The Sleep of the Nation: Problems and Prospects

The Sleep of the Nation: Problems and Prospects

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Catherine Coveney (University of Sussex), Simon Williams (University of Warwick), and Jonathan Gabe (Royal Holloway University of London)

 

Are we a sleep-deprived nation of bleary-eyed Britain’s? If so, does it matter and what, if anything, should be done about it?

There is certainly no shortage of expert claims, echoed and amplified through the media and popular culture, that sleep is another national ‘problem’ or ‘debt’, albeit a neglected one, with public as well as personal costs we are only now fully realising. Surveys and reports from think tanks such as Demos (Dream On: Sleep in the 24/7 Society) and professional bodies such as the British Association of Counselling and Psychotherapy  (Insomniac Britain), and the Mental Health Foundation (Sleep Matters), all lend support to such claims and contentions. A third of respondents in the first wave of the new longitudinal ESRC Understanding Society survey also report less than 7 hours sleep a night on average, with 12% stating they regularly get less than six hours sleep a night.

Whether or not this is ‘enough’ sleep is itself a contested matter of course.  Like everything in late modern times, the need for sleep is often individualised. Sleep scientists and medical experts do tend to agree that getting 6 hours or less is probably not sufficient for most of us on a regular basis, and sleeping for 4 hours or less per night is really not good for anyone. The health implications of sleep loss or chronic sleep deprivation have been studied over recent decades too, with sleep loss linked to all manner of health problems including heart disease, obesity, diabetes, lowered fertility, mental health issues and cancer. Sleep deprivation moreover, it is claimed, has contributed to such notable accidents as the Exxon Valdez oil spill, the Chernobyl nuclear meltdown and, closer to home, the Selby rail crash. Poor sleep then, it is suggested, has public as well as personal costs for society, including matters of productivity and performance as well as public health and safety.

We may, nevertheless, still be sleeping ‘better’ or at least quite ‘differently’ today than our ancestors did even a few centuries ago. Consider, for instance, the much poorer, colder and cramped sleeping conditions common in pre-industrial times (Ekirch 2005), and the long work hours of the working poor in Victorian Britain where men, women and children regularly worked 14-16 hour days. Night shift work is certainly not a new phenomenon either. So the ‘golden age’ of everyone sleeping for 8 hours a night may well be over as we embrace the so-called 24-7 society, or quite possibly might never have existed in the first place prior to the flood of artificial light, given the ‘segmented slumber’ of pre-industrial times. This was characterised by a ‘first sleep’ soon after dusk, followed by ‘second sleep’ later during the night with a period of ‘quiet wakefulness’ in between (Ekirch 2005).

As for wider trends and transformations regarding the sleep of the nation today, the data we do have at our disposal are suggestive.

For example, as one part of our recent ESRC study exploring the role of pharmaceuticals in the management of sleep and wakefulness in contemporary Britain we asked around 100 people detailed questions about their sleep; their attitudes towards it, how much sleep they thought was enough for them, and if they thought they were getting enough sleep on a daily basis.

What we found was intriguing, to say the least. There seems to be a paradox in relation to sleep, where it is both valued and dismissed at one and the same time. Intuitively, people do value sleep, they see it as a natural bodily function, something we all need to sustain our vitality, much like the air we breathe or the food and water we consume. The people in our study linked getting enough sleep to their overall wellbeing and ability to function, mentally, physically and socially. Sleep was thought to be hugely important for overall health.

Despite being perceived as an essential part of everyday/night life, sleep was often not at the forefront of people’s minds. Sleep need was individualised, sleep was cut back on and put last in the list of priorities, if given a place in the list at all. Many felt that time was at a premium, and those few extra hours in bed, where they could be getting the rest they needed, were instead given to other things. Work, study, childcare, housework, leisure and precious ‘me time’ in their otherwise busy lives were often prioritised over the time afforded to sleep, sometimes wilfully, but mostly not.

