Land of unrest
Shakespeare said sleep “knits up the ravelled sleeve of care”, but the pressure of modern life and the stimulation of technology are making it harder for us to nod off.
Shakespeare said sleep “knits up the ravelled sleeve of care”, but the pressure of modern life and the stimulation of technology are making it harder for us to nod off.
It’s one thing to let your eyelids droop in a post-lunch fug. It’s another to wake to a class of 30 pupils watching you wipe away a thread of drool from your afternoon slumber. As a teacher, Joe Bennett had to force himself to stay awake in the early hours of the afternoon. Now, as a freelance writer and columnist, he happily indulges in a daily siesta. “It’s something I have done all my life. I get up about 6.30 and function well in the morning, but regardless of how much sleep I have, half an hour to an hour’s sleep in the afternoon is a blessing. Anytime between 2 and 4, if I get into a vaguely horizontal position, I will fall asleep.”
This is not a surreptitious snooze at the desk or the famous “power nap”; instead, in the legendary manner of serial afternoon napper Winston Churchill, he sets the alarm, undresses, gets into bed, wakes up in 30-60 minutes (Churchill clocked up a daily twohour kip) and is back at work 10 minutes later. “It is a very nice form of sleep,” says Bennett. “It is lighter, thinner.”
Napping has its rewards, particularly if we are sleep-deprived, says Barbara Galland from the University of Otago’s Department of Women’s and Children’s Health. “It’s well established that napping leads to considerable benefits to subjective levels of sleepiness and fatigue and improvements in mood, alertness and performance.”
Galland takes a 30- to 60-minute nap about twice a month, always on a weekend afternoon. “I should probably do it more often, but it’s very difficult to schedule during the working week. The important thing for me is to let all other members of the household know that’s what I’m doing, so I can nap well with the knowledge that I won’t be disturbed.”
MEMORY BOOST
Napping, and napping well, is growing in popularity. Spain is looking to bring an end to working hours that allow for a daily siesta, but lunchtime napping is becoming more popular in Japan and the US. And for good reason. A 2008 study by the University of Düsseldorf has shown that even very short naps enhance memory processing. Nasa research into pilots on long flights shows 20-minute naps can “maintain or improve subsequent performance, physiological and subjective alertness, and mood”.
More recent findings from a study of 3000 Chinese people over the age of 65
“We tend to see sleep as tradeable for waking time, which it is definitely not.”
found those who catnapped for an hour after lunch showed “better overall cognition” than those who took no naps, shorter naps or longer naps.
Our farmers, long used to rising before the sun, have traditionally taken an after-lunch snooze, but in the city it is not so easy to surrender to afternoon fatigue. Even among over 65s, according to a Sleep Well Clinic report, only 6% nap every day. And as drivers, says the NZ Transport Agency, we are inclined to try to “push through tiredness” – drinking coffee, turning up the radio volume, putting our faith in sheer willpower
– rather than take a short nap.
Elsewhere, however, high-profile companies such as Google, Cisco and Uber now provide nap pods or nap rooms for their staff, hoping to recoup the billions wasted each year on sleepy workers. It’s also been suggested that such recharging can extend the careers of workers in in-demand occupations such as teaching, nursing and medicine into what were once their retirement years.
It makes complete sense, says US neurologist and sleep researcher Chris Winter. As he writes in his new book, The Sleep Solution, a 20- to 30-minute nap will boost your wakefulness without taking you into the groggy aftermath of prolonged deep sleep. Winter takes his siestas seriously, turning off any lights, muting the phone, settling into his fully reclining chair with a pillow and blanket.
SLEEP SNACKING
But daytime napping is not okay, he says, if it is part of a habit of sleep “snacking” to compensate for going to bed later and getting up earlier.
“We tend to see sleep as tradeable for waking time, which it is definitely not,” agrees Philippa Gander, director of Massey University’s Sleep/Wake Research Centre. “We need to revalue sleep. We need to step back and say if you want to stay healthy and if you want to be functional and happy in your daily life, sleep is an essential part of that.
“We used to think there were two pillars of health – diet and exercise. But there are three pillars – we need to add in sleep.”
