Sleep sits alongside air, food, and water as one of the most fundamental needs for human survival. And while most US adults (62%) agree that it's important, a third still don't get enough of it. It's become such a global phenomenon that we're seeing the same pattern of sleep loss in both the developing and developed world, as well as across age groups.
Unfortunately, the impact of sacrificing these precious hours of daily rest is far-reaching. Not only is it affecting our individual health and functioning during waking hours, but communities and economies are experiencing follow-on effects from our collective sleep debt.
In fact, it's become such a big public health issue that the US Centers for Disease Control and Prevention (CDC) has even called it an epidemic.
A global sleep survey (across 12 countries) conducted by Philips and KJT Group in 2019 found that 62% of adults don't feel that they get enough sleep — and most were not getting the recommended 8 hours each night. Adults clocked an average of 6.8 hours of sleep on weekdays, while on weekends it was 7.8 hours. As a comparison, people slept an average of 9 hours per night in 1910. Things also don't appear to be improving with time, as 44% also felt that their sleep has deteriorated over the past 5 years.
To make matters worse, even though we've been more homebound during the COVID-19 pandemic, we haven't been sleeping as well. During this period, online searches relating to insomnia in the US increased by 58% between January to May 2020.
Full-fledged sleep disorders (which are more serious and regular) are also on the rise.
Insomnia: Problems falling asleep or staying asleep at night. The worldwide estimate of chronic insomnia in adults is 10-30%.
Sleep apnea: Regular pauses in breathing while sleeping. Affects about 25 million Americans and prevalence has increased by 40% from 2013 to 2016.
Narcolepsy: Suddenly falling asleep or feeling extremely sleepy in the day. Rates of Narcolepsy in the US have increased by 14% from 2013 to 2016 (38.9 to 44.3 per 100,000 persons)
Restless legs syndrome: The uncontrollable urge to move your limbs or body (most commonly during sleep time). The prevalence of this syndrome has increased by 30% from 2013 to 2016 in the US.
There are many biological and genetic factors that contribute to why we're all getting less sleep. But experts are saying that environmental factors are playing a big part in this.
Our modern societies have made enormous advancements in terms of technology and industrialization. And while this has brought about its own set of benefits, it's led to an environment that negatively impacts sleep.
One of the main culprits is our use of electric lighting at night. One US study has found that people who live in areas with more outdoor nighttime lighting (e.g. city areas) are more likely to report issues with sleep — like reduced sleep hours, waking up confused at night, and feeling fatigued in the day.
This is because excessive exposure to light disrupts our body's natural circadian rhythm (or sleep/wake cycle) which is our internal clock that tells us when to feel awake or tired.
Here's how it happens. The hypothalamus is the part of the brain that controls our circadian rhythm, and it's also highly influenced by biological, genetic, and environmental factors. One of the strongest cues from outside our body is light. When we're exposed to too much light, it reduces our production of melatonin (a sleep-inducing hormone). This then tricks our circadian rhythm into thinking it's daytime and that we should stay awake.
Interestingly, while all kinds of light can affect our sleep/wake cycle, blue light is the one that we should be particularly wary of. Unfortunately, it comes from the things that we spend the most time with — smartphones, computers, tablets, and televisions.
In an experiment conducted by Harvard University researchers, they found that participants who were exposed to blue light had reduced melatonin levels and their circadian rhythms were shifted for twice as long as compared to those who were exposed to green light.
While turning out the lights is one issue, another modern life sleep problem is our inability to switch ourselves off.
Again, technology is a contributory factor as it now allows us to work from anywhere, at any time, and even across time zones. While this has opened up many global professional opportunities for many, drawing the line between time for rest and work has become harder.
This has been especially so during the COVID-19 pandemic as work-from-home became the norm. A survey from 2000 US workers during the early part of the outbreak found that 67% of those working from home felt pressured to be available at any time of the day, while 65% reported that they'd been working longer hours than before.
When we're not working, many of us spend our time consuming news, connecting on social media, or playing games online — especially before we go to sleep. This makes that crucial period for winding down very difficult.
In a national survey of 1062 American participants, 71.8% that had sleep disorders use some form of technology before bed every night. The most popular ones being watching TV and using social media. Similarly, a global survey found that 83% of adults use their phones in bed.
Worryingly, teenagers are following in the footsteps of older generations and social media is likely to be what's keeping the kids up at night. A study by researchers at The University of Glasgow found that teens who used social media for more than 3 hours a day were more likely to go to bed past 11 pm and wake in the night.
Another study involving 250,000 US teenagers has found that it didn't use to be like this as youth sleep patterns have gotten progressively worse over the years from 1991 to 2012. By the end of the study, 85% of teens were getting less than the recommended 8-10 hours per night for their age group. Experts also add that the lack of sleep could be a contributory cause of behavioural or attentional issues seen in young people.
One of the more entrenched issues surrounding sleep deprivation isn't just related to our individual bedtimes habits. There is a wider cultural acceptance — and even glorification — of forgoing sleep to work harder or play harder.
