Sleep

If you only read four things:

1.  The annual cost of sleep loss to the UK is £30-40 billion equivalent to 2% of the GDP for the UK1,2.
2.  200,000 working days lost in the UK each year due to insufficient sleep2.
3.  Estimates suggest that around 1 in 3 people are affected by insomnia – equating to over 201,000 adults in Suffolk3.
4.  National survey data indicates that getting enough sleep was the most important factor determining whether people feel like they were living well4.

Key Points

Sleep is essential for everyone, we spend about one third of our entire life sleeping5.  It’s an indispensable part of a healthy lifestyle, impacting on both mental and physical wellbeing.

Sleep has several critical functions, including6:

  • Memorising and processing the development of your cognitive skills.
  • Repairing your brain after experiencing physical stress.
  • Clearing toxins produced, and consumed, during the day.

Sleep is a key element of the circadian rhythm. The circadian rhythm is a natural, internal, cycle lasting 24 hours on average. This physiological process is responsible for the sleep-wake patterns our body encounters. Circadian rhythms are endogenously generated, meaning everyone’s cycle is unique. External cues, such as temperature, light and sound, can also help shape your circadian rhythm.

There are 2 main categories circadian rhythms can be differentiated into7:

  • Larks: These are people who naturally wake-up and go to bed early
  • Owls: These are people who naturally stay-up and wake-up late

Recent research has indicated that that sleep and circadian rhythm disturbances are not just consequences of disease, but also play important roles in the development and expression of neurodegenerative and cardiometabolic disorders8. Associations between lack of sleep and an increased risk of obesity, strokes, heart attacks, depression and anxiety have also been made9.

There are no official guidelines about how much sleep you should get each night because everyone is different.  However, recent news reports have indicated that Ministers are planning to issue guidance on how much sleep people should get every night (July 2019)9.

The importance of sleep is vital throughout life and varies with age10:

  • adults – 7 to 9 hours of sleep needed
  • children – 9 to 13 hours of sleep needed
  • toddlers and babies – 12 to 17 hours of sleep needed

On average, a “normal” amount of sleep for an adult is around seven to nine hours a night. Children and babies may sleep for much longer than this, whereas older adults may sleep less. What’s important is whether the individual feels they get enough sleep, and whether that sleep is good quality. Constantly feel tired throughout the day, and tiredness affecting your everyday life is likely to indicate a lack of good-quality sleep11. Taking steps towards preventing sleep deprivation is crucial when considering a healthy lifestyle12.

The numbers

Figure 1: Sleep in numbers

small sleep infographic

Source: 13

  • 1 in 3 people in the UK are affected by insomnia11.
  • People today, on average, are getting between 1 and 2 hours less sleep then they were 60 years ago14.
  • Individuals who sleep for fewer than 6 hours a night, on average, had a mortality risk 13% higher compared to those sleeping at least 7 hours1.
  •  Survey data indicates that UK’s public sector employees sleep for 6 hours, or less, a night15.  2018 data indicates that an estimated 17.8% of Suffolk’s employed population work in the public sector16.
  • On average, social care employees, within the UK, sleep for a dangerously low 5 hours, or less, a night15, Skills for Care data indicates there are 20,000 adult social care jobs in Suffolk17.
  • Recent survey data also found that one in five people reported serious issues related to tiredness - including problems staying awake,  maintaining concentration on tasks such as driving, socialising and feeling enthusiastic about day-to-day tasks15. Applying this proportion to Suffolk residents equates to about 121,000 adults. Additionally, about 21% of respondents reported that they worked over 40 hours a week and 30% reported that their work negatively affected their sleep.
  • A 2018 study found that night owls are 10% more likely to have early deaths than morning larks, night owls were also 90% more likely to have psychological disorders and 30% more likely to have diabetes, they were also more prone to gastrointestinal and neurological disorders18,19.  However, the research asserts that mortality risk in evening types may be due to behavioural, psychological and physiological risk factors.
  • Shift workers are generally more at risk of being affected by sleep deprivation. A US study found that workers who saw more light between 8am and 12pm slept for, on average, 20 minutes longer and took around 27 minutes less to fall asleep than those who weren’t exposed to a significant amount of light20.
  • Night workers are the main group of individuals which fit within the Owl circadian rhythm group. The TUC estimate that 11.4% of employees in the East of England worked nights in 201821. Applying these estimates to Suffolk equate to roughly 41,600 night shift workers in the county.
  • 97% of night workers fail to adapt to the demands of their work pattern, regardless of how many years they have been doing night work5.
  • Artificial light within an office or factory can be very dim. In comparison with natural light, office lights are 250 times less bright. Therefore, office and factory lights have little effect with regards to helping to realign your circadian rhythm with your working hours5.
  • Driver fatigue is thought to be a contributory factor in up to 20% of road accidents22. Between 2015-2017, 812 people were killed or seriously injured on Suffolk’s roads23, using the 20% figure it can be estimated that 162 of these were related to driver fatigue.
  • Additionally, obstructive sleep apnoea is where the walls of the throat relax and narrow during sleep, interrupting normal breathing. This may lead to regularly interrupted sleep24Sleep apnoea significantly increases the risk of traffic accidents25.

