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22 August 2016

You snooze, you lose: why sleep is back on the agenda

A history of sleep from the premoderns to today’s health geeks reveals that today's "sleep revolution" is not as radical as it pretends to be.

By Sophie McBain

“Have we reached peak sleep?” a New York Times beauty feature asked back in May, before directing readers to the latest “painstakingly researched Italian- and French-made” white sheets and a luxury retailer of “performance pajamas”. Unfortunately, the answer seems to be: not yet.

Newspapers continue to print frequent updates on the so-called global sleep crisis and publishers are churning out a soporific selection of insomnia self-help books. Right-on employers are nudging workers away from the coffee machine and installing sleep pods. Those who can afford to do it might book themselves a holiday at a five-star sleep retreat. Most of the rest of us are warding off late-night wakefulness with sleep apps, electronic white-noise devices and anxious spritzes of lavender.

Ours isn’t the first society to place special importance on sleep. In the premodern world, it was seen as a mystical activity and a route to communion with the divine. The ancient Egyptians and Greeks sometimes slept in temples so that the gods could guide them in their dreams; in religious scriptures, prophets and holy men often receive messages from above in their sleep. For 17th- and 18th-century Britons, sleep was seen as a state midway between life and death, Earth and heaven. This conception is understandable. Many people say they believe in an afterlife because the alternative – never-ending nothingness – is inconceivable. Then each night they submit to oblivion gratefully, as though slipping into a hot bath.

Most sleep writers trace the origin of our perceived problems to the Industrial Revolution and the invention of electric light. The great industrialists did not consider good sleep important to a spiritual life: rather, it was a potential obstacle to it. Hard work was seen as godly and laziness a sin, which was all very convenient when workers needed to cope with gruelling shifts to keep factories running 24/7. Fittingly, Thomas Edison, the inventor of the first commercial electric light bulb, bragged about how he slept no more than five hours a night. He seemed to capture the 19th century’s prevailing sentiment when he said: “Most people overeat 100 per cent and oversleep 100 per cent because they like it. That extra 100 per cent makes them unhealthy and inefficient.”

Business leaders and politicians still like to boast about how their late nights and pre-dawn workouts have helped them stay ahead, but they are less likely to speak about sleep moralistically. Until very recently, sleeping was just uncool: in a globalised, post-industrial world where money never sleeps, snoozers are losers.

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It is here that the publisher Arianna Huffington – the author of one of the most high-profile of the new sleep manifestos, The Sleep Revolution: Transforming Your Life One Night at a Time (W H Allen) – intrudes into the narrative. She was a member of the work hard, play hard elite, until in 2007 she collapsed with exhaustion at her desk and broke her cheekbone. She draws repeatedly on her own experience and recounts several tragic stories – such as that of the Goldman Sachs analyst who killed himself after staying awake for 48 hours – and urges readers “to renew your relationship with sleep . . . and join the sleep revolution, transforming your life and our world one night at a time”.

The Sleep Revolution is part self-help book, part exploration of modern sleep patterns and the emerging science of sleep. Huffington describes herself as a “sleep evangelist” and she writes like a zealot. She describes the question “Why am I so tired?” as “the existential cry of the modern age” and argues that sleep is a “gateway to the sacred and to life’s mystery”.

Huffington and her fellow sleep evangelists are supported by strong science in making their case for a good night’s sleep. Scientists are finding that, far from being dead time, sleep is crucial to learning and memory formation. The hours we spend in bed help our body regulate itself. A few bad nights’ sleep can make a person irritable, impulsive and hungry. Over a longer period of time, poor sleep is linked to obesity, ­diabetes, heart disease and a host of other ailments. When we are deprived of sleep, we become more accident-prone. Huffington cites an Australian study that found that staying awake for 17 to 19 hours leads to a cognitive impairment equivalent to just under the US drink-driving limit. Stay up a few hours longer and your reactions are equivalent to someone with a blood alcohol level of 0.1 per cent: “legally drunk”. These days anyone attempting to drive home drunk from a party is likely to be stopped by their friends, but driving back from an all-nighter at work is normal – isn’t it?

