The Science of Sleeping Smarter, Living Better, and Being Productive
This edition first published 2018
© 2018 Neil Stanley
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Library of Congress Cataloging‐in‐Publication Data
Names: Stanley, Neil, 1965‐ author.
Title: How to sleep well : the science of sleeping smarter, living better and being productive / by Neil Stanley.
Description: Chichester, West Sussex : Wiley, 2018. | Includes index. | Identifiers: LCCN 2018014786 (print) | LCCN 2018017650 (ebook) | ISBN 9780857087874 (epub) | ISBN 9780857087850 (pdf) | ISBN 9780857087683 (pbk.)
Subjects: LCSH: Sleep. | Sleep disorders—Treatment.
Classification: LCC RA786 (ebook) | LCC RA786 .S73 2018 (print) | DDC 613.7/94—dc23
LC record available at https://lccn.loc.gov/2018014786
Cover Design: Wiley
Cover Image: © chuckchee/Shutterstock
I started my career in sleep in 1982 at the age of 16 when I got a job in the Neurosciences Division of the R.A.F. Institute of Aviation Medicine (IAM) in Farnborough, Hampshire. At the time the RAF were interested in sleep because of issues such as jet lag, aircrew work load, shift work, and medicines that could positively or negatively affect sleep. When I joined the IAM it had a three‐bed sleep laboratory, although over the years this increased to six. During my time at IAM I was involved in numerous research studies, the most notable of which was my participation in a medical expedition to Pakistan where my colleagues and I recorded sleep in eight people for six nights at 18,500 feet (5400m) in the Karakoram Mountains.
In 1993 I took a position at the Human Psychopharmacology Research Unit (HPRU), part of the University of Surrey, where I eventually became Director of Sleep Research. At the HPRU I created and ran a 24‐bed trials sleep laboratory, primarily designed for clinical trials into the effects of medications on sleep.
I received my PhD from the University of Surrey on the basis of my published works in 2004.
I have published 38 peer‐review papers on various aspects of sleep research and psychopharmacology and I have presented my research to numerous national and international scientific and medical societies.
I am a member of the following professional bodies:
I was a member of the Executive Committee of the Assembly of National Sleep Societies (2004–2009) and through that I am a co‐author of the guidelines for accreditation of Sleep Medicine Centres; guidelines for Sleep Medicine Education in Europe, and standard procedures for Adult Sleep Medicine.
In addition to setting up a clinical sleep service at the HPRU, I was also involved, on a freelance basis, in setting up and developing the sleep service at The London Clinic.
I have also worked freelance for Scansleep in Copenhagen and the Lovisenberg Hospital in Oslo.
I now spend most of my time writing about sleep and travelling worldwide lecturing on the benefits of good sleep to both healthcare professionals and members of the public. I am widely quoted by the UK and international media as a sleep expert.
Since 1982 I have spent much of my life watching other people sleep, (which when I write it down does sound rather sinister!).
Sleep is my life – it's what I do.
If I am not talking about sleep, I am writing about sleep; if I am not writing about sleep I am reading about sleep; if I am not reading about sleep, I am probably asleep.
(For more information see www.thesleepconsultancy.com).
I think that it is only right if I am going to give advice about sleep, that you should at least know if I practice what I preach. So below is a brief description of my sleep environment and habits.
I am not medically qualified. However, I have spent all my adult life researching sleep. My advice is based on my research, my experience, my reading of the relevant scientific and popular literature on the subject, and a life‐long interest in the subject of sleep. My advice is in no way intended to replace medical opinion and I must stress that if you are in any way worried about problems you, your partner, or your child are having with sleep, or if you have medical problems or are taking any treatments that disturb your sleep, you should always see your GP as only they, in the full knowledge of your medical history, can recommend an appropriate course of action.
Many of us have a problem with everyday poor sleep, low‐grade exhaustion, and sleepiness during the day that most of us experience on a more or less regular basis. A few years ago, I coined the word ‘semisomnia’ to describe the phenomena but alas it never really caught on.
To illustrate this point, honestly answer the question ‘how do you feel during the day on a scale of 0 to 10?’, where 0 is that you have an irresistible desire to fall asleep and 10 you are the most awake you have ever been. Now I can pretty much bet that none of you are a 10, but what is perhaps more worrying is that I also doubt that many of you are a 9 or 8. I know some of you think you are very awake but that is probably because you have fooled yourself into believing this in order to get you through the day. Honestly look at how you feel, is this really the best you could be, if so I would suggest a lifestyle change!