Teachers and parents assume that it's normal for teenagers to be sleep deprived. In fact, pulling all-nighters at the library are seen as a rite of passage to fully earn the college-student identity.
Ironically, our youths' greatest role models for sleep avoidance may be adults themselves. Since the 1970s, when the term "workaholic" was coined by psychologist Wanye Oates, it's often used in casual conversations as a compliment.
Various successful CEOs, artists, and political figures have also been known to talk down the importance of sleep. Former US President Donald Trump sleeps 4-5 hours a night and believes this is what allows him to get ahead of the competition. And serial entrepreneur, Elon Musk, feels 6 hours is the best amount of sleep needed for optimal productivity.
Sleepless nights have become equated with success. While proper rest is for the lazy and unambitious. It's no wonder that almost 1 in 3 millennials feel sleep is a waste of time.
"Sleep is not like the bank, you can't accumulate a debt and then pay it off at a later point in time" — Matthew Walker, Sleep Scientist
Most of us have felt the effects of not resting well at night. We might feel irritable the next day, lose concentration easily, or perform poorly at work. But what we may not realize is that lack of sleep has much more serious consequences on our health and society as a whole.
Sleep is a time for our body to recharge and repair. This includes crucial processes like creating proteins to help fight off infections, consolidating memories, cellular repair, and much more.
When we inhibit sleep, many of these important functions cannot take place. Even with just one night of poor sleep, 82% of adults experience some form of negative effect like appearing tired, having decreased motivation, or being less productive. Furthermore, it can even increase our risk of chronic conditions and death.
One study has found that those who sleep between 7-9 hours a night have a lower risk of all-cause mortality compared to those with less sleep. This means if you sleep less than 7-9 hours a night, you're more likely to die earlier.
A report by the CDC also showed that adults who slept less than 7 hours a day were more likely to report having various chronic health conditions compared to those who got enough sleep (7 or more hours a day). This included conditions like depression, coronary heart, disease, cancer, and diabetes.
Other studies also indicated that sleep deprivation may be linked to an increased risk of developing ADHD, obesity, Alzheimer's Disease, and more.
We often think of sleep deprivation as something only affecting personal health and wellbeing. But it actually has a much more far-reaching effect on society as a whole — including road fatalities. Because sleepiness affects cognitive functions like reaction times and judgment, it decreases our ability to drive safely. But many of us still drive anyway. A survey found that 1 in 25 adult drivers admitted to falling asleep behind the wheel within the previous 30 days from reporting.
What's the impact of this? The CDC indicates that drowsy driving is the cause of up to 6,000 fatal car crashes every year in the United States. These numbers are pretty close to drunk driving which caused around 10,000 deaths in 2016.
In fact, the effect that drowsy driving has on the body can also be quite similar to when we're under the influence of alcohol. Our driving performance after 17 hours without sleep (like getting up at 7 am and then driving home at midnight) is similar to driving with a blood-alcohol level of 0.05%. Driving after 24 hours without sleep would be similar to driving with a blood-alcohol level of 0.10%. The legal blood alcohol content limit in all US states is 0.08%.
While counterintuitive as it may seem, sleeping less doesn't give us more time to do more things. It actually makes us less productive and economies are paying the price for this.
One study estimated that the US economy loses $63 billion a year due to insomnia. But this isn't due to the fact that people who don't sleep enough are skipping work. In fact, they were present for a similar number of days as those who got adequate sleep. The issue is that they were less effective in their jobs. And this is causing workers to lose an average of 11.3 days (or about $2,280) of productivity every year.
When other researchers took into account more macroeconomic effects of sleep issues (like increased mortality rates and hindered skill development in youth), the yearly loss to the US economy was increased to $411 billion. Unfortunately, other developed nations like the UK, Japan, and Germany are also in the same situation where societal sleep deprivation is costing between 1-3% of GDP annually.
Looking at the personal and societal effects of sleep problems, our perception of its importance needs to be re-evaluated. As these sleep researchers have explained: "The general public often devalues the seriousness of insufficient sleep and may have a more general attitude that, in the larger scheme of life’s difficulties, “not getting enough sleep” occupies a fairly low rung on the stepladder of personal health concerns."
Public health bodies are already recognizing it as a widespread issue. But how it's addressed will be the key to reducing the negative effects we're seeing in individuals and communities around the world.
And for many experts, this all starts with education. Governments should be investing in public health campaigns to raise community awareness of the importance of sleep, whether it's at schools, workplaces, or clinics. We often hear about drunk driving, safe sex, and cancer prevention — but not the effects of sleep deprivation.
Even medical professionals, who are in the best community position to educate the public about sleep, may not have enough knowledge about the topic themselves. According to a recent survey sent to various medical schools in 12 countries, physicians were reported to have an average of only 2.5 hours of sleep education.
Changing our societal attitudes towards the importance of sleep could be the key to preventing many of the health and economic issues that we see in the world today. We need to prioritize our need for rest as much as food or water and stop glorifying sleep avoidance.
The author, Dawn Teh, is a health writer and former psychologist who enjoys exploring topics about the mind, body, and what helps humans thrive.
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