Image credit Vic Lawrence.
Sleep interacts with many biological processes, impacting performance, and physical and mental health. Sleep problems may affect up to a third of the population and most sleep-wake disorders are likely to be underdiagnosed. Night-time work, which disrupts sleep, is common to many sectors, covering 12% of the workforce. Sleep deprivation is linked to an increased risk of workplace and driving accidents. Research also suggests that long-term sleep problems may be a factor in many health conditions. Interventions that aim to improve people's sleep may help to prevent disease and improve overall public health.
Sleep and Health
Researchers and clinicians are concerned that sleep-wake disorders are underdiagnosed and thus undertreated. Two of the most common problems seen by doctors are:
- Obstructive Sleep Apnoea (OSA) - caused by a recurrent blockage or narrowing of the upper airway during sleep, leading to frequently interrupted breathing, sleep disturbance and daytime sleepiness. An estimated 1.5m people in the UK are affected.
- Insomnia - a persistent, subjective disturbance in initiating or maintaining sleep, despite adequate opportunity, which results in daytime impairment. Depending on how it is defined, anywhere between 6-40% of people experience it. Its symptoms are the most common expression of mental health conditions.
Both conditions can be treated but there are concerns around a lack of awareness among the public and health profession about OSA. A cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment rather than sleeping tablets, with apps to deliver it through smartphones and other devices now available in some parts of the NHS.
There is a wide body of research that has examined the short and long-term health implications associated with sleep and sleep disorders. For example short term effects of disrupted sleep include impaired attention, memory and decision-making. These effects are amplified if sleep deprivation accumulates. Sleep is equally important for long-term health, with research showing that decreases in sleep quality and duration are associated with worse health outcomes. Chronic short sleep duration is linked to an increased risk of obesity, type 2 diabetes, cardiovascular disease, mental health conditions, cancer and impaired immune function.
Key areas for policy discussed in the briefing include:
- sleep-related driving accidents (20% of accidents are sleep related) and their prevention
- adolescents' sleep patterns and implications for school start times
- workplace factors - such as shift work and long or irregular hours
- the role of light and other environmental features
- the impact on sleep of using digital devices at night
- the growing market for consumer sleep technology
Key Points in the POSTnote:
- Sleep is affected by physical and mental health and environmental and social factors.
- Short-term sleep disruptions increase the risk of workplace and driving accidents.
- Long-term sleep disruptions are associated with a range of poor health outcomes.
- School schedules and nightly use of digital devices may affect adolescents’ sleep.
- Consumer sleep technologies may increase awareness of sleep but many are not validated for accuracy in measuring sleep.
- Public health strategies include increasing awareness of healthy sleep habits and sleep-related issues in workplaces, schools and other settings; optimising lighting; and improving the treatment and diagnosis of sleep-wake disorders.
POSTnotes are based on literature reviews and interviews with a range of stakeholders and are externally peer reviewed. POST would like to thank interviewees and peer reviewers for kindly giving up their time during the preparation of this briefing, including:
- Professor Derk-Jan Dijk, University of Surrey *
- Dr Michael Farquhar, Guy’s and St Thomas’ NHS Foundation Trust *
- Dr Hugh Selsick, The Royal London Hospital for Integrated Medicine/University College London Hospitals *
- Professor Franco Cappuccio, University of Warwick *
- Dr Michelle Miller, University of Warwick *
- Professor Jim Horne, Loughborough University *
- Professor Niro Siriwardena, University of Lincoln *
- Professor Graham Law, University of Lincoln *
- Professor John Stradling, University of Oxford, OSA Partnership Group *
- Gillian Gibbons, OSA Partnership Group *
- Professor Paul Montgomery, University of Birmingham *
- Dr Nicole Tang, University of Warwick *
- Dr Simon Kyle, University of Oxford *
- Professor Colin Espie, University of Oxford and Big Health *
- Dr Chris Miller, Big Health and University of Oxford *
- Dr Richard Stott, Big Health and King’s College London *
- Dr Christopher-James Harvey, University of Oxford *
- Dr Katharina Wulff, University of Oxford *
- Professor Matt Jones, University of Bristol
- Dr Pete Blair, University of Bristol
- Professor Peter Fleming, University of Bristol
- Dr Donna Littlewood, University of Manchester
- Dr Rob Hunter, British Airline Pilots' Association *
- Anh Tran, Public Health England *
- Health and Safety Executive *
- Department of Health and Social Care *
- Mary Higgs, Department for Work and Pensions *
- Anna Jones, Department for Education *
- Department for Transport
- Richard Allday, Unite the Union
- Marco Hafner, RAND Europe
- Petr Nalevka, Urbandroid *
- Jiri Richter, Urbandroid *
- Gary Garcia, Philips *
- Megan King, Philips *
- Helen Bogan, NHS Employers
- Lisa Artis, The Sleep Council
- Laurie Heselden, Trades Union Congress
- Hugh Robertson, Trades Union Congress
- Caitlin Turner, Royal Society of Public Health *
- Sleep Apnoea Trust Association *
- Kevin Clinton, Royal Society for the Prevention of Accidents *
- Dr Josie Cheetham, Welsh Junior Doctors Committee, British Medical Association *
- Robert Wilson, British Medical Association *
- Kim Sunley, Royal College of Nursing *
- Dr Tim Quinnell, British Sleep Society and Papworth Hospital Foundation NHS Trust*
- Professor Jason Ellis, British Sleep Society Research Committee and Northumbria University *
- British Lung Foundation
- Caroline Heron, AQNB Productions
*denotes people who acted as external reviewers of the briefing.