We spend on average from 24 to 26 years of our lives asleep, but how much we need each night is still debated. UK sleep expert Jim Horne, who is sceptical of the notion of chronic sleep debt, argues that, throughout the ages, humans have regulated their sleep according to their working lives. Five centuries ago, Britons would take an early-evening nap, called “fyrste slepe”. This would be followed by supper, a period of prayer or socialising lasting into the early hours of the morning, then a five- to six-hour sleep.
Some of us need eight or even nine hours a night in one hit, but it is not that common, says Alex Bartle, director of New Zealand’s Sleep Well Clinics. Most of us cope well with seven hours a night, “but six is the watershed – with less than that, we don’t compute very well. Some people think they do, but they almost certainly don’t.”
Can we squeeze better-quality sleep into a shorter time in bed? “No, you can’t,” says Winter. “You have to get your sleep. Apart from the president of my country, I don’t think there is anyone out there who doesn’t think sleep is important. For the average intelligent person, that is not in question.”
GOING SHORT
So sleep is important, but too few of us are getting enough of it. Results from national surveys undertaken between 1999 and 2008 and in the 2013-2014 New Zealand Health Survey show 37% of New Zealand adults aged 30-60 report never or rarely getting enough sleep.
Up to 15% of the adult population, says Bartle, have chronic insomnia that affects their waking life. “Huge numbers are affected by poor sleep and part of the problem is that a lot of people who can’t sleep accept it as normal. It is not normal.”
As in most societies, we are forever pushing more into our days. We get up early to beat the traffic, we refuel on coffee and other stimulants, and we work, play and relax in front of various-sized screens into the small hours. Then, when we feel we should be asleep, we fret over our sleeplessness.
“I used to get jealous of my ex-partner,” recalls 27-year-old Wanaka sports instructor Zack Yusaf. “I’d hear her breathing and wish I could be asleep. Then anxiety about what was to come the next day kicks in.”
Yusaf survived high school on little sleep, making the most of each waking hour before giving in to the inevitability of sleep and another school day ahead. Once he began working, this conditioned wakefulness was exacerbated by the added anxiety of not performing well the next day.
“If someone said, ‘We’re working early tomorrow morning and we are going to get up at 4am’, I pretty much wouldn’t sleep that night. I’d have three to five nights in a row of four to five hours’ sleep, then the weekend would come by and I’d crash out.”
Alarmingly, after the first two or three nights of restricted sleep, we might not even notice how dog-tired we really are.
Yusaf has largely broken his insomniac habits: he avoids dark chocolate, coffee, heavy meats and cheese, and limits alcohol. More importantly, perhaps, he has learnt not to be anxious as the hours of darkness tick by. “I know without a full seven to eight hours’ sleep, I can still function. Then I relax about it, then I sleep better.”
This confidence, says Winter, is key to addressing insomnia. As he writes, insomnia is not simply a case of not sleeping; it is about fear, an overwhelming but common anxiety that “paralyses your sleep”.
Winter sleeps well. At home, on planes, in an ice cave, lashed to the side of a cliff, even in a hotel reputed to be haunted (the Ahwahnee Lodge in Yosemite National Park was one of the inspirations for the Overlook Hotel in Stanley Kubrick’s The Shining, but he heard no bumps in the night and saw no blood pouring from elevators). “I was a little disappointed,” he says from his home in Charlottesville, Virginia. “I slept well. I sleep well most places. Every night when I go to bed, I expect it to be great.”
His clients have no such expectations. Rather, they describe hours of fretful wakefulness, counting down the restive hours till it is time to get up. But he says anxiety can make people misperceive sleep as wakefulness.
“We all have that. You’re nervous about a job interview or sports performance and you
In 2015, fatigue was a contributing factor in 43 fatal crashes, 119 seriousinjury crashes and 450 minor-injury crashes.
feel you didn’t sleep well or at all – but when you think about it, did you really lie there in the dark for eight hours? That is a very long time to do nothing.”
This “paradoxical insomnia”, he says, when you feel you haven’t slept a wink but in fact you’ve had a sixhour slumber, magnifies minor sleep problems to “catastrophic proportions”.