The impact

Figure 2: Signs of sleep deprivation

Poster showing signs of sleep deprivation, including poor concentration, performance, mood, and memory.

Source: 13

Everyone has trouble sleeping at times, and everyone has nights where they find it hard to fall asleep or find themselves waking up in the night. However, the cumulative effects of sleep deprivation and upsetting the ‘body clock’ are significant26.

Circadian rhythms contribute to the homeostasis of body temperature, metabolism mechanisms and various other bodily processes. Your circadian rhythm doesn’t only affect your physical state, it may also affect your mental wellbeing to. Your mood and hormone levels are both affected by your circadian rhythms, and are linked to depression, bipolar disorder, loneliness and low levels of happiness27. However, it is not clear whether sleep disruption is causing mental ill health, or is a symptom of it27.

Smoking

Multiple studies suggest a correlation between smoking and sleep deprivation. Nicotine and nicotine withdrawal have the tendency to be the main contributors to sleep deprivation in these cases. Non-smokers have been explained to be more alert in the morning and smoking can increase the probability of snoring and sleep apnoea. It was also found that smokers complained of significant comorbidity with high levels of depression being reported. Overall, individuals with sleep complaints should be queried about tobacco use. Those who are smokers should be advised that there is a relationship between cigarette smoking and sleep disturbance28.

Additionally, studies have also found that individuals with sleep complaints often exhibit unhealthy lifestyles, including obesity, excessive alcohol use, lack of physical exercise, and cigarette smoking.

Screen time

The link between screen time, sleep and wider wellbeing is mixed.  There are obvious links e.g. if you are spending more time on your smart phone /tablet before bed, when you would otherwise be sleeping, then your overall sleep time will be reduced.

However, there is evidence indicating that blue light exposure (such as artificial light from our phones) can throw the body's biological clock (the circadian rhythm)—out of its natural rhythm29,30.  

There is often a large focus on teenage screen use at bed time, however recent research has found that screen time before bed has very little impact on mental health in teenagers31.  This is still a relatively new area of study, so further research is needed to fully understand the links.

Pregnancy

Pregnancies can be affected by sleep deprivation and it is natural to have some unsettled nights whilst pregnant. Existing evidence suggests that there’s an association between sleep deprivation and high levels of cytokines with pro-inflammatory abilities. Postpartum depression has been shown to correlate with high levels of pro-inflammatory serum cytokines. Additionally, research has found that sleep deprivation can cause adverse birth outcomes such as preterm delivery. Despite the research being based on existing data on sleep deprivation during pregnancy, there is limited research that has directly reviewed maternal and foetal outcomes32.

Children and young people

For children, teenagers and adolescence still in fulltime education getting enough sleep is essential. It’s a key contributor for successful memory encoding within the limbic system and assists the retention of cognitive skills. Studies found that even mild sleep disruption can supress memory recall by negatively effecting the encoding-related hippocampal activation within the brain; thus, making it harder to consolidate information within the short- and long-term memory. This has been shown to affect grades within the education system and therefore implementing the future of people within the education system33.

There is considerable evidence suggesting that adolescents do not attain enough sleep to function under optimal capacity. Research indicates that British schoolchildren are the sixth most sleep-deprived in the world, with American children topping the rankings34.

It has also been emphasised that the main cause of young driver accidents is due to drowsiness and lack of sleep33.

Suggestions for a later school time have been perused and evidence suggests that later school times increases the average amount of sleep an adolescent has. For example, one study indicated that delaying school start times for teenagers can have major benefits, including better academic performance and improved mental and physical health34. However, it is noted that any change to school scheduling can affect the whole environment and is not likely to be a sustainable solution for communities33.

More information on sleep in children and young people

Older people

Difficulties with regards to sleep within your later years of life are often overlooked and considered as a normal part of ageing. However, research has implied that age is not a significant contributor to sleep deprivation and that the ageing process takes no responsibility for the increased levels of insomnia- often more prevalent within the elderly population. Instead, a lack of physical movement, discontent with social presence and inadequate mental and physical health are the most prominent contributors to disturbance of sleep35.

Despite adequate attempts of a good night sleep it has been estimated that 50% of the elderly population struggle with sleep and are typically untreated36; this suggests that roughly 88,000 people over 65 are likely to suffer from sleep deprivation in Suffolk3.

What are we doing?