Because you don't feel good during the day, you spend time, and indeed money, on trying to feel better, the multi‐vitamin pill to supposedly keep you healthy, the cup of coffee to get you going, the chocolate bar as a treat because you don't feel good, the ‘energy’ pill/drink to give you a boost during the day, the glass of wine to help you relax. At the end of the week you treat yourself to a spa treatment and you cannot wait for your holiday, when you can finally chill out. Just imagine how much better life could be and how much more productive you would be if each day you were at your best.
So why are you going through each day at less than your full potential? The most likely explanation is because you are not sleeping well. Simply, getting better sleep will make you feel better each and every day. Sleeping better tonight will make you feel better tomorrow. Getting better sleep tomorrow night will make you feel better the next day, and so on.
And let's not forget that good sleep can also be one of our greatest pleasures.
So how to sleep better?
As parents we ensure our children wind down before bedtime – bath, story/lullaby, bed – because we know it works. But what is true for children also holds true for adults. It is just that in our busy lives we seem to forget the basics.
But really how hard can it be?
Imagine putting your children to bed, spending a few hours with your partner, and then running yourself a nice warm bath with your favourite bubbles, candles, nice music softly playing in the background, and maybe a small glass of wine. You luxuriate in the bath soaking away all the cares and worries of the day, then just as it starts to cool, you get out, put on a big fluffy towelling robe, and then get into a bed that has been freshly made.
That would work, wouldn't it?
So why don't you do it?
Imagine, your partner is upstairs in the bath, you are sitting in your candlelit drawing room, comfortable in your leather, button back armchair, wearing your velvet smoking jacket, a fire burning in the grate, your faithful hounds asleep at your feet, a generous measure of a fine single malt in a lead crystal glass in one hand, and a large Havana cigar in the other.
Ok maybe not everyone's idea of an ideal end to the day, but admit it, it comes close.
Getting better sleep should not be a chore or an inconvenience. It should be something we choose to do, something we want to do, and something that can be very pleasurable to do.
Our ancestors were using fire, for heat, protection and light, between 300 000–400 000 years ago, before Homo sapiens evolved. Thus, for our entire history we have not been slaves to going to sleep with the rising and setting of the sun. The idea that this only happened recently, because of Edison and his lightbulb, is frankly ridiculous. The oldest evidence for something that specifically functioned as a bed dates back at least 77 000 years. Approximately 10 000 years ago we started building substantial structures, first in wood and later of stone, as our houses. Then about the same time we stopped believing in ghosts, witches and the devil, we started putting glass windows in our humble abodes. All these trappings of civilisation mean that we now sleep in an environment where
These should be halcyon days for sleep.
However, it has been claimed that we are actually living in the midst of a ‘catastrophic’ sleep loss epidemic, which is having a ‘catastrophic’ impact on our health, our life expectancy, our safety and our productivity. Furthermore, claims are made that virtually every major disease is said to be linked to sleep loss and this lack of sleep is perhaps the greatest curable disease in the world right now.
Scary stuff I think you will agree, but is it actually true?
Well the first issue with this idea is one of definition, because it is not clear as to what the research is actually referring to when they talk about poor/ insufficient /short sleep. Is it people who naturally only need <6 hours sleep a night, i.e. they have a genetic disposition to short sleep, or is it someone who only sleeps <6 hours and by doing so is getting less sleep than they their genetics dictate. These are two different things, the first person cannot change nor can the risk of any negative effects, whereas the second person can, and probably should, change.
Are we really in the midst of a sleep‐loss epidemic, ‘catastrophic’ or otherwise?
Despite what is claimed, there is actually very little reliable data about how we slept during the last hundred years and absolutely none from before that time. In light of all the recent scaremongering it is hard to believe that there is actually very little evidence to support the assertion that adult sleep duration has decreased in recent decades.
In a review of data from 15 countries from the 1960s until the 2000s, self‐reported average sleep duration of adults was found to have actually increased in 7 countries: Bulgaria, Poland, Canada, France, Britain, Korea, and the Netherlands (range: 0.1–1.7 min per night each year) and decreased in 6 countries: Japan, Russia, Finland, Germany, Belgium, and Austria (but only by 0.1–0.6 min per night each year). Inconsistent results were found for the United States and Sweden. There was no clear social or economic grouping of the countries that might explain the diverse trends. So even where there has been a decrease in sleep duration it could hardly be considered ‘catastrophic’.
