Commentary: Always tired yet can’t fall asleep? It’s a wake-up call to sleep better
Insomnia can persist and when entrenched can be a misery. So start sleeping better now, says Duke-NUS Medical School’s Michael Chee.
SINGAPORE: Mark Tan, a driven 40-year-old, was a competitive athlete in school. Academic success egged on by like-minded classmates took him to an elite university where it was a badge of honour to sacrifice sleep for grades and activities.
He graduated to a good job but one where he was under constant pressure to perform. He engaged in fortnightly inter-continental travel and never said no to conference calls.
Finding less time to exercise and having to accommodate business meals at odd times, Mark filled out his body with 10kg of extra weight in unflattering places.
Two years ago, he started having difficulty falling asleep. He now finds that he wakes up in the middle of the night thinking about work issues and has difficulty falling asleep again.
Mark also recently found he has pre-diabetes, mild obstructive sleep apnea and pre-hypertension.
In a recent study comparing Fitbit users from five countries, Singaporeans slept on average 20 to 64 minutes less than peers in Australia and New Zealand across life.
This difference is more marked in young adults where over half obtained less than the lower but achievable level of 7 hours of sleep on weekday nights.
While there appears to be genuine recognition that something needs to change about how we sleep, the needle hasn’t moved much on a societal or policy level. Health and wellness magazines have a penchant for advising on “sleep hacks” – quick fixes that in my opinion, do not get to the root of the problem.
Change can and should actually begin with individuals. Here are five pointers to get us to the tipping point on better sleep.
1. EVALUATE HOW YOU USE YOUR PERSONAL TIME
Writer Laura Vanderkam in her commentary The Busy Person’s Lies, noted than six in 10 Americans felt they did not have enough time for things they wanted to do. Yet, when she ran a year-long time-use audit on herself, she was surprised by the opportunities she had to repurpose her time.
Our subjective assessment of time-use is often distorted and keeping a record of how we use our time, even over a week, would be helpful.
For example, people in Southeast Asia appear to underestimate daily smartphone usage by as much as 50 per cent. Cutting down on non-essential time sinks could allow us to repurpose some of that time for sleep.
2. CURTAIL AFTER-HOURS WORK COMMITMENTS
Those who participate in European and North American conference calls often have to stay up into the wee hours of the morning.
It pays to hold your ground and to negotiate for more sleep-friendly times for such calls. There is a health cost to doing late-night conference calls and the organiser should be made aware.
Draw boundaries on evening networking events. Not winding down before sleeping can result in one staying awake, unable to fall asleep from thinking about work involuntarily, or waking up in the middle of the night riddled with thoughts about work or issues surrounding work.
3. BE DELIBERATE ABOUT SETTING ASIDE TIME FOR FAMILY AND SLEEP
Making a conscious effort to set limits for family time and sleep will force one to be more focused while at work. We have also found that in families where parents set bedtimes, children sleep longer.
Many Singaporeans accede to being contactable at all times, even when on vacation. This may be necessary for mission-critical roles or situations but should be resisted under more routine conditions.
Arianna Huffington, the hard-driving owner of the Huffington Post, pushed herself to exhaustion before she realised her disregard for sleep was harmful to herself, her family and her business.
The epiphany she had led to write a book and to start Thrive Global, a company that focuses on sleep, burnout reduction and well-being.
4. REDUCE PROCRASTINATION - BY GETTING ENOUGH SLEEP
We are all too familiar with deferring what we need to get done to a later time because we feel we can’t do a good enough job now.
My colleague Dr Stijn Massar has shown that sleep deprivation leads to a higher reward being required before we choose to put in the same level of mental effort as compared to performing the same task when well-rested.
Sleeping sufficiently in the first place might thus reduce our tendency to procrastinate.
5. PUSH FOR SOCIETY-WIDE CHANGES
How we each sleep influences how our friends and colleagues sleep. Data based on responses from over 2500 Singaporean teenagers indicates that the mean self-reported sleep duration is 6.5 hours a night. This isn’t enough and we now have hard evidence for that.
In the quasi-laboratory Need for Sleep Studies June Lo, Joshua Gooley and myself have led in Singapore, we found that even high-performing teens claiming they sleep 6.5 hours a night, cannot sustain this for consecutive nights without showing cumulative decline in vigilance and mood, if prevented from dozing off in the day.
Duration is easy to measure, and it matters. However, when we get to bed also counts. Older adolescents sleep and rise later than their primary school selves.
Starting secondary school later has been shown to have sustained benefit in at least one Singaporean school but before this can occur on a larger scale, we must overturn the unfounded fear that disrupting the status quo will reduce productivity.
We must not be afraid to get our kids to sleep more and sleep earlier.
If anything, keeping longer waking hours has diminishing, even negative returns. In both in the US and China, studies have found that later sleep time is associated with lower economic productivity.
Gooley’s survey’s on thousands of Singaporean school students found that the leading cause for late sleep is finishing homework.
Ironically, it is the adolescents who sleep around 10.30 pm who do academically better than those sleeping later or earlier. This is true of Singapore teens as it was in earlier studies elsewhere, including Norway.
Cynics will say that talented people have a leg up. They may have, but they are also likely to use their time more judiciously and plan better – surely these are traits to emulate?
A HAPPY ENDING FOR MARK, BUT WHAT ABOUT YOU?
Mark, the person featured at the beginning of this piece had insomnia associated with obstructive sleep apnea. Insomniacs can have difficulty initiating, maintaining sleep, and waking up in the early morning.
Most commonly, insomnia has its roots in hyper-arousal – an over-active mind that may be anxious.
Fortunately for him, Mark was able to re-evaluate his life, and undertake therapy that eventually helped him sleep better and lose weight.
He’s lucky - insomnia can persist and when entrenched can be a misery. More people suffer from insomnia than meets the eye and its hurting individuals and our community.
Living smarter, not working harder, has to be part of a national strategy even if it means stumbling a little along the way to find well-grounded, acceptable solutions.
Michael Chee is a Professor at Duke-NUS Medical School. He is an avid advocate of sleep for cognition, health and wellbeing.