Both sides of the pillow have become uncomfortably warm.
It’s now light outside, and your mind races with thoughts of work, or thoughts about thinking, and endless replays of that one time you called your boss “Dad”.
During the day, you look and feel as though your face is melting. You’re jealous of babies and cats, smug in their slumber, as you cling to your third coffee of the day. Yet somehow, by 1am, you’re on your fourth episode of Wild Wild Country in a row and writing out to- do lists, as if you hadn’t just spent the entire day exhausted and wanting to be back in bed.
According to the World Health Organisation, you are likely part of the “sleep-loss epidemic”. Two-thirds of adults in developed nations are now falling short of the recommended eight hours a night. But while there has been a global rise in sleep disorders such as insomnia and sleep apnoea, this is less a medical issue than a social one. Even those with the capacity to sleep well aren’t doing enough of it.
In Japan, where the epidemic is at its most extreme, the average time spent asleep is just six hours and 22 minutes. There are even phrases in the language for falling asleep in public ( inemuri) and dying from the exhaustion of overwork ( karōshi). But we in the UK aren’t far behind, averaging just six hours and 48 minutes per night. In 1942, a study found that under 8% of Britons were trying to get by on six hours or less. Now, it’s almost half of us.
The British neuroscientist Matthew Walker is the director of the Center for Human Sleep Science at the University of California, Berkeley. He is also the author of Why We Sleep, a treatise he describes as “a manifesto of sleep science”. The book both collates and dispels a number of sleep myths, while linking the “pernicious erosion of our sleep in developed nations” to pretty much every major modern illness, from cancer and diabetes to heart disease and Alzheimer’s.
In person, Walker is disarmingly chirpy, but he is serious about the message of the book. “I think sleep is a missing piece in the puzzle of health,” he says. “It’s not something people are necessarily recognising as a critical issue when it comes to fighting disease and sickness. That’s partly the fault of people like me: the science has not been communicated well enough.”
The link between poor sleep and illness is far from casual. In one study, adults over the age of 45 who slept for less than six hours a night were 200% more likely to have a heart attack or stroke in their lifetime than those who slept seven or eight hours.
Deep sleep also helps the brain to clear away harmful deposits that can lead to cognitive degeneration. Last year, a study published in the journal Neurology linked dreamless sleep to dementia. In short, an over-reliance on coffee could prove to be the least of our concerns.
Wake-up Call
Most of us have some idea of why we aren’t sleeping. Our commutes and working hours are growing ever longer, the latter in part because hyper-connectivity means we’re never truly away from the office. As well as maintaining relationships with our colleagues, friends and family, we have online lives to nurture and Twitter
arguments with strangers to settle. We are perpetually drenched in the light of our TVS, phones and laptops. We are frustrated by cities that dare to sleep. When we get home from work, it’s easy for real rest to take a back seat when Reddit threads about deep-sea creatures beckon.
However, our sleep poverty can’t simply be blamed on technology and modernity. After all, technology has also made us more aware of what Walker calls “quantified self-improvement” – our need to monitor and improve our health. But metric-tracking and self-care apps do nothing to address the cultural attitudes behind our lack of sleep.
We continue to praise political leaders and CEOS – from Barack Obama to Steve Jobs and Twitter’s Jack Dorsey – for their lack of sleep. Boasting about the “rise and grind” has become one of the oddest forms of machismo. It’s as if we believe that achieving anything significant requires a masochistic slumber deficit. John Major struggled to follow Margaret Thatcher’s fearsome reputation in cabinet, which she cemented by keeping her aides on their toes by sleeping only four hours a night. Less is said, however, about Thatcher’s final years, which were plagued by strokes and dementia so profound that she would often forget about the death of her husband.
Nor is the stigmatisation of sleep confined to the world of offices and big business. How often have insomnia and late-night hedonism been romanticised as sources of creativity, as if sleep deprivation were a mindexpanding drug? Walker believes this is a thoroughly modern and senseless predicament. “Sleep is not like a bank,” he explains. “You can’t accumulate a debt, then pay it off later. There are times when our body does work like that – for instance, you can undergo a period of starvation because you’ve built up a repository of calories in the form of body fat.” But sleep is different. “Human beings are the only species that deliberately deprives itself of it. Mother Nature took 3.6 million years to put this thing called ‘eight hours of sleep’ into Homo sapiens, and we deprive ourselves of it for no good reason. It is an entirely man-made problem.”
As a society, we are only just starting to understand the price we pay for this. The Rand Corporation, a global policy think tank, concluded recently that insufficient sleep was a “public health problem” costing the global economy hundreds of billions of pounds in lost productivity each year. In the UK alone, it is estimated to cost us over £35bn a year – 1.86% of our GDP. The solution – switching off our laptops and turning in early – seems almost a little too simple.