A further study of data from 10 developed countries found that instead of the anticipated increase in short sleep, longer sleep durations had become more common across these nations. Short sleep had increased only in Italy and Norway but had decreased in Sweden, the United Kingdom, and the United States. Long sleep had increased in Australia, Finland, Sweden, the United Kingdom, and the United States but had decreased in Canada and Italy. No changes were observed in Germany or the Netherlands. The limited increases in short sleep duration challenge the claim of increasingly sleep‐deprived societies, especially as long sleep has become more widespread than short sleep, at least when reported in time‐use diaries. The worldwide decline in adult sleep duration seems to have been somewhat overstated.
A recent meta‐analysis of objective sleep duration in healthy volunteers, as measured by polysomnography, (recording a person's brainwaves and other physiological variables in order to accurately measure sleep), also demonstrated that sleep time has not declined over the past 50 years.
But one might point out that the Centers for Disease Control and Prevention (CDC) states more than one third of US respondents reported typically sleeping less than 7 hours in a 24‐hour period. While that may be true, it is only relevant firstly if you accept that fewer than 7 hours is the definition of short sleep and, secondly, if you can demonstrate using precisely the same survey methodology that there has been a change over time in the numbers of people having short sleep. Such data does not exist.
Is there evidence of a ‘catastrophic’ impact of poor sleep on our health, our life expectancy, our safety and our productivity?
The idea that an epidemic of insufficient sleep is a contributor to the development of major diseases, such as to Parkinson's, dementia, cancer, heart disease, obesity, diabetes, etc., rests largely on the question of whether sleep duration has declined in the last few decades. As shown above, evidence to support this notion does not in fact exist, at least in healthy sleepers.
Poor sleep may be associated with all of these illnesses, and doubtless many more, but a large study of middle‐aged adults found that insomnia complaints did not predict an increased risk of death, nor interestingly did use of sleeping tablets.
The suggestion that there has been a ‘catastrophic’ impact of poor sleep on our life expectancy would seem hard to justify given the steady and significant increase in life expectancy over the last 150 years or so, for instance in the UK, data from the Office for National Statistics, has shown that over the last 100 years life expectancy at birth has increased by nearly 3 years per decade, essentially doubling since 1841.
Male | Female | |
1841 | 40.17 | 42.16 years |
1900 | 44.13 | 47.77 years |
1950 | 66.42 | 71.54 years |
2000 | 75.96 | 80.59 years |
2010 | 78.97 | 82.80 years |
Data from a large study showed that taking 7 hours sleep as the norm, people sleeping 6 hours had a 7% relatively greater risk of dying. This may seem to be worrying proof of the negative effects of short sleep on longevity, however this is not the whole story, the increased risk of dying in the group having 8 hours sleep was actually 12%, and for those sleeping 9 hours as much as 42% when compared to 7 hours.
With regards to safety, figures from the Bureau of Labor Statistics in the US shows that the number of non‐fatal occupational injuries and illnesses per 100 full‐time employees has fallen from 11 in 1973 to 2.9 in 2016.
Other data from the Bureau of Labor Statistics concerning productivity shows that US business sector output has increased more than ninefold since 1947 while the hours worked to produce that output have not quite doubled.
Of course, there are a number of contributory factors which account for the change in these figures, but to make the argument that there has been a ‘catastrophic’ effect of poor sleep seems problematic unless you are able to show that these figures would be appreciably different if we all slept better.
A survey attempted to quantify the benefit of the complete eradication of insomnia on work performance due to presenteeism, (this is where you are at work but are doing nothing productive), they found that it would lead to a reduction of between 5.4% and 7.8% of work performance lost.
A recent report found that a person sleeping less than six hours loses six more working days due to absenteeism or presenteeism per year than a worker sleeping seven to nine hours.
So, it is not really evident that there is a large negative impact of poor sleep, let alone one that is ‘catastrophic’.
Is virtually every major disease linked to sleep loss?
Poor sleep may be linked with various diseases. However, these are associations not evidence of causation. Data from large studies mean that even a very small effect can become statistically significant, but that does not in any way mean that it is clinically relevant. For instance, data from the ‘Sleep Heart Health Study’ shows that people sleeping 6–7 hours had a significantly higher risk of hypertension that people sleeping 7–8 hours. However, the difference in blood pressure between the two groups was actually very small (systolic 2.1mmHg and diastolic 0.7mmHg).