Such social factors have also been referred to in other studies on the disruption of sleep. For example, sociological research into sleep has highlighted how various stages and transitions across the life course can impact on our sleeping patterns. Sleeping with a bed partner, caring for young children or older relatives during the night have been linked to disturbed sleep. Work and working hours in particular, has a huge impact on how long people sleep for, and how well they sleep. The aforementioned ESRC Understanding Society survey devoted a whole chapter to this very issue. It is not only long work hours, but also commuting times, stress and worry associated with work that impact on the sleep of the nation. Unemployment is also a key factor (see for example Arber and Meadows, 2011; Byran, 2011; Chatzitheochari and Arber, 2009).

In our study it was only when sleep, or lack of it, became a problem for the individual, in the sense that they perceived their self-management strategies were not working, that sleep issues were given more importance. Visiting their GP about sleep problems was very much a last resort once they had tried unsuccessfully, sometimes for many years, to manage their sleep problems themselves. Our respondents talked of using a whole range of behavioural techniques, routines and rituals and various over the counter medicines and herbal products to help them sleep. One of the reasons given for their reluctance to seek help was that people often thought that they should be able to manage their sleep themselves. Sleep problems were often not considered to be ‘real’ problems that warranted medical attention. We found the issue of medicating sleep was highly moralised in our focus group discussions where taking sleeping pills was linked to a weakness of character and the stigma of addiction. Those who had taken this type of medication strove to present themselves as not only deserving patients but also responsible users of these medicines.

Despite being considered a last resort by many in our study, including GPs and patients alike, and with non-pharmacological treatments such as good sleep hygiene and the use of cognitive behaviour now being recommended by NICE as first line treatments and sleeping pills only recommended by NICE for short-term use (a maximum of 2 -4 weeks) at the lowest dose, approximately 10 million prescriptions for sleeping pills are, nevertheless, issued in England and Wales alone, year on year, costing the NHS approx. £88 million in 2013.

As for the causes of this conundrum, the finger of blame points far and wide from many supposedly undiagnosed sleep disorders or problems and a lack of basic medical training in sleep medicine to the wider demands and dynamics of life and living in the 24/7 era of fast, flexible, capitalism and the wired awake world.

So is it time to wake up to sleep matters and if so what should be done to improve the sleep of the nation, if anything? This, of course, is the most contested matter of all; part and parcel indeed of the growing politicisation of sleep matters today (Williams 2011).

Criticisms, for example, come in many shapes and sizes, from the previously alluded to cautions and disputes over the nature and extent of the ‘problem’ in the first place, to the continuing dismissal or devaluation of sleep as anything other than a personal, private matter for responsible adults or citizens to decide upon themselves as they see fit, or a medical matter perhaps in the case of persistent sleep problems or disorders. Calls for wider more coordinated and concerted policies to promote the sleep of the nation, in this regard, may well risk the charge of the nanny state gone mad!

To the extent that many people today do indeed struggle to get sufficient sleep, and to the extent that these struggles are socially structured or patterned, with public as well as personal costs for us all, then concerted efforts to protect if not promote the sleep of the nation may still be justified on precisely these counts. Sufficient sleep after all, should be a basic human right in any society. It is also of course central not simply to health but to the well-being of all of us: a point of no small significance given the current political backing of the Global Well-Being (GWB) not just the GDP agenda. And yes, while this latter GWB political agenda is equally open to criticism on all manner of counts, not least as an excuse or smokescreen for continuing inequalities of the material kind, the ‘wealth’ of nations is clearly more than just a matter of GDP, as a recent UN report  further suggests.

Looking to the future then, at least two possible scenarios suggest themselves regarding the sleep of the nation.

The first, more sleep ‘negative’ or sleep ‘poor’ future, is one in which we see a continuation if not exacerbation of existing sleep problems in the 24/7 era, based on the further dismissal or devaluation of sleep matters on the one hand – including any further concerted or coordinated national pro sleep policy initiatives – and the lure of future ‘enhancement’ strategies and technologies, beyond the not so humble shot of caffeine, to extend our days and nights still further.

