Sleep - An Underrated Health Intervention

Sleep – an underrated health intervention?

As I have progressed through my career I have become more interested in societal and environmental factors within health and human behaviour.

The environment we live and work in, the people we interact with, societal and cultural values and norms can really shape our behaviour.
One thing I see as underrated in our culture is sleep.

We prioritise busyness, productivity and “doing” over resting and recovering. With the recent COVID 19 pandemic, many people have really struggled with sleep due to altered routines, increased stresses and anxiety and limitations on travel and access to usual social and recreational pastimes.

Lack of sleep can inhibit training effects, impact on recovery, increase risk of injury and make you more susceptible to an array of medical conditions from diabetes to chronic pain. Our ever-busy lives mean sleep is often viewed as an inconvenience that interrupts us doing stuff and is not prioritised for health.

My own interest in sleep came after a particularly stressful period of life which led to an 18-month bout of insomnia, it affected virtually every aspect of my life. I started to research the issue and found that a significant proportion of the population is sleep-deprived and many of my clients too. I successfully improved my sleep, my relationship with sleep with self-management and lifestyle changes and whilst sleep occasionally eludes me due to worries, this is quite normal and manageable.

What is Sleep?

For an activity we spend on average 1/3 of our lives doing, most of us have very little understanding of what sleep is and why we need it.
Sleep is a state characterised by changes in brain wave activity, breathing, heart rate, body temperature and other physiological functions, where we are less responsive to external stimuli, but able to rouse easily unlike other states of reduced consciousness.

Many physiological functions reduce during sleep but others are increased such as the release of growth hormone and cell repair, in fact, some genes associated with repair are only activated at night suggesting that this is an important function of
sleep.

The brain remains active throughout sleep and can be more active than when you are awake during certain phases, which scientists believe may be related to memory formation, but this is not fully understood. 2 internal biological mechanisms control sleep, your circadian rhythms and sleep-wake homeostasis. Circadian Rhythms direct a variety of functions from wakefulness, variation in body temperature, and metabolism and they control the timing of sleep along with our natural Cortisol cycle and melatonin production (and other mechanisms). They are controlled by your biological clock and synchronise with your environment but do continue in their absence which is why jetlag is so horrible! Your Sleep-Wake homeostasis internally tracks the need for sleep increasing deeper, longer sleep after a period of sleep deprivation.

There are 5 stages of sleep shown in the graphic below, which repeat x4-5 per night on average. Slow-wave sleep or deep sleep is most important for recovery which is why sleep quality matters.

How Much Sleep Should I be getting?

Sleep requirements vary by age and individuals, some people need more or less than others. Teenagers are amongst some of the most sleep-deprived with many only getting 5-6 hours per night. Statistics from 2013 show that 40% of people sleep less than 6 hours per night which can be detrimental to health and wellbeing.

What are the effects of too little sleep?

A few nights of reduced sleep due to life events or an acute period of stress will do no harm, but with insomnia estimated to affect 1/3 of the UK population, longer-term effects of sleep deprivation should be taken seriously.

The effects of chronic sleep deprivation are extensive and include:

• Impaired cognitive function– affecting our ability to learn, concentrate and remember things. Creativity is enhanced x3 with a good night’s sleep.
• Impaired motor skills - resulting in an increased risk of accidents. 31% of drivers are estimated to fall asleep at the wheel once in their life and 10,000 traffic accidents a year reported in the USA as a result of lack of sleep. Major incidents such as Chernobyl and Challenger Shuttle disaster are linked to fatigued shift workers and impaired decision making as a result.
• Increased risk of injury – athletes who sleep less than 8 hours per night are almost twice as likely to get injured.
• Increased incidence of depression, anxiety and other mental health issues.
• Weakened immune system.
• Increase in Chronic pain.
• Increased risk of heart disease, stroke and high blood pressure.
• Increased risk of Alzheimer’s disease and dementia.
• Increased risk of Obesity.
• Increased risk of drug and alcohol dependency.
• Increase in certain types of cancer and reduced life expectancy in shift workers.

What Can I do to get a better night’s sleep?

If you don’t sleep well, don’t panic! The good news is there is plenty you can do to improve your sleep.

• Prioritise sleep – view it as an essential part of health.Explain to those you live hhhhh with why it is important and encourage healthy habits throughout the family.
• Reduce your caffeine consumption – especially after lunch. For me, only having 1 coffee per day has really helped.
• Make your bedroom a sleep haven and keep it free of technology and screens. In our house, we leave all tech downstairs and there are no TV’s in the bedrooms – not always popular but super important!
• Use light to your advantage – make your bedroom as dark as possible at night and use natural light to stimulate wakefulness in the day. I personally find my natural light alarm clock really helps with getting up in the winter months.
• Switch off your mobile phones AT LEAST 1 hour before bed and keep them out of the bedroom – blue light interferes with Melatonin production which essential for sleep. Plus, they’re a bit antisocial and fraught with other problems right?!
• Have a set sleep/rise routine.
• Pay attention to diet – carbohydrate-rich meals tend to promote sleepiness.
• Exercise regularly but not too late. Often we are emotionally tired but not physically tired these days. The old adage of fresh air and exercise can really help.
• Spend as much time as you can outside, especially in daylight. Exposure to natural light can really help your body with its natural cycle of sleeping and wakefulness. We also know that spending time outdoors, especially in nature can improve wellbeing and reduce stress.
• Create a relaxing bedtime routine – a warm bath, read a book or try meditation or yoga. I have used Headspace, Insight Timer, guided meditations to help, especially when I started out and progressed to self-practice as I learned to “self soothe” more effectively
• Write down your worries or to-do lists. A problem shared is a problem halved, as they say, sometimes writing things down can really help to get things off your chest and help you settle.

If you regularly struggle to sleep and it is affecting your quality of life, then speak to your GP as well as trying the measures above, to ensure there is no underlying medical problem.

And finally a thought from Thomas Dekker, an Elizabethan writer who clearly knew a thing or two...