Addressing the sleep deficit, NOT one person at a time

The more I learn about health and wellness, the more convinced I am that sleep is magic.

Not only does getting the recommended 7-9 hours help you feel awake and refreshed in the morning, it also helps regulate your metabolism and improves your memory, focus, judgment, problem solving, and athletic performance.

New and terrifying research links not-enough-sleep (the 5-6 hours most Americans currently get) with weight gain, increased risk of cold/flu, diabetes, cancer, and ADHD-like symptoms. Additionally, not getting enough sleep results in poorer cognitive abilities (lack of focus, concentration, ability to remember what you’ve learned), poor judgment, and impaired driving on par with drunk driving. It’s also correlated with depression, anxiety, and other mental illness.

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When I saw this New York Times post basically summing it all up (and providing links if you want to check out the research) I was ecstatic and all “That’s what I’ve been saying!” Then I read the comments.

“You assume it’s a choice, that people actively choose to get less sleep and, if they want to, can choose to get more. That may well be true of upper class people who can hire others to do their work for them – housework, tutoring, etc. As for me, a middle class shlub, well, I would LOVE to get more sleep. But I am a single mom. I have to get up at 5:30 am for my job. And I have to work or I will land in the street with my kids. ANd I have to stay up at least until 10:30 pm most nights to get this or that child hither and thither, help with homework, and son on. I cannot hire anyone to do any chore– lawnmowing, housecare, homework, driving, shopping, bill paying, college planning for kids, etc etc etc etc. Basically, I work from the moment I get up until the moment I sleep. I have no time to exercise either.”

And it hit me. The sleep deficit is a lot like the obesity epidemic; it is a systemic problem that cannot be solved by encouraging individuals to make healthier choices.

I work with college students who probably could get more sleep if they spent a couple fewer hours playing videogames.

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Shit college students say.

Of course, some of my students work more than the recommended 10 hours per week and can’t choose to sleep more. But in general, I feel okay about trying to encourage them to prioritize sleep over partying or more time on Reddit because they can usually make changes without too much trouble. For the general adult population, however, this really isn’t the case.

The comments on the New York Times post read like a laundry list of reasons why Americans are not sleeping. Parents are kept up by new babies. Physicians-in-training are working 28-hour shifts. People who travel constantly for work (flight crews, journalists, musicians, etc.) are forced to keep irregular schedules in different time zones. Single parents are working full time jobs in addition to the “second shift” just to make ends meet.

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But it isn’t just our jobs, families, and full schedules that are keeping us up. The world has changed. Energy drinks and caffeinated latte drinks are sold on every corner and and marketed either as health supplements or entertainment. We are constantly connected, if not tethered to, our phones, tablets, and the internet — whether it’s for work, entertainment, or connection. A recent study found that the light from backlit screens can disrupt sleep by suppressing melatonin, a hormone that helps regulate our circadian systems. But this is even bigger than a gadget issue.

Our circadian rhythm, which is how our body knows when to sleep and when to wake, is informed by both light and temperature. Darkness and cooler temperatures let our bodies know it’s nighttime, and therefore bedtime. So what happens to our circadian rhythm when we live in consistently temperature-controlled environments? And about that darkness thing? Yeah. We don’t really have that anymore. Just check out these NASA images of the world at night.

Captured in 1994

Captured in 1994

Light pollution projected growth

Light pollution projected growth in 2025

So basically our artificial environment is  really screwing with our circadian systems, and we wonder why no one can sleep? Some scientists are even concerned that light pollution is killing off wildlife.

Animals need sleep too.

Animals need sleep too.

It’s no wonder that the New York Times post, which encouraged readers to get more sleep and discuss the issue with their doctors, made some people angry. For so many of us, sleep is simply outside our realm of control. Before I’ve made the argument that our obesity problem should not be addressed through individual behavior change because it is a systemic problem that can really only be solved through systemic changes to our environments and our policies. When we try to treat obesity as if it were simply an individual problem, it manifests as shaming people for things beyond their control. When we consider that sleep and weight are inextricably linked, it’s not surprising that the same thing happens when we tell people they need more sleep.

