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.

“Emotional Eating” is more than just emotional

In addition to working full time, I study health communication. You know, how people communicate about their health, how we can better bridge the communication between healthcare providers and everyone else, and how we can use communications to educate and motivate people to live healthier lives. For a class assignment, I was given the charge of making a “lifestyle transformation challenge.” I had to pick a behavior I wanted to change and track my progress towards making it a long-term lifestyle change. The point of this was to gain a full understanding of just how hard making a lifestyle transformation really is – an important thing to know if you are trying to convince others to do it.

So what behavior did I decide to change?  I’m a snacker. A big one. I feel most comfortable when I am eating something. My favorite foods are ones that you can eat over a long period of time – foods like artichokes or tacos that are more of a hobby kit than an actual meal.  I don’t have much of a sweet tooth, but I certainly have a salt tooth. Anything I can munch mindlessly while watching tv, writing or studying is a-okay by me. Anything with cheese is even better.

My lifestyle transformation challenge was to try to cut back on snacking, especially at night.  I came up with what I thought was a really creative way to do it – nothing like any diet plan I had ever seen.  I would give myself an hour-long window to eat dinner, and that would be it for the night.  I would not count calories or stress about what I ate for dinner, as long as I ate it within the hour window and didn’t nosh afterwards. I thought this would be easy.

Long story short: I failed to transform my lifestyle and stop snacking in the evening. But the good news, I suppose, is in what I learned along the way. During this challenge, I read Perfect Girls, Starving Daughters, a powerful book about my generation’s relationship to achievement, perfectionism, and food, by Courtney Martin. I had of course heard of “emotional eating” prior to reading the book, but had never realized what it really meant or considered my snacking habits to fall under that category.

I have come to really hate the term “emotional eating” and all that it conjures up. The idea that millions of women are crying into a bowls of ice cream or “eating their feelings” is a myth. It’s a myth with plenty of moral stigma attached – weakness, gluttony, failure, loneliness. (Cat ladies? Cathy comics?) The reality is that when stressed, depressed, tired, etc., one is more likely to consume more calories for a number of reasons that are much more complicated than just “eating your feelings.”

In Perfect Girls, Starving Daughters, Courtney Martin described a “perfect girl/starving daughter” dichotomy in each of us, and while I’m sure her book resonated more with some than others, it was so true to my own experience that I now consider it gospel. You see, girls of my generation were raised by feminist moms– moms that told us that girls could be or do anything. These were also moms that managed (somehow) to work and raise us and take care of the home at the same time. They were “supermoms” and we grew up observing their busy schedules and overachiever lifestyles. And we became overachievers. We are breaking barriers in the sciences, outnumbering men in colleges, playing competitive sports, and we still look beautiful and feminine and thin. We don’t sleep much because all of this takes time.  We are Martin’s “perfect girls.”

But we are also “starving daughters” – weak, needy girls who are tired and lonely and just want to be cuddled, looked after, and loved. There is a hole in our center – you could call it spiritual, you could call it psychological – that wants to be filled with love and comfort.  Every now and then the break-neck pace of overachieverdom overwhelms us and the “starving daughter” comes out. I can literally hear mine repeating the phrase “I am just so tired” or “I am NOT okay” over and over in my head. These are the days we spend on the couch, watching TV and feeling weepy. And for many of us, these are the days we eat – consciously or not – in an attempt to fill that hole.  Thanks to Courtney Martin, I am now able to recognize my starving daughter self for what she is – my own body telling me I’m putting too much pressure on myself. She’s telling me that I don’t need another resume-builder; I need comfort, rest and love.

But there are other ways to look at the issue of “emotional eating.”  From a more medicalized perspective, there is a strong correlation between obesity and stress, depression, and sleep deprivation.  And let’s remember that according to medicine, stress and depression and sleep deprivation are legitimate medical ailments with diagnoses, treatments – the whole shebang. Overeating is a symptom of these diseases. Eating is soothing, and therefore a quick and dirty method for coping with anxiety or stress. Not to mention the fact that busy (and often stressed) people don’t have a lot of time for grocery shopping or meal prep, and often grab less-healthy foods on the fly. Sometimes their only option is a vending machine. And when you need energy NOW, your choices will reflect that with sugar, caffeine, and carbs. With depression comes apathy and the need to self-soothe. Again, these symptoms make it more likely that one will eat to soothe, and will care less about what they are eating so long as it is satisfying (warm, filling, sweet, salty, etc).

And finally, sleep deprivation is a huge factor in so-called “emotional” eating.  For one, if you’re awake for 19 hours a day, you’re likely to consume more calories than someone who is only awake for 16.  Also, sleep has a big effect on your metabolism and the way you process food. Sleep deprivation can actually cause you to gain weight, or make it harder to lose weight. Also, sleep deprivation makes us tired – and contributes to anxiety and depression, for which we often use food to cope.  I am not going to lie.  The more I learn, the more I realize sleep deprivation is a big part of my problem.

I now understand that the reason my lifestyle transformation failed was that I was trying to treat a symptom instead of the disease. I was trying to stop snacking when I should have been addressing the reasons why I snack. Working full time and being a full time student was just too much for me. I was stressed out and living with more anxiety than usual. And I had physical symptoms too – particularly a sore neck that some days hurt so badly I couldn’t turn my head.  I wasn’t sleeping much, and homework kept me from spending as much time with my friends – the people who give me love.  I also gave up exercise (the great stress-reducer) partly because I didn’t have the time, but also because I didn’t have the energy. I also didn’t have time or energy to go grocery shopping or cook. All of these things were factors in my snacking. There were physical factors, mental factors, and environmental factors contributing to my low level of health, for which snacking was a coping mechanism. Taking away my coping mechanism without making any other changes simply wasn’t going to work.

The irony in all of this is that I have been studying health all semester.  I began this semester as a “perfect girl,” pushing myself to do it all because working full time while I was in school was a smart career move and the financially responsible thing to do. I made it about halfway through the semester before the “starving daughter” took over. But during this difficult time, I managed to learn some things.

There are a lot of messages out there that tell us that success and achievement are more important than happiness, or even one’s health. Those are the messages I pretty much bought into, and despite my new-found perspective, I still have trouble challenging them. After all, we are a nation of workaholics that tends to view illness as weakness, and obesity as failure.  Even though we often view medicalization as a bad thing, this is one of those times that medicalizing an issue can actually be helpful in overcoming the moral stigma attached to it.  And as Courtney Martin showed us, sociology – looking at “emotional eating” on a society-wide level – can also be a tool for overcoming stigma.

Now that the semester is finally coming to a close, I am committed to making a real lifestyle transformation: the decision to drop to working part-time. While my “perfect girl” cringes at my laziness and self-indulgence, my “starving daughter” is hopeful. With the extra 16 hours a week, I will be able to sleep more, exercise more, and get to the grocery store before it closes. I will be able to see my friends on weekends. Surely it will be a financial hit and probably not the smartest career move, but it is a real step towards reaching balance and achieving mind/body health. It is my hope that by treating the real problem, some of the symptoms – like snacking – will clear up on their own.