The statistics on our lack of sleep are bleak. According to the Sleep Health Foundation’s report Asleep on the Job: Costs of Inadequate Sleep in Australia 2017, an estimated 39.8 percent of Australians experience some form of inadequate sleep, with the total cost estimated to be $66.3 billion annually.
Clearly, we have a problem. But that problem doesn’t just relate to the impact of losing sleep. Rather, in mulling over this information, we’re growing anxious about our lack of shut-eye, which in turn reduces our chances of slumber, compounding the issue.
We still need to hear about the importance of sleep, says Melbourne-based sleep consultant and co-founder of the Sleep Hub, Dr David Cunnington. But we don’t want to spike anxiety. “That’s the really tricky balance,” he says.
Health psychologist Dr Moira Junge, who is on the board of advocacy organisation the Sleep Health Foundation, believes we’re losing that balance from all the “noise” surrounding sleep. She says the media plays a part, creating conflicts and potential barriers to the simple message of “good sleep is important for health”.
Then, there are the financial opportunities from those hoping to tap into the lucrative market of “selling sleep”. They aim to whip people into a frenzy, fuelling a “potentially obsessive” interest in slumber. The slew of sleep-monitoring devices, apps and products don’t help either. We’re obsessed with numbers, she says. We gauge how tired we feel based on how much sleep we’re told we had.
Interestingly, while we appear to be in the grips of a “sleep crisis”, research shows we’re not actually sleeping any less than our previous ancestors in the 19th or 20th century, says Cunnington. Rather, he says, people report feeling more tired and sleep “cops the blame” for that tiredness.
“Lots of people put all their eggs in the ‘sleep’ basket,” he says. “They eat badly, they don’t exercise, they don’t look after their mental health, but they’ll ignore all those other factors and say, ‘I was up a couple of times during the night; if only I could not wake up, my life would be fine’.”
He says our response to poor sleep is also amiss. “The culture in the business world is, if you’re not keeping up, you go harder. But there’s research showing the way to ‘go harder’ and make better decisions is to pull back a bit.”
That research was published in the journal Organizational Behavior and Human Decision Processes in July 2017. It found that people who haven’t had enough sleep tend to perceive people as more hostile and are more likely to behave in a hostile way themselves. It also found they aren’t aware of this effect and may harm relationships without realising it.
With pressure to perform, and the belief that sleep is key to achieving that, comes a smorgasbord of products claiming to help. The makers of such products perpetuate the story that slumber is the panacea for all that ails you, says Cunnington. “Be it bedding, furniture, sleep aids, mists, sprays, aromatherapy, devices; there’s no shortage of things in almost every product category that promise not just better sleep, but a better you.”
Treatments for snoring are a perfect example, and like all health fields there is no shortage of acronyms.
According to a Sleep Health Foundation’s report, 24 per cent of men and 17 per cent of women report snoring loudly. Successful treatments for some people are Theravent and Provent, which use nasal expiratory positive airway pressure (nEPAP) in the form of small valves placed in the nostrils to open the airways, says Cunnington.
He says another proven therapy for snoring is custom-made adjustable mandibular advancement splints – mouthguards that hold the jaws in a position to keep the airways open. They cost about $2000 and have spawned a range of cheaper products that can be bought off the shelf. While these can retail for as little as$50, Cunnington says that, despite their popularity, there’s no evidence backing theiruse.
While the marketplace is heaving with options for snorers, the field is narrower for those with obstructive sleep apnoea, a condition that affects a subset of those whosnore. The Sleep Health Foundation’s report shows the prevalence of sleep apnoea is about 8.3per cent. The proven established treatment for sleep apnoea is continuous positive airway pressure (CPAP).
A CPAP machine, which comprises an air pump linked to a mask, increases the pressure of the air you breath to keep your airways open. Businesses such as ResMed have tapped into this need and provide a full range of these devices, including the AirMini, the world’s smallest sleep apnoea machine. “CPAP is a fantastic treatment for the right patient,” Cunnington notes.
