Why lack of sleep may be the greatest curable disease in the world
'The number of health issues related to sleep pretty much trumps everything else'
No sleeping pill promotes a natural sleep – ‘it’s sedation, not sleep’
Hands up if the following conversation, usually held around 3am, is even remotely familiar:
You: Have you thought about which way you might like to die?
Also You: No! It’s 3am. Go back to sleep.
You: Which would be worse? Having no money, or having no friends?
Also You: Seriously now, stop talking. Stop thinking. It’s time for sleep. You have to be up in four hours.
You: How many minutes is that? Technically it’s 3 hours and . . .
Also You: Enough!
You: Marilyn Monroe. Do you think she ever learned how to drive? What about the Queen?
Also You: Stop. Stop. Stop. Stop. My god, stop.
You: I think there might be someone in the back garden.
Also You: There isn’t anyone in the garden. Just relax.
You: Well, then I think you need the bathroom.
There has been plenty of lip service paid to “sleep hygiene” (fancy speak for putting away all screens and chilling out for a bit in the evenings).
Children and teenagers of all ages are sleeping two hour and 10 minutes less a night, on average, than they did a century ago
Sleep hygiene or not, most insomniacs will know the drill by now: becoming more alert and fretful during nighttime hours, with a feedback loop stopping the brain from truly turning off.
In 1942, less than 8 per cent of the population was trying to survive on six hours or less sleep a night; in 2017, almost one in two people is.
Children and teenagers of all ages are sleeping two hour and 10 minutes less a night, on average, than they did a century ago.
Anxiety around modern life and current affairs plays its part: likewise, the blurring between work and home life. A world in which the night is electrified with LED lights and screens contributes, too.
Author Matthew Walker, founder/director of The Centre for Human Sleep Science at University of California, Berkeley*, has noted that insomnia is just one of around 100 sleep disorders people experience. Snoring, Restless Leg Syndrome, and sleep apnea are just some of the malaises that affect sleep quality and impact on our ability to get a prescribed eight hours’ sleep.
With Walker noticing a dearth of reading material on sleep for the subjects in his clinic, he wrote Why We Sleep: The New Science Of Sleep And Dreams. On the promotional tour for the book, he jokes that many interviews start with a “sleep salon”.
“I get hundreds of emails from people in desperate need of sleep, and on these interviews, often the first port of call, before we get started, is to talk about how someone’s husband or wife isn’t sleeping,” he smiles. “So much so that when I get on a flight, or meet new people, I just tell them I’m a dolphin trainer. It’s just a lot easier for everyone.”
Still, Walker is entirely passionate and convinced that humanity is sleepwalking itself into a massive health catastrophe, on par with smoking, lack of exercise or obesity. Not getting the requisite amount of sleep every night, he says, will eventually take years off our lives.
“After just one night of only four or five hours’ sleep, your natural killer cells – the ones that attack the cancer cells that appear in your body every day – drop by 70 per cent,” explains Walker.
There are also links to lack of sleep and Alzheimer’s disease, cardiovascular disease, weight gain, stroke and cancers of the breast, prostate and bowel. In the case of the former, the deposits of toxin proteins don’t get “cleared out” from the brain when a person becomes sleep deprived.
Some studies show that short sleep can affect our cancer-fighting immune cells. Elsewhere, brain scans carried out by Walker revealed a 60 per cent amplification in the activity of the amygdala – a key area for triggering anger and rage – in those who were sleep-deprived.
“If the fight-or-flight branch of your central nervous system is revved up, like you have a car stuck in gear and you’re revving it, this comes with a kaleidoscope of problems,” he adds. “It triggers long-term chronic inflammation, high levels of (stress hormone) cortisol, free radical damage and a blunting of the immune system.
“It also leads to a slew of altered genes, meaning that it will erode the very fabric of biological life itself. Sleep deprivation is like a broken water pipe in your home – it will leak into every nook and cranny of your physiology.