“If you can get individuals to have confidence and faith in their sleep and expect it to be good, it will be much better. “Then, when you have a bad night, you’ll see it as an outlier and not the beginning of a big problem. People who sleep well – when they have a bad night, they barely remember it.”
PAYING THE PRICE
If we don’t regularly sleep six to seven hours, we pay for it by being tired, grumpy,
unfocused and unproductive. More alarmingly, says Gander, after the first two or three nights of restricted sleep, we might not even notice how dog-tired we really are. The resulting fatigue can lead to microsleeping – brief nod-off periods of up to a few seconds that can make the difference between swerving and braking or hitting that tree.
Most of us microsleep, says University of Otago neuroscientist Richard Jones. “But the sleep-deprived, which a lot of us are, are more likely to have microsleeps. The brain is struggling to keep awake and sometimes it just slips into brief sleep.”
This can happen up to several times an hour if we are sitting through a mind-numbingly boring chore. But it can also happen if we are doing a more active task, such as driving or flying an aircraft.
“That is why you read about fatal accidents happening on straight bits of road where someone has crossed the centre line,” says Jones. “On the road, the aim is to stay awake. The brain knows that, but something in the brain, part of the whole sleep-wake thing, in certain conditions tips you over.”
Most of us are aware of the risks of driving drunk, he says, but if we are tired, even if we are struggling, “we keep on going [and] some of these people don’t make it home”.
According to Ministry of Transport figures, fatigue was a contributing factor in 43 fatal crashes, 119 serious-injury crashes and 450 minor-injury crashes in 2015. Alcohol/ drugs or speed were also contributing factors in 25% of the fatal crashes that involved driver fatigue.
At the Ahuwhenua Trophy Maori farming awards in Whangarei in May, Prime Minister Bill English recounted how, as a 14-year-old behind the wheel of a D2 Caterpillar, an eight-tonne tractor, he fell asleep and ended up in the neighbour’s paddock. A month earlier, Christchurch developer Antony Gough totalled his BMW when he fell asleep behind the wheel. In January, warehouse worker Francis Hall, 22, was only five minutes from his Karaka home in rural South Auckland after a 10-hour shift at work when he fell asleep at the wheel, crashing through three fences and ending up with a 1.2m piece of fence rail protruding from his chest.
HEALING TIME
Even if you’re not at risk by being at the wheel of a vehicle, sleep deprivation takes its own bodily toll. Sleep is a vital time for muscle repair, memory consolidation and the release of hormones regulating growth and appetite.
“When you are awake,” says Gander, “your brain is incredibly busy processing all the information coming in from the environment: what you are seeing, hearing, tasting, thinking and what you are going to react to. Offline, however, there’s a whole lot of other processes the brain has to go through to restore brain and body function.”
Recent research shows that, just as the body’s lymphatic system is efficient at
Insomnia means caring a lot about not sleeping when you want to sleep. It is a fear that “paralyses your sleep”.
collecting and disposing of waste, the brain’s glymphatic system, managed by the brain’s glial cells, helps rid it of toxic molecules associated with neurodegenerative conditions. This plumbing system, writes Winter, is 60% more productive while you are sleeping.
Sleep is also the time for the greatest production of growth hormone, which encourages tissue growth and repair, and for stimulating the immune system.
It is possible to catch up on missed sleep. For teenagers going to bed late and getting up early or shiftworkers on a night-time roster, two full nights of unrestricted sleep in a row will provide an opportunity to recover. But for those with prolonged sleep deficiency, the ones who would fall asleep at the drop of a hat if they had the opportunity, rather than those taking sneaky looks at the clock in the middle of the night, chronic sleep deprivation has been associated with cancer, diabetes, heart disease, cognitive decline and obesity.
This can be partly explained by the sleep-promoting hormone melatonin, the production of which is suppressed by natural light during the day, Bartle says.
“Our Stone Age brains like being outside – it’s our outside mind that suppresses melatonin. Our brains haven’t changed much over the past few thousand years. We’ve been developing them for 500,000700,000 years, so this past hundred years, when we’ve had electricity, is really a drop in the ocean. We spend all our time indoors now, which is not good.”