Many of the modern‐day illnesses such as Parkinson's, dementia, cancer, heart disease are due to our longevity, we die from them because we live long enough to develop them, something we perhaps would not do if our poor sleep was having a ‘catastrophic’ effect on our longevity.
It is also true that for many people sleep becomes more disturbed and potentially shorter as we get older and the risk of developing various diseases also increase with age. However, the headline risks quoted for these diseases are nearly always given merely for ‘adults’ with no breakdown of ages, this could be important as an increased risk of heart disease in a short sleeping 18‐year old would be very worrying, an increased risk of heart disease in a 65‐year old short sleeper could very well be simply a consequence of aging.
Coming back to the widely quoted statement from the CDC, mentioned above, that one third of all Americans are sleeping less than 7 hours in a 24‐hour period – this is a good headline, because it implies that this is an issue facing all Americans. The problem is that research shows that poverty, unemployment, and being African‐American or Latino/Hispanic are the risk factors for poor sleep, and interestingly they are also the risk factors for the majority of diseases linked to poor sleep. These populations are more prone both to an unhealthy lifestyle and to poor sleep. Doing something about poverty, unemployment, and racial inequalities would do much to lower the risk of disease and improve the sleep of the nation.
Interestingly it is rarely mention that, as seen in the data above concerning mortality, sleeping >8 hours can actually increase your risk of disease to a greater degree than short sleep e.g. the risk of developing diabetes in women.
Is lack of sleep the greatest curable disease in the world right now?
Malaria is curable and, according to the World Health Organisation in 2016, there were an estimated 216 million cases of malaria in 91 countries, which represented an increase of 5 million cases over 2015. Malaria caused 445 000 deaths in 2016. How many people have ever actually died of lack of sleep? Who knows, but it is safe to say that lack of sleep is not the greatest curable disease in the world right now, not by a long way. (It may seem petty and pedantic but lack of sleep isn't actually a ‘disease’ anyway.)
So why all the doom and gloom?
Why, given the lack of scientific evidence, do people (including bona fide sleep experts) make such alarmist statements? Do they really believe that it is helping the public to get better sleep?
Well I may be cynical but such statements do make great headlines, which not only result in bigger sales or increased ‘clicks’ for the media outlet but also is cheap and easy publicity for the book/app/workshop/consulting service/mattress, or whatever that is being ‘sold’ in the story. Given the appetite of the media for ‘doom and gloom’ making such statements can also be a good way to get your name in to the public consciousness and this can help in securing interviews across the media, attracting speaker engagements, advisory roles for multinationals, positions on the board of start‐up companies or increased research funding, (for who could complain about increased research funding for something claimed to be the greatest curable disease in the world right now?).
There is no good thing about poor sleep, but the simple fact is that we are living longer and healthier than at any time in history. The sleep loss epidemic, if there is actually one, is perhaps not having too ‘catastrophic’ an effect on our morbidity and mortality.
So, if we aren't sleeping less than we did in the past, is that a good thing? You don't have to worry, the end of the world is not nigh, we are not all going to die from sleep deprivation. So, can you carry on regardless?
Well not quite. You see I believe that it is not the quality of sleep, or indeed the quantity, that is important to us in this day and age but our changing ‘need’ for sleep. Over the years research has shown that sleep, in particular deep, Slow Wave Sleep (SWS), plays a crucial role in our capacity to deal with the events of the day, to lay down memories, and to learn new tasks. This is important because what has undeniably changed over the last few years is the amount of information we are routinely exposed to, which we then need to process during sleep. It does not matter that the vast majority of this ‘information’, the funny cat videos, and the selfies, have absolutely no benefit to the development of the individual or the enrichment of society. Our brain still needs to process them, even if it is just so that we can forget it. The amount of information is quite literally ‘mind‐blowing’, according to Eric Schmidt, CEO of Google, speaking in 2010: ‘Every two days now we create as much information as we did from the dawn of civilisation up until 2003.’ It was estimated that in 2006 alone the amount of ‘information’ created was three million times the amount of information contained in all the books ever written. Because of this increasing information load, that has to be processed during sleep, I would argue that our ‘need’ for good sleep is greater than it has ever been. Much of the stress and anxiety that we experience in the modern world is, I believe, a result of our inability to process all of this information adequately because we are not sleeping as well as we could.
This is the reason why sleeping better is so all important.
As the Rev. Dr Wills wrote in 1864