The new sleep evangelists are also carried along by strong cultural headwinds. Today, when hipsters are more likely to be found in juice bars and knitting circles than at all-night raves, Huffington’s calls for an early night will find a more receptive audience than they might have done a decade ago. As a society, we’re more preoccupied than ever with living healthily. The “wellness” and fitness industry is booming: a 2015 report by the accounting firm PricewaterhouseCoopers estimated the size of the global market at $1.49trn. Ten years ago, anyone who counted the number of steps they took in a day would have been considered a nutcase. But now millions are micro-monitoring their daily movements and calorie intake using tracking technology such as Fitbits. We live in the self-optimisation era, in which the truly “health-conscious” display an obsessive interest in their lifestyle and their bodies. If an expert tells us to get more sleep, we are more than likely to give it a go.

Huffington et al fit neatly into the broader wellness industry. Like the new generation of food writers, they conceive of their subject in grand, pseudo-religious terms. Wellness bloggers don’t just peddle restrictive diets, they sell a “food philosophy” to demonstrate how a spiraliser can act as a key to greater happiness and self-love. ­Madeleine “Get the Glow” Shaw writes that her eating philosophy “is all about enlivening the hottest, happiest and healthiest you”; the strapline for Deliciously Ella (née Ella Woodward) is “Love Your Life, Love Your Food, Love Your Self”. Shawn Stevenson, the author of Sleep Smarter, offers his readers “21 essential strategies to sleep your way to a better body, better health, and bigger success”. Like Woodward, who says that her diet helped her overcome a rare illness, postural tachycardia syndrome, ­Stevenson attributes his success in overcoming a diagnosis of degenerative bone disease – a miracle for the 21st century – to overhauling his exercise, diet and sleep patterns. A book by the “elite sleep coach” Nick Littlehales, to be published this autumn, promises to “redefine your rest, for success in work, sport and life”. Similarly, Huffington’s goal isn’t just to help people sleep better: it’s to transform lives and help “shift our focus from our worldly problems to a higher reality”.

The parallels don’t end there. Hailing Huffington as a “sleep revolutionary” is a mistake comparable to crediting Deliciously Ella with helping to fight global malnutrition. Just as the average convert to goji berries and chia seed puddings already eats relatively healthily, Huffington addresses a readership that is already likely to sleep comparatively well. Her case studies of power mums and fraught bankers signal that her book is aimed at stressed-out white-collar workers. Some of them may be pulling all-nighters at the office or staying up too late binge-watching box sets but, on the whole, the more affluent you are, the healthier your sleep patterns.

The relationship between hours of sleep and mortality is actually a U-curve: too little sleep is bad, but so is too much. A study of the sleeping patterns of over a million people by Franco Cappuccio of the University of Warwick found that those who slept less than six hours a night were 12 per cent more likely to die early than those who slept between six and eight hours a night. Yet people who slept more than eight hours were 30 per cent more likely to die within the study period. Sleep advocates rarely mention that sleeping too much is also linked to early mortality; if you were feeling generous you would say that is because most scientists believe that sleeping long isn’t dangerous in itself, but can be a sign of an underlying problem such as depression or chronic illness. A less generous explanation is a tendency to cherry-pick information.

This U-curve is also important because of a sleep data problem picked up by the number-crunching podcast ­Freakonomics. Some studies assert that the wealthy and higher-educated get less sleep than the rest of society, but much of this research is based on the average number of hours slept by a particular group. The American Time Use Survey, which analyses the lifestyle patterns of roughly 150,000 people in the United States, shows that Americans who are black, who have low levels of education or who have low socio-economic status are more likely to fall at the extreme ends of the U-curve: they sleep either too little or too much – a feature you could easily miss if you focus on averages and not spread. Could differences in sleep patterns contribute to the persistent gap in life expectancy in the UK, and the higher rates of heart disease, diabetes and stroke among the poor?