Overnight Change
As is the case with many wellness trends, we all know some of the rules of “clean” sleeping, but we’re seemingly intent on finding shortcuts. In the UK, we are generally sceptical about high-strength sleeping pills, in part as a result of the notoriety of drugs such as Ambien that are widely prescribed in the US. The gap left by our comparatively strict regulation of these drugs has begun to be filled by a proliferation of less regulated sleep aids, from herbal sedatives such as valerian and passion flower extract to the frequentflyer favourite, melatonin tablets.
One of the most popular is 5-HTP, though scientific evidence of its efficacy is limited. A naturally occurring amino acid reputed to increase the body’s production of serotonin, it was initially touted as “nature’s Prozac” and adopted by drug users to take the edge off MDMA comedowns. It is now widely sold online and in health food stores as a sleep aid.
Anecdotally, at least, high doses of 5-HTP seem to deliver some of the effects associated with selective serotonin reuptake inhibitors such as Prozac or Lustral. Users recount vivid dreams and “brain fog”. Researching this article, I spoke to many people who were eager to talk about their pursuit of sleep by any means necessary, including taking 5-HTP. Luke, a 31-year- old teacher, was enthusiastic about its initial benefits: “It never helped me fall asleep, but it would make me stay asleep, and sleep for much longer than I would without it. I’d also have these incredibly lucid, often unpleasant dreams. I would wake up feeling completely calm, though not really rested.”
To be clear, Luke says he was taking handfuls of 5-HTP capsules every night and for well beyond the recommended three-month time frame. “The longer I was taking them, the foggier I felt in the daytime, despite getting eight or nine hours in bed. I’m sure I only stopped taking them because I kept forgetting to order a new batch.”
If neither prescription medicines nor herbal drugs can guarantee true rest, what is the solution for those of us turned into zombies by our lack of sleep? “If we had a good medication that produced naturalistic sleep, I’d be very much in favour of it,” says Walker. “But we just don’t. However, in 2016, the American College of Physicians (ACP) made a landmark recommendation, suggesting that cognitive behavioural therapy (CBT) must be used as the first-line treatment for chronic insomnia, not sleeping pills.”
Crucially, he says, the ACP found that the benefits are maintained even after you stop working with the therapist – “Unlike with sleeping pills, where stopping not only means you go back to bad sleep, but you have what’s called rebound insomnia. That’s even worse.” CBT for insomnia is offered in the UK, too, except with the added strain of NHS therapy waiting lists.
There are some alternatives. A Newcastle-based group called Sleepstation offers a “six-week insomnia cure” for £295, including expert analysis, video guides and your own personal “sleep coach” (NHS referrals are available). More than 8,000 people have signed up to date, and the group asserts that nine in 10 people see a positive difference. It points to a slightly more nuanced view of treatment than simply “drugs or no drugs”.
Mind Over Mattress
The recommendation of sleep-based therapies also opens up a broader discussion about the role that sleep plays in our mental health. While the public discourse around men talking about their mental states has improved significantly, many still find it far more palatable to go to their GP complaining of insomnia than to talk about the thoughts that are keeping them awake. “Getting insufficient sleep is a two-way street,” says Walker. “Anxiety is a big contributor to disorders such as insomnia, but sleep deprivation also
raises your risk of the development of anxiety and depression.”
Luke has spoken to his GP about his insomnia, but has never broached the subject of what might be causing his lack of sleep. “I’m sure there is bigger stuff at play and a large element of anxiety,” he says, “but you get in the habit of wanting to zone in and treat what is most disruptive to your daily life. I just want to sleep and deal with the rest later.”
Perhaps the biggest hurdle we face is that the most effective solutions to our sleep loss feel so mundane. Walker is armed with a list of reasonable lifestyle changes: setting yourself a non-negotiable bedtime, moderating your alcohol intake, sleeping in a cool, dark bedroom, a moratorium on evening screen time, among others. (See our Fitse Index on page 28 for more suggestions.) But, he says, you also need the ability to get out of bed when you just can’t drift off. “The worst thing you can do when you can’t sleep is to stay in bed,” he explains, as the brain will form a connection between your bed and restless anxiety. “Just go to another room and read until you are sleepy.”
However, a prescription alone is not enough. We need to approach sleep as we would our gym routines: to stop expecting it to be easy, or results to come quickly. Sleep, counter-intuitively, is hard work. Banking on a restful night without examining our habits and eliminating the problems is like tackling a marathon without training – only with a whole lot more at stake.
As for the wider battle of how we reclaim our eight hours a night from our jobs, the solution is a little more ambitious. But Walker is resolute. “There has to be change at government level, as well as in our health-care systems and in education, to stop us lauding long working hours as somehow heroic,” he says.
“When was the last time you saw the UK government put forward a public health campaign regarding sleep? I’ve seen them for smoking, drinking, exercise and diet, but I’ve never seen one for sleep. I hope – no pun intended – that this renewed discussion is a wake-up call.”