The second, more sleep ‘positive’ or sleep ‘rich’ future, involves on the one hand a more or less wholesale revaluation and reprioritisation of sleep matters in the face of any further encroachments of this kind, and the successful development of a range of more pro-sleep policies and on the other hand measures to promote or protect the sleep of the nation. Momentum is already gathering on this latter front on both sides of the Atlantic, where sleep is being promoted as the ‘ultimate performance enhancer’. For example, a handful of large multinational companies (such as, Google, Ben and Jerry’s and Nike) are recognizing the merits of a well-slept workforce in terms of mood, enthusiasm and performance. Thus they are reportedly encouraging employees to nap at work or are introducing more sleep-friendly scheduling, instead of glorifying individuals who work around the clock without a break. In addition, we see reports coming from the US advocating “sleep friendly schools” where principals are being encouraged to adapt school hours for teenagers to fit around teenagers’ sleep patterns.

Despite this, however, the first ‘negative’ sleep future seems the most likely, given that other priorities will in all probability continue to trump sleep.

The social sciences have a critical role to play here; a role which extends beyond mere description or critique of these developments and debates, to the adoption of a more normative stance on these matters which draws attention to the social inequalities, tensions and pressures embroiled in the contemporary politics of sleep. Although we do have some sociological data to draw on, the sociology of sleep is still in its infancy. There is a real need for more detailed sociological studies and surveys on the social patterning of sleep across our society, the variation in sleep patterns, practices and expectations and the norms, values and structures that influence the ways in which sleep is positioned, problematized and policed in the 24/7 era.

Time then to ‘wake up’ to sleep as another vital matter and measure of the ‘wealth’ of the nation.

References:

Arber, S., & Meadows, R. (2011) Social and health patterning of sleep quality and duration in Understanding Society, Chapter 10, pp. 87- 98

Bryan, M.L. (2011). Measuring work: prospects for labour market research in Understanding Society, Chapter 5, pp. 35-42.

Chatzitheochari, S. & Arber, S., (2009). Lack of sleep, work and the long hours culture: evidence from the UK Time Use Survey. Work, Employment & Society, 23(1): 30-48.

Ekirch, A.R. (2005) At Day’s Close: A History of Nighttime. London: Weidenfeld and Nicolson.

Leadbeater, C (2004) Dream On: Sleep in the 24/7 Society. Demos: London.

Williams, S. J. (2011). The Politics of Sleep: Governing (un) Consciousness in the Late Modern Age. Palgrave Macmillan.

 

Catherine Coveney is a Research Fellow in the Department for Global Health at the University of Sussex and an Associate Fellow (2014- 2017) in the Department of Sociology at the University of Warwick. Her research to date has looked at the different ways in which people understand and use biomedical and health technologies in daily life.  She has spoken about her work to many different audiences, at academic conferences, invited lectures and to the media, and has several publications relating to the sociology of sleep, including the recent paper, Coveney, C.M (2014) Managing Sleep and Wakefulness in a 24 hour world, Sociology of Health and Illness 36(1):123 -136, which was featured on BBC Radio 4’s Thinking Aloud on 21st May 2014.

Simon Williams is a Professor of Sociology in the Department of Sociology at the University of Warwick. He has longstanding research interests in the sociology and politics of the body, health and medicine, and more recent research interests in the sociology and politics of sleep. He has published extensively in these areas, including his latest book, ‘The Politics of Sleep’ (2011), which was featured on BBC Radio 4’s ‘Thinking Allowed’ (22nd June 2011). He is currently researching the problems and prospects of new mobile technologies for the tracking or ‘m-apping’ of sleep and the ‘optimisation’ of ourselves in the digital age.

Jonathan Gabe is Professor of Sociology in the Centre for Criminology and Sociology at Royal Holloway University of London. He is also currently President of the International Sociological Association Research Network on Sociology of Health. He has researched, written about and lectured on medical technology, particularly pharmaceuticals, for over thirty years. He is Principal Investigator on the ESRC funded research project, The Pharmaceuticalisation of Sleep and Wakefulness: A Social Scientific Investigation of Stakeholders Interests, Policies and Practices. The study addresses both development and regulation issues regarding sleep and wakefulness medications and issues concerning their meaning and use in clinical practice and everyday/night life.

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