***

Huffington isn’t interested in these issues. She conceives of sleep as a lifestyle choice, and has little to say to people who aren’t sleeping enough because they have two jobs, or nowhere safe and quiet to rest, or who sleep too much because they are struggling to find a reason to get out of bed in the morning. A hot, milky drink and a meditation disk can’t transform their lives. A true sleep revolution would be a campaign against poverty, low-paid and insecure labour, poor housing, violence, mental illness. But Huffington, and the many other sleep self-help authors, do not address such subjects. It’s the kind of wilful blindness you can expect from a revolution that is calling on its followers to block their hearing with earplugs and their vision with sleep masks and direct their inner gaze deep into their navels.

The sleep crisis is both bigger and smaller than Huffington envisages. It is bigger because poor sleep is a function of inequality. It is smaller because global sleep patterns may not have changed as much as most sleep advocates believe. The American Time Use Survey has shown few changes in how Americans sleep since it started in 2003. One 2015 study gave smartwatches to people ­living without electricity in hunter-gatherer communities in Tanzania, Namibia and Bolivia to see if their sleep habits were any different from those in modern cities. They weren’t. Most slept for a solid 6.9 to 8.5 hours a night, much like anyone else, which could suggest that the invention of electric light didn’t bring about as profound a change as sleep gurus imagine.

There was one difference, however: none of the subjects complained of insomnia. Sleep specialists have speculated that perhaps this was because their sleep patterns were more regular, and more attuned with changes in light and temperature. Were they also less anxious about sleep? Regardless of the objective reality, people in post-industrial societies certainly think that they have a problem with sleep. In a 2011 Great British Sleep Survey, nearly two-thirds of those interviewed described suffering from a “sleep problem”: often insomnia, but also teeth grinding, sleep apnoea and other disorders. Insomnia can be spirit-crushingly awful – and I’ve only ever experienced short bouts of it – but are some of our other “sleep problems” merely the result of unrealistic expectations? Maybe a perfect’s night sleep is sometimes unattainable. Maybe we’ll always sometimes feel tired and groggy.

Worrying about sleeping is, after all, half the problem. On a recent night, I gave up trying to sleep and read a book until the early hours. It would have been quite enjoyable, if I hadn’t been freaking out so much about how I would feel at work the next day. There is evidence to suggest that the more anxious about sleep you are, the less of it you think you’re getting. A study found that 42 per cent of people with insomnia underestimated by more than an hour how long they slept, compared to 18 per cent of people with normal sleeping patterns; and that people who sleep well but little often overestimate how much they sleep. If you sleep soundly and don’t fret, you don’t even remember hours of late-night wakefulness.

Despite my scepticism, my recent ­reading diet of sleep self-help books had a creeping effect on me. I stopped checking my phone in bed (because the blue light emitted is bad for inducing sleep), I tested a sleep app to nap on a plane (it worked well) and I spent more time than I ever have contemplating my sleep habits (usually fine, sometimes erratic). Perhaps, with time, we will all feel pushed into “prioritising” sleep. We’ll be persuaded by the scary newspaper headlines or the counters on our Fitbits to tuck in
earlier and sleep longer. We might feel pressured by our employers, too. One US insurance firm has started paying its staff extra if they sleep more than seven hours a night. It’s not hard to imagine a future in which turning up to work bleary-eyed is considered a faux pas akin to showing up drunk. The good workers will be the ones who turn down evening trips to the pub and switch off the telly to spend their night “investing” in sleep. That might be healthy and good common sense – anyone watching obscure YouTube videos at 2am on a weekday knows there are better things they should be doing – but it is also depressing. How many of our waking hours, how much of our precious leisure time, should we be expected to devote to preparing for sleep? Isn’t our cultural infatuation with soothing teas and sleep hotels and designer PJs just turning us into crashing bores?

On this matter, I am happy to be proved wrong. By all means head off to a sleep retreat, rub your body with magnesium, swap your usual nightcap for Horlicks. Maybe the perfect night’s sleep will still elude you, or maybe you’ll find yourself rejuvenated and refreshed. It might even change your life. But just don’t fool yourself: this isn’t the sleep revolution.

Sophie McBain is a contributing writer for the New Statesman

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This article appears in the 17 Aug 2016 issue of the New Statesman, Corbyn’s revenge