  • Awareness towards the body’s circadian rhythm is improving and more and more individuals are adapting to a system which reduces sleep deprivation.
  • Many Suffolk workplaces offer flexi-working’. Flexi-working means that for certain roles, people can work a distinct number of hours a day in the time periods that best suit their optimal productivity; thus, suggesting a decrease in sleep deprivation within these office environments20.
  • Healthy Suffolk offers safer sleeping tips for babies and young children to promote healthy sleep and to lower the risk of Sudden Infant Death Syndrome (SIDs)37.
  • GP services are available if your finding it difficult to fall and stay asleep and it’s affecting your daily life11.
  • Cognitive behavioural therapy (CBT-I) is designed for people with insomnia and may be recommended by a GP. This is a talking therapy that aims to help avoid thoughts and behaviours affecting a goodnight sleep.   

What else could we do?

  • Work to raise the awareness of sleep as a public health issue, and highlight the holistic approach to improving health and wellbeing.

  • Encourage Suffolk employers to adopt flexible working practices where possible.

  • Continue to promote the ‘5 ways to wellbeing’ and highlight the importance of sleep as part of this: https://www.healthysuffolk.org.uk/projects/5-ways-to-wellbeing.

Recommendations

Prevention of sleeping disorders and sleep deprivation usually can be controlled by promotion of ‘healthy’ habits and a change in everyday lifestyle (such as regular physical activity, reducing caffeine intake, and eating a balanced diet).

The are many common suggestions around your diet and your lifestyle, that if followed can have a dramatic improvement on your sleeping patterns and energy levels, these include:

  • Setting regular times for going to bed and waking up
  • Lower heart rate before bed, could be done with a warm bath or calming music
  • Remove sense distractions- Light/Noise/Temperature
  • Avoid stimulants such as caffeine before bed
  • Try not to lie in bed feeling anxious about lack of sleep.

You can find more information here: https://www.nhs.uk/conditions/insomnia/

GPs now rarely prescribe sleeping pills to treat insomnia. Sleeping pills can have serious side effects and you can become dependent on them11.

If you have been feeling constantly tired for more than 4 weeks, it’s a good idea to see your GP so they can confirm or rule out a medical condition that could be causing your tiredness38.

Workplaces can help to ensure healthy working patterns are adhered to, and that flexible working is an option wherever possible.

Public Health Suffolk will keep up to date with any plans to publish sleep guidance.

Useful links

References

1.           The Telegraph. Lack of Sleep Coasting the UK Economy Up tp £40 Billion a Year. https://www.telegraph.co.uk/news/2016/11/30/sleep-deprivation-costs-british-economy-40billion-year-scientists/. Published 2016. Accessed July 11, 2019.

2.           RAND Europe. Why Sleep Matters: Quantifying the Economic Costs of Insufficient Sleep. https://www.rand.org/randeurope/research/projects/the-value-of-the-sleep-economy.html. Published 2019. Accessed July 11, 2019.

3.           Office for National Statistics. Mid Year Population Estimates 2018. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/populationestimatesforukenglandandwalesscotlandandnorthernireland. Published 2019. Accessed July 4, 2019.

4.           Oxford Economic and The National Centre for Social Economics. The Sainsbury’s Living Well Index.

5.           Foster R. Light and the circadian rhythm: The Key to a good night’s sleep? https://www.bbc.co.uk/news/health-48268110. Published 2019. Accessed July 11, 2019.

6.           England B in the community (BITC), Public Health England (PHE). Sleep and recovery in the workplace.

7.           Phillips ML. Circadian rhythms: Of owls, larks and alarm clocks. https://www.nature.com/news/2009/090311/full/458142a.html

8.           Abbott S, Knutson K, PC Z. Health implications of sleep and circadian rhythm research in 2017. Lancet Neurol. 2018;17(1):17-18. https://doi.org/10.1016/S1474-4422(17)30410-6.

9.           BBC News. Ministers may advise on how much sleep people need. https://www.bbc.co.uk/news/health-48972243. Published 2019. Accessed July 15, 2019.

10.         National Health Service (NHS). Insomnia. National Health Service. https://www.nhs.uk/conditions/insomnia/. Published 2019. Accessed July 11, 2019.

11.         National Health Service (NHS). Insomnia.

12.         England, Business in the community (BITC)  and PHE. Sleep and Recovery Toolkit. Business in the Community.

13.         Public Health England. Is lack of sleep affecting your work? https://publichealthmatters.blog.gov.uk/2018/01/30/is-lack-of-sleep-affecting-your-work/. Published 2018. Accessed July 11, 2019.

14.         Gallagher J. “Arrogance” of ignoring need for sleep. BBC. https://www.bbc.co.uk/news/health-27286872. Published 2014.

