How do you sleep at night?

How did you sleep last night? Did you sleep the sleep of the just? Or did you just toss and turn and watch the clock, fretting away the hours till dawn? Or did you simply choose to stay awake watching TV, playing computer games or tapping at some digital device until the wee small hours?

If you’re something of an insomniac, you’re not alone – even though that’s how it feels in the night. About one in three Scots suffers from sleeplessness. But it’s just the tip of an iceberg of issues which have serious implications for the wellbeing of the individual and the health of our NHS.

Obesity is writ large in our society for all to see, but sleep deprivation happens in private. It’s one of the modern ‘dis-eases’ which feeds off contemporary culture and social attitudes, a paradoxical cost of socio-economic success.

Along with its modern bedfellows – depression, anxiety and addictive behaviour – sleep problems are hard to treat. Over 40% of people on sleeping pills have been taking them for over 10 years. In other words, when the sleeping tablets don’t work, we give people more sleeping tablets. It’s one of those startling ideas, like building bigger ambulances for the morbidly obese, which shows how adapted our society has become to the expensive sticking plaster. And that’s despite the fact that the NHS’ own guidelines suggest that sleeping tablets should not be given to long-term poor sleepers.

Indeed, clinical researchers recently criticised doctors for ‘inappropriate and extended’ prescribing of powerful, potentially addictive hypnotics to elderly patients. Compared to younger people, older insomniacs were half as likely to be advised by their physician of alternative treatment options, such as sleep advice, relaxation techniques or cognitive behavioural therapy.

But addiction to sleeping tablets isn’t the only risk which the sleep deprived run.

Everybody knows that stress keeps you awake: your mind racing as your body fidgets. But, if you’ve never experienced a personal problem or work issue going round and round in your head at night –– you must be very lucky indeed. Even over the short-term, disturbed nights can build quickly into a disturbing pattern.

Sleep problems are associated with poor mental well-being in a classic chicken-and-egg cycle. You won’t be surprised to learn that people with poor sleep – remember that’s one in three of us – are twice as likely to lack energy during the day. But they’re also three times as likely to have trouble concentrating and ‘getting things done’. You’re also three times more likely to feel down – and four times more likely to have a relationship problem.

So, it’s not hard to see the sudden downward spiral. Sleeplessness leads to fatigue, to low performance at work, to sluggishness at home, to feelings of impending failure… and to more stress and more sleeplessness. In the darkest nights, the darkest thoughts arise: people on sleeping pills are around 80% more likely to feel helpless and alone.

Broken sleep can breed mental health problems, and mental health problems can break sleep. According to a study by the University of Texas, insomniacs are about ten times as likely to experience clinically significant depression, and about 17 times more likely to suffer from serious anxiety.

One of the deeper reasons why lack of sleep may be associated with depression is that wakefulness disturbs our dreaming. About two-thirds of our dream content deals with ‘bad stuff’: that seems to be its function. We “knit up the ravell’d sleeve of care”, and tidy away the unresolved emotional baggage of the day. If you don’t rest well enough to dream, you don’t necessarily feel sleepy, you just feel more agitated… and knackered.

The trouble is that we’re inclined to take sleeping lightly. The reality is that good sleep is fundamental to good health. And poor mental wellbeing may not be the biggest price we pay for insufficient sleep.

In a major Norwegian study which followed 50,000 people over 11 years, scientists found that people who had trouble falling asleep and staying asleep were three times more likely to suffer heart failure. Stress hormones may be at the root cause, but it also seem that good sleep is essential for your body’s repair system.

In 2012, researchers at Surrey University found that ‘insufficient sleep and circadian rhythm disruption are associated with negative health outcomes, including obesity, cardiovascular disease, and cognitive impairment’. Their study found that even just restricting sleep to six hours a night for a week had significant effects on the body’s fundamental biochemistry. Over 700 genes were affected by sleep reduction. It’s worth quoting Professor Colin Smith’s stark warning: “Clearly, sleep is critical to rebuilding the body and maintaining a functional state. All kinds of damage appear to occur – hinting at what may lead to ill health. If we can’t actually replenish and replace new cells, then that’s going to lead to degenerative diseases.”

For the weary wakeful, the phrase ‘ you can sleep when you’re dead’ has an eerie prophetic ring to it.

And yet, perhaps more than outright insomnia, modern society’s attitudes to sleep could be the most dangerous. It’s been described by the Harvard School of Medicine as ‘the sleep conspiracy’. We’ve all heard of those who, like Mrs Thatcher, clawed out a career on just a few hours’ sleep a night. She literally didn’t sleep her way to the top. But you don’t have to be a sociopath to feel that ‘life is too exciting to sleep’ – as suggested by a number of top CEOs in The Guardian recently.

Even if you only define ‘exciting’ as staying up playing Xbox or watching Netflix into the night, it’s hard to escape the feeling that a fun modern life depends on sleeping less.

Like Macbeth, more and more of us are finding new ways to murder sleep. Especially the young. A recent study in a Scottish school found that 15% of pupils fell asleep at their desk, every day. Stop sniggering in the back row because it’s not because the teaching is boring: 40% of the first years admitted to having stayed up all night twice in the preceding fortnight, with most averaging just five or six hours sleep a night.

It’s commonly accepted that the average human needs about 8 hours sleep a night. The elderly need less, but a teenager needs about 9 hours a night – so young people are going to school chronically deprived of sleep. The problem is so bad that the Scottish Government is investing £100,000 a year with Sleep Scotland to educate pupils on the need for proper sleep, but it’s a lesson we could all learn.

In some ways, it seems we have forgotten how to care for ourselves. We look to the food industry to nourish us, instead of cooking for ourselves. We want the entertainment business to take up our time, instead of filling our own minds. We hope that pharmaceutical firms can cure our ills, instead of looking after our own health. We expect to go without enough sleep, and get away with it.

The consequences for our own wellbeing – and the strain on the workload and finances of Scotland’s NHS – are plain to see. The pharmaceutical firms will lobby for over-priced remedies. Under pressure doctors will reach for the easy treatment. To clear waiting lists for treatment, Scotland’s NHS will continue to spend more on private healthcare – up last year by 60% to £40 million.

But, if we really wish to reduce the queues for NHS beds, we could make a start with a regulation, health-giving, refreshing 8 hours’ shut-eye in our own beds. It’s just an idea. Maybe we should sleep on it.


A version of this article has appeared in ‘The Scotsman’