tackle the cultural attitudes fuelling our lack of sleep.
Former UK Prime Ministers Margaret Thatcher and John Major at the Conservative Party Conference, 1995
We continue to canonise powerful political leaders and CEOs – from Obama to Trump to Steve Jobs to Twitter's Jack Dorsey – for their lack of sleep. Boasting about the "rise and grind" has become one of the oddest forms of machismo, as if to achieve anything in life requires a self-flagellatory lack of slumber. John Major famously struggled to follow Margaret Thatcher's fearsome reputation in cabinet, which she cemented by keeping her aides on their toes by never having more than five hours sleep a night. Less is said, however, about Thatcher's final years plagued by minor strokes and dementia so profound that she barely recognised her own family. Nor is our stigmatisation of sleep confined to the world of offices and big business. How many times has insomnia and late night hedonism been romanticised as the magic source of creativity? As if the hysteria of sleep deprivation was the most powerful drug available to man.
But as Walker reiterates, it is a thoroughly modern and stupid predicament we've got ourselves into. "Sleep is not like the bank, you can't accumulate a debt and then pay it off at a later point in time," he explains. "There is a precedent in our body that does work like that: you can undergo a period of starvation because you have built up a repository of stored calories in the form of fat cells. Why don't we have that for sleep? Because human beings are the only species that deliberately deprive themselves of sleep. Mother Nature took 3.6 million years to put this thing called 8 hours of sleep in homosapiens and we deprive ourselves of it for no good reason... it is an entirely man-made problem."
The cost of this is something we as a society are only just getting to grips with. Global policy think-thank, RAND corporation, concluded recently that insufficient sleep was a 'public health problem' costing the global economy billions in lost productivity each year, and the UK alone 1.86% of its GDP.
Poster issued by the United States National Program on Insomnia and Sleep Disorders, 1985.
So what is the solution? As with every wellness trend before and to come, the idea of "clean" sleeping is one where we already know the rules, but are still intent on finding shortcuts. This is where the "natural" sleep supplement has become king. In the UK, NHS spending on sleeping pills is on the rise but we've been routinely horrified at the even faster and looser prescribing of them in the States, thanks to celebrity overdoses and horror stories of sleep-emailing and even sleep-driving on drugs such as Ambien. Walker states of the US fondness for sleeping pills; "they are a class of drugs we call sedative hypnotics and sedation is not normal sleep, so they do not give you the refreshing, restorative effects of natural sleep. I'm clearly not going to argue that when you take those pills you're conscious...but to say that you're in natural sleep is an equal falsehood." But the gap left by our comparatively strict hold on prescription sleeping pills has instead begun to be filled by a proliferation of unregulated sleep aids, from herbal sedatives like valerian and passionflower extract to the frequent flyer favourite of melatonin tablets.
One of the most popular, despite nominal scientific proof of its efficacy, is 5HTP. A naturally occurring amino acid said to increase the body's production of serotonin, it's now sold widely online and in health food stores as a sleep aid, having initially been touted as "nature's Prozac" as well as used by seasoned drug users to take the edge off MDMA comedowns.
Anecdotally at least, 5HTP seems to carry some of the powerful effects on our sleep usually associated with SSRI antidepressants, with users recounting vivid dreams and a "brain fog". Even in researching this article I had a disproportionately large number of responses, from people eager to talk about their pursuit of sleep by any means necessary including a dependency on 5HTP. Luke*, a 31 year old teacher, enthused about the initial benefits of 5HTP: "It never helped me get to sleep but it would make me stay asleep, and sleep for much longer than I would without it. I'd also have these incredibly lucid and often unpleasant dreams, but would wake up feeling completely calm though not really rested...To be clear, I was taking handfuls of 5HTP capsules every night and well beyond the recommended three months at a time. The longer I was taking them the foggier I felt in the daytimes, despite getting a good eight or nine hours in bed...I'm sure I only stopped taking them because I kept forgetting to order a new batch."
A WWII health poster, issued by the Navy, in 1942.
What then is the solution to those of us rendered zombies by a dire lack of sleep, if neither prescription or herbal drugs offer true rest? "If we had a good medication that produced naturalistic sleep I'd be very much in favour of it but we just don't and have never had one." Walker emphasises, "However, last year, the American College of Physicians made a landmark recommendation, suggesting that Cognitive Behavioural Therapy for Insomnia (CBTI) must be used as the first line treatment for chronic insomnia, not sleeping pills.
"Critically, they found that once you stop working with the therapist that benefit is maintained - unlike sleeping pills, where stopping not only means you go back to bad sleep but you actually have what's called rebound insomnia, which is even worse." CBTI is an approach advocated in the UK too, except with the added strain of NHS therapy waiting lists and alternatives such as SleepStation clocking in at a prohibitive £50 per week. You can understand why many turn to herbal remedies instead.
This recommendation of CBTI also opens a broader discussion about the dramatic impact of sleep on our mental health. While the the public discourse around men in particular talking about their mental health has improved significantly, it's still far more palatable to go to your GP complaining of insomnia than it is to talk instead about the thoughts that keep us awake at night. But as Walker points out, it's compounding. "Getting insufficient sleep is a two way street; anxiety is both big contributor to disorders like insomnia but also sleep deprivation itself markedly raises your risk for the development of anxiety and depression, as well as being highly predictive of suicide."
I quiz Luke as to whether he's ever spoken to his GP about what might be causing his lack of sleep in the first place: "Only in the context of insomnia. I'm sure there is bigger stuff at play, and more than a large element of anxiety, but you get in the habit of wanting to zone in and treat what is most disruptive to your daily life. I just want to sleep and deal with the rest later, so to speak."
So how do we counter this war on sleep that has morphed into a legitimate global crisis while we have been too tired to notice? Walker is readily armed with a list of reasonable lifestyle changes we can make as individuals: a non negotiable bedtime, staving off alcohol and caffeine, a cool and dark bedroom which includes a moratorium on evening screen time and, most importantly, the ability to get out of bed when we just can't sleep. "The worst thing you can do when you can't sleep is to stay in bed, our brain is a completely associative device so the best thing is to just break the connection, go to another room and read until you are sleepy."
As for the wider battle of how we get our eight hours a night back to its rightful owners, the solution is a little more ambitious. But Walker is resolute: "There has to be change at government level, as well as in our healthcare systems and in education, to change the attitudes that mean we laud long working hours as heroic.
"When was the last time you saw the UK government set forward a public health campaign regarding sleep? I've seen them for smoking, drinking, exercise and diet, I've never seen one for sleep. I hope, no pun intended, that this renewed discussion around sleep is a wake up call."
From: Esquire UK