CPAP doesn’t just improve sleep quality, it also modifies the risk of associated diseases – patients with sleep apnoea are at a seven times higher risk of death and heart disease. Research, published in the Journal of the American Heart Association in June 2018, showed that people over 60 with sleep apnoea who didn’t use CPAP had a 38 per cent higher risk of heart failure compared with those who did.
However, CPAP gets a lot of unjustified negative press as a “clunky, cumbersome thing,” says Cunnington. John, a 56-year-old digital producer from Sydney, understands. He was diagnosed with sleep apnoea following a sleep study five years ago and agrees their appearance can be off-putting.
Price of sleep
“You don’t feel very amorous wearing a mask,” he says. But he says such issues pale in comparison to its benefits. “You can see it in your own health, just how well you feel when you wake up.” He didn’t hesitate forking over $1000 for his machine online, saying, “You can’t put a price on good sleep”.
It’s that mantra – about not being able to put a price on good sleep – which the insomnia industry is banking on. The Sleep Health Foundation’s report indicates that roughly one-third of adults report at least one nocturnal insomnia symptom, such as difficulty falling asleep or staying asleep. But commercial products claiming to cure insomnia are “largely rubbish”, warns Cunnington.
Tanya Byham, a 56 year-old web designer from Tasmania, wishes there was a quick fix for her inability to nod off. “I’m hopeless,” she says. She goes to bed about 11pm most nights, tosses and turns, plays a game on her phone, then tries again. It’s often after 3am when she finally dozes off.
Her biggest problem, she explains, is her brain doesn’t switch off’. “I think about stupid things, things that don’t matter; like I’ll go back to childhood and think about a girl that said something to upset me. If I haven’t got anything to worry about, I’ll find it in my head.”
Mindfulness and CBT
Having an overactive brain is a recognised cause of insomnia, and cognitive behaviour therapy (CBT) is an effective therapy. Now new research, published online in June 2018 in the scientific journal Behaviour Change, shows mindfulness-based therapy and cognitive therapy are equally effective at combating insomnia.
But for those looking for a non-therapy based solution to insomnia, there may be hope on the horizon. Called Ebb Insomnia Therapy, it’s the first and only FDA-cleared prescription device that reduces the time it takes to fall asleep, and enter deep, restorative sleep. It claims to do this by cooling the frontal lobe of the brain (through a headband worn over the forehead) to reduce brain activity. Results from a small study, presented at the SLEEP 2011 conference, seem promising, but don’t get your hopes up too high yet, as it’s only available in the US in a pre-market release.
While Byham struggles to fall asleep, others can’t stay asleep. In general, there’s no single, simple product that can miraculously fix your sleep, says Cunnington. However, in certain subgroups of those with insomnia, light therapy may play a part. That’s because light exposure affects the body’s production of the sleep hormone, melatonin. People with circadian rhythm issues, mental health issues or chronic conditions that have limited exposure to daylight may therefore benefit from light therapy, says Cunnington.
Research reflects this. Published in the Journal of Clinical Sleep Medicine in January 2018, it found that bright light therapy improved sleep in people treated for cancer in a pilot study. The makers of Re-Timer – a portable, light-therapy device worn like glasses – have cottoned on to this need. Cunnington says there’s preliminary research showing Re-Timer can help with the aforementioned subset of people with insomnia but for the average person, he says, it isn’t the main treatment for insomnia.
As our obsession with sleep continues to grow, the market will keep spitting out new so-called “solutions”. Instead of seeking the latest “gadget and gimmick”, Junge says it’s time we get back to basic principles based on good quality research and expert information.
The aim is for people to respect sleep, but also be ambivalent about it, says Cunnington. Carve out time to prepare for slumber, but once your head hits the pillow, don’t stress about how much of it you get. It’s also time to tweak our expectations about sleep, accepting, for example, that night-time waking is normal, and that sleep quantity can reduce with age.
Besides, obsessing about sleep is futile. Unlike other pillars of health such as nutrition and exercise – where focused attention can affect outcomes such as weight – obsessing about sleep will only make matters worse, says Junge. “The more you obsess about sleep, the more elusive it’s going to be.”