But researchers have discovered that exposure to light at night – particularly the blue light from smartphones, tablets and laptops – may continue to suppress the secretion of melatonin, just when we should be benefiting from large natural doses. And melatonin has now been found to have anti-cancer properties.
For those battling with underlying stress that interferes with their sleep, Winter and Gander both recommend cognitive
It is possible to catch up on missed sleep. Two full nights of unrestricted sleep in a row will provide an opportunity to recover.
behavioural therapy (CBT). But even though it is internationally recognised as an effective treatment for insomnia, there is no public funding in this country to address those beliefs, behaviours and underlying issues that disrupt our sleep. Gander argues that public spending on CBT would be costeffective: the Sleep/Wake Research Centre estimates appropriate treatment for adults with insomnia would save the country $3.9 million a year.
There are measures we can take at home to improve our sleep. Winter uses the term sleep hygiene to describe the routines and rituals around bedtime that let the brain know it is moving into sleep phase: dimming the lights, taking a hot shower or bath an hour before going to bed, getting into a made bed, wearing special night clothes, meditating or reading before lights out. For children, it might be a favourite toy or blanket that assures them they will sleep well.
The list of what not to do is even longer. Avoid tea and coffee and limit alcohol. Do not have an alarm clock or cell phone beside your bed. Do not sleep in an overheated room – a cooler bed is better for rest. Do not go to bed with stimuli such as TV, news feeds, social media or emails. Nor are backlit e-readers recommended: Harvard University research participants who read on light-emitting devices took longer to fall asleep, had less REM sleep and had higher alertness before bedtime than those people who read printed books (most devices now have screen-dimming controls and bluelight blocking filters are coming on stream).
Exercise – particularly outdoors – is helpful first thing in morning or after work, but not, says Bartle, just before you sleep, because it raises your internal body temperature.
DON’T SWEAT IT
Most important, don’t lie awake staring at the ceiling. “If you are in bed and anxious, you shouldn’t be in bed,” says Bartle. “Get out of bed, even just for 10-15 minutes, then go back to bed.”
Going to bed earlier is not necessarily the answer, either. Bartle tells the story of a patient who lay in bed for nine hours but thought she’d been asleep for only four and a half hours. “That’s about 50% sleep efficiency. By restricting her time in bed to five hours when she sleeps only four and a half hours, her sleep starts to be consolidated. She’s going to bed and going to sleep. After two weeks, you start increasing that time in bed by 15 minutes every two nights. By that time they think, ‘I can do it.’”
For those with “middle insomnia”, who go to sleep exhausted, then wake up during the night and can’t get back to sleep, the advice is the same. “We get them to get up and down until they can go to bed and go to sleep. Everybody wakes at night; waking isn’t the issue. But people often wake, they look at the clock and that immediately gives that anxiety pulse and they can’t sleep.”
Our understanding of the importance of a good sleep or timely nap will grow. Last month, scientists at Western University, Ontario, led by British neuroscientist Adrian Owen, launched what is set to become the world’s largest study of the effects of sleep deprivation on the brain. People from around the world are being asked to sign up online to do specially devised computer games to test their reasoning, comprehension and decision-making to better understand how lack of sleep affects cognition, memory and concentration. As Owen told the BBC, “It may be that lack of sleep is having very profound effects on decisionmaking. Perhaps we should avoid making important decisions like buying a house or deciding whether to get married when we are sleep-deprived.”
Back in Lyttelton, Joe Bennett is not holding out for any research to convince him of the pleasures of a daily nap that he has enjoyed since he was 18. “If I’m trying to do academic work or writing, I find it very hard mid-afternoon. But it is a luxury, an indulgence. If people want to do it, they should do it – I’m privileged to be self-employed and work at home so I can – but I’d hate [daytime naps] to become official policy. If Google has them, I’d have to stop doing it.”
The Sleep Solution: Why Your Sleep is Broken and How to Fix It, by W Chris Winter (Berkley Books, $22.99)
Snooze: The Lost Art of Sleep by Michael McGirr (Text, $37)
“If you are in bed and anxious, you shouldn’t be in bed. Get out of bed, even just for 10-15 minutes.”