“I’m not trying to suggest that epidemics of infectious diseases aren’t important, or that issues around food aren’t, but they are clearly already public health disasters. But the number of health issues related to sleep pretty much trumps everything else out there right now.”
Most worrying of all to Walker is the widely held idea that sleep deprivation is just an unfortunate side-effect of modern day living. We wear busyness like a badge of honour – it is associated with productivity and popularity. To that end, no one ever truly worries about sleep deprivation, and there’s certainly no such thing as being “sleep-shamed”.
“Sleep has an image problem in society,” Matthew observes. “Getting sufficient sleep is equated with being slothful and unimportant.”
What Walker would like to see is an instance in which government and other policy makers address sleeplessness as a matter of urgency.
“Sleep is perhaps the greatest curable disease in the world right now,” he observes. “There is no one single lever that we can pull. It has to happen at a societal level. Firstly, we need to stop stigmatising sleep with terrible laziness. When was the last time you were prescribed sleep?
“And when as the last time you saw a government public health announcement about this?” he adds. “We have published them for smoking, eating and physical activity. Sleep is the neglected stepsister in the health conversation. We need government to take charge. The science has yet to be fully communicated to government.”
It’s not just the government, says Walker, who should assume responsibility. “Doctors have so little sleep education during their medical degree, so they have to change the structure of education for doctors.
“Aside from that, we need to educate people on the devastating consequences of insufficient sleep,” he adds. “When I present them to people, they are shocked.”
There are some steps that individuals can take themselves to ensure a level of “sleep health”.
“Sleep regularity is a big thing,” says Walker. “Go to bed and wake at the same time. Short sleeping during the week and binge sleeping on the weekend is the equivalent of flying between New York and San Francisco every weekend.
“Keep your bedroom cool, at 18 and a half degrees, have dim light in your bedroom, and use blackout blinds if you need to. Caffeine and alcohol are also the greatest enemies of sleep.
“If you can’t sleep for more than 20 minutes, get out of bed,” he continues. “If you remain in bed awake, what happens is that you learn that being in the bedroom means being alert and awake.”
To combat the dreaded feedback loop, says Walker, put pen to paper. “Write down all of the concerns, fears and thoughts keeping you awake,” he advises. “It turns out that catharsis very much helps.”
No sleeping pill promotes a natural sleep (“It’s sedation, not sleep”), and Walker notes that cognitive behavioural therapy is now being used to treat insomnia instead.
Whenever Walker experiences a sleep problem, he himself turns to meditation: “I found it incredibly beneficial,” he says.
In his work, Walker encounters many people who have no problem sleeping, but might sleep next to a person with sleep apnea, or who snores.
People think if you’re not sleeping together you’re not sleeping together, but the exact opposite is true
“I’m a fan of separate bedrooms in this case,” he says. “Almost 30 per cent of people don’t sleep in the same bedroom, and almost 40 per cent start off sleeping in the same room, but are in separate locations by the morning. I think whatever it takes for you to get a good night’s sleep, do it. People think if you’re not sleeping together you’re not sleeping together, but the exact opposite is true. If you get regular sleep your reproductive hormones increase, and people report better physical relationship in that regard.”
There are of course many people who swear they can get by just fine in four hours’ sleep or less (among them Donald Trump, Margaret Thatcher and Ronald Reagan). Walker says they aren’t fortune freaks of nature; rather, they are merely deluding themselves.
“It’s a little bit like a drink driver at the bar, who has had seven pints but feels they are okay to drive home when objectively they are not,” he surmises.
“One of the problems with sleep deprivation is that gradually, your baseline health gets reset as your sleep declines. Based on 10,000 scientific studies, the number of people who can survive on six hours’ sleep, rounded to a whole number, is zero.”
Why We Sleep: The New Science Of Sleep And Dreams by Matthew Walker is available now via Allen Lane for €28 (hardback).
*This article was amended on December 14th, 2017 to correct an error