And, just like weight shaming can cause people to develop eating disorders or depression/self-esteem issues that lead to further weight gain, warning people about the health risks of sleep deficit can actually make the problem worse:

“As a law school graduate studying for the New York Bar and planning an impending move to NYC–without yet a job, praying to find one in public interest law–I lie awake every night, worrying.  But at least now I know all of the harmful things that are happening to me.”

“Constantly counting the number of hours of sleep I got each night hasn’t been good for my mental health either. It’s like counting calories. It made me obsessed. So I stopped.”

“One thing that would help me sleep is not being constantly told how awful it is not to get it.”

The Health Belief Model of behavior change tells us that if you scare people about a health issue without providing a clear solution for how they can prevent or treat it, they are not going to respond well. Telling folks the dangers of not getting enough sleep without providing realistic solutions will cause them to feel like it’s hopeless and shut down. This issue cannot be solved by telling people to try to get more sleep.

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So how can we address the sleep deficit at the systematic level? In college health we have an advantage because we have a fair amount of control over the environment our students inhabit. We have the ability to provide a campus that encourages and supports healthy behavior. We can close down our libraries, gyms, labs, and campus centers at 10 pm. We can ban 8 am classes to let our students sleep in later. We can mandate quiet hours in our residence halls. We can ban Red Bull and 5 Hour Energy from promoting their goods on campus. It’s a little more complicated in the real world.

tumblr_inline_mmq91iJGyJ1qz4rgpWhat could some of those systemic changes look like? Is it even possible to regulate light pollution in urban areas? How would we accomplish that? We could tax the crap out of energy drinks like we tax cigarettes. We could create similar disincentives for 24-hour service availability. For example, in Spain, most businesses are closed during siesta in the afternoon. People simply have to run errands another time, and they make it work. We could also place stricter regulations around the “full time” (read: eligible for benefits) work week, reducing it from the standard 4o-45 hours to something closer to 35. (Again, a lot of Europeans do it this way.)

But beyond regulation, true systemic change requires a culture shift. We need to foster a culture that doesn’t reward employees for putting in extra hours, or make anyone feel like they need to put in extra hours to keep their job. In industries where it’s possible, like in most office jobs, we need to institutionalize flex time and let workers telecommute in order to snooze that extra hour it would take to commute. We need to change the norm from one where we lie in bed with our phones checking email to one where that kind of behavior is uncommon. We could stop creating reasons for people to stay up late, like scheduling evening events earlier and no longer airing popular TV shows after 10 pm.

But this kind of societal change takes decades and requires tireless efforts from public health folks and other advocates. Perhaps the first step of that work is recognizing that the sleep deficit is bigger than you and your insomnia, her and her new baby, or him and his ridiculous work schedule. For those who can make the choice to sleep more, doing so will definitely improve their health. But the focus of public health messaging and health journalism should not be to scare or shame people who, for whatever reason, can’t get enough sleep.

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TL;DR sleep zombie friends?

What I’m really trying to say is that the only way to really address the issue is to treat society’s sleep deficit as the gigantic, systemic, clusterfuck of a problem that it truly is.

Goodnight.

Goodnight.

One thought on “Addressing the sleep deficit, NOT one person at a time

  1. I think your heart is in the right place, and agree that you are spot on, pegging the reason not getting enough sleep is the norm, to be the society many of us live in.

    As long as this system functions, people will have to work harder to survive. This is the root cause of the problem you addressed in your post. The solutions you proposed are mostly top-down. You mentioned taxing people and changing the laws that decide who must be paid benefits, etc. This reminds me of an argument for socialized healthcare. I think a closer examination would show that the countries where this works have bigger issues than other countries, in other areas.

    These are the reasons life is so stressful, as it is. Remove taxes and threats about who gets what and who doesn’t, and you make it easier for smaller businesses to compete, which means more jobs, and more normal work weeks. This is just a small example, but it just keeps going from there. Removing market restrictions and market protections make it easier for people to do what they need to do and to survive and thrive.

    One of the most popular responses to this is that it would be bad if we removed corporate restrictions. I think the reason for this is that we are not taught what makes it possible for corporations to mess up this world we live in.

    Here are some posts that address it:
    http://fskrealityguide.blogspot.com/2009/12/can-large-corporations-exist-in-free.html
    http://fskrealityguide.blogspot.com/2009/01/limited-liability-incorporation-is-evil.html

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