15.         University of Leeds. Public sector workers sleep-deprived. https://www.leeds.ac.uk/news/article/3809/public_sector_workers_sleep-deprived_says_study. Published 2016. Accessed July 12, 2019.

16.         LG Inform. All persons employed in public sector as percentage of all persons in employment in Suffolk. https://lginform.local.gov.uk/reports/lgastandard?mod-metric=511&mod-area=E10000029&mod-group=AllCountiesInCountry_England&mod-type=namedComparisonGroup. Published 2019. Accessed July 12, 2019.

17.         Skills for Care. Local authority area information and reports. https://www.skillsforcare.org.uk/NMDS-SC-intelligence/Workforce-intelligence/publications/Local-authority-area-summary-reports.aspx. Published 2019. Accessed July 12, 2019.

18.         Therrien A. Late risers at increased risk of early death, study finds. BBC.

19.         Knutson KL, von Schantz M. Associations between chronotype, morbidity and mortality in the UK Biobank cohort. Chronobiol Int. 2018;35(8):1045-1053. doi:10.1080/07420528.2018.1454458

20.         Cain S. Disrupted sleep patterns can led to “deviant behaviour.” The Guardian. https://www.theguardian.com/lifeandstyle/2019/may/27/disrupted-sleep-patterns-can-lead-to-deviant-behaviour-hay-festival-hears. Published 2019. Accessed July 12, 2019.

21.         TUC. Number of people working night shifts up by more than 150,000 in 5 years. https://www.tuc.org.uk/news/number-people-working-night-shifts-more-150000-5-years. Published 2018. Accessed July 12, 2019.

22.         ROSPA. Driver Fatigue and Road Accidents. https://www.rospa.com/road-safety/advice/drivers/fatigue/road-accidents/. Published 2019. Accessed July 12, 2019.

23.         Public Health England. Public Health Outcomes Framework - July 2019 -Killed or Seriously Injured. https://fingertips.phe.org.uk/public-health-outcomes-framework. Published 2019. Accessed July 12, 2019.

24.         NHS. Overview - Obstructive sleep apnoea. https://www.nhs.uk/conditions/obstructive-sleep-apnoea/. Accessed July 11, 2019.

25.         Driver & Vehicle Licensing Agency. Tiredness can kill. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/677964/inf159-tiredness.pdf. Published 2019. Accessed July 11, 2019.

26.         Gallagher J. Night owls: Simple sleep tweaks boost wellbeing. BBC.

27.         Gallagher J. Body clock linked to mood disorders. BBC. https://www.bbc.co.uk/news/health-44113414. Published 2018. Accessed July 12, 2019.

28.         Phillips BA, Danner FJ. Cigarette Smoking and Sleep Disturbance. JAMA Intern Med. 1995;155(7):734-737. doi:10.1001/archinte.1995.00430070088011

29.         Harvard University. Blue light has a dark side What is blue light? The effect blue light has on your sleep and more. https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side. Accessed July 12, 2019.

30.         Paddock C. Screen time disrupts sleep by resetting internal clocks. Medical News Today. https://www.medicalnewstoday.com/articles/323846.php. Published 2018. Accessed July 12, 2019.

31.         Orben A, Przybylski AK. Screens, Teens, and Psychological Well-Being: Evidence From Three Time-Use-Diary Studies. Psychol Sci. 2019;30(5):682-696. doi:10.1177/0956797619830329

32.         Chang JJ, Pien GW, Duntley SP, Macones GA. Sleep deprivation during pregnancy and maternal and fetal outcomes: is there a relationship? Sleep Med Rev. 2010;14(2):107-114. doi:10.1016/j.smrv.2009.05.001

33.         Danner F, Phillips B. Adolescent sleep, school start times, and teen motor vehicle crashes. J Clin Sleep Med. 2008;4(06):533-535.

34.         The Independent. Starting school at 10am halves student illness and improves academic performance, finds study. https://www.independent.co.uk/news/health/school-start-tim-10am-student-illness-health-academic-performance-study-a8072231.html. Published 2018. Accessed July 12, 2019.

35.         Ohayon MM, Zulley J, Guilleminault C, Smirne S, Priest RG. How Age and Daytime Activities Are Related to Insomnia in the General Population: Consequences for Older People. J Am Geriatr Soc. 2001;49(4):360-366. doi:10.1046/j.1532-5415.2001.49077.x

36.         Kamel NS, Gammack JK. Insomnia in the Elderly: Cause, Approach, and Treatment. Am J Med. 2006;119(6):463-469. doi:https://doi.org/10.1016/j.amjmed.2005.10.051

37.         Suffolk County Council. Safer Sleep. https://www.healthysuffolk.org.uk/advice-services/children/safer-sleep

38.         National Sleep Foundation. National Sleep Foundation Recommends new sleep times. https://www.sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times

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