…..I’ll sleep when I’m dead.

…..I’ll sleep when I’m dead.

by Samantha Dockray

Depending on your age and/or musical preference I may have just given you an earworm from Bon Jovi, the Cure or Warren Zevon. Giving away my age – if not musical preference – the lyrics most familiar to me are by Bon Jovi:

Till I’m six feet under
I won’t need a bed
Gonna live while I’m alive
I’ll sleep when I’m dead
Till they roll me over
And lay my bones to rest
Gonna live while I’m alive
I’ll sleep when I’m dead

The message is clear, there’s always something more interesting to do than sleep, and there are certain times of life where this is more likely to be true. Teenagers and young adults are especially good at delaying sleep for something that seems more fun than going to bed when feeling sleepy. Teenagers aren’t the only ones though, in Ireland and similar cultures, most adults are often in need of more sleep than they currently get 1.

Teenagers and adults suffer sleep deprivation as a result of spending time doing things other than sleep including work, care-giving, watching ‘just one more’ episode of a favourite show, reading ‘just one more’ chapter…the list goes on. Often people believe that sleep is always something that can be caught up on later, when we have more time, less to do, and we can do it tomorrow, on the weekend, when we’re older, when we’re dead. The paradoxical thing is though, that not getting enough sleep will get us to dead more quickly than if we had sufficient sleep.

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There is evidence that insufficient sleep is associated with Type-2 diabetes, high blood pressure and obesity and mortality2, 3. Insufficient sleep has also been associated, not surprisingly, with greater reports of negative emotions, anxiety and depression, and poorer overall wellbeing 4, 5. The links between sleep, wellbeing and disease are still to be fully examined and described but there are several plausible pathways. For some diseases and conditions, it is likely that insufficient sleep leads to an activation of hormonal responses: hormonal changes in response to insufficient sleep – or sleep deprivation – include changes in leptin and ghrelin, which then lead to an increase in appetite and so increases in calorie intake. Evidence for this comes from experiments such as the one by Spiegel and colleagues6 who used measured daytime profiles of plasma leptin and ghrelin levels and subjective ratings of hunger and appetite. The findings indicated that short sleep duration in young, healthy men is associated with change in leptin and ghrelin as well as increased appetite. Of course this evidence comes from severe sleep deprivation rather than more moderate sleep deprivation many people experience across the week, however large scale epidemiological studies show that people who have short sleep are more likely to be obese. Similar evidence exists for diabetes and other diseases, with explanations largely built around observed changes in physiological function. It’s important to flag though that the changes in physiology and metabolism are not the only explanation.

Our behaviour when we are sleep deprived is different than when we have had sufficient sleep. Recent public health campaigns in Ireland7 remind us that insufficient sleep can have the same effect on our cognitive abilities, decision making and attention, as drinking alcohol. This is relevant to the diseases that are also mediated by health behaviours – when people have insufficient sleep they have lower regulatory capacity – and that includes for managing their eating behaviour and getting sufficient exercise. So sleep is directly related not only to changes in biological functioning, but also psychological wellbeing – both of which affect physical health.

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We know that school-age children need at least 10 hours of sleep daily, teens need 9-10 hours, and adults need 7-8 hours. The difference in sleep needs and patterns across the lifespan is explained by the differences in mental and physical development and activities at different ages. Recently there has been an Irish public health initiative to remind people about the need for sleep and what the consequences are but missing from the public discussion are an exploration of the reasons why many adults and children don’t get sufficient sleep. Sleep insufficiency may be caused by broad scale societal factors such as round-the-clock access to technology and work schedules. The amount of time many families spend on work, travel, meal preparation, homework, sports, socialising – well, it adds up to many more hours than we have in the week if we include between 8 and 10 hours sleep a night.   Society generally accepts the benefits of a good diet and exercise but attitudes to the benefits of sleep are more varied. Strangely, being able to survive on a few hours’ sleep a night is still considered by many people to be a badge of honour, but one day that badge becomes a bill that paid with the person’s health and wellbeing.

Sleep Hygiene

The promotion of good sleep habits and regular sleep is known as sleep hygiene. The following sleep hygiene tips can be used to improve sleep.

  • Go to bed at the same time each night and rise at the same time each morning. One way to help you do this is to set an alarm to remind you that it’s a good time to go to bed. It may seem silly, but oftentimes people will sit on the sofa watching dreck unless they receive a prompt to ‘go to bed’.
  • Avoid large meals before bedtime.
  • Avoid caffeine and alcohol close to bedtime.
  • Avoid nicotine.
  • Avoid using light-emitting devices in bed or before bedtime (laptops, phones and so on). Til Roennenberg, an expert chronobiologist, recommends a program called F.Lux to remove the blue light emitted from your screen if you really can’t quit the tech-use.

So yes, the message is clear, and it’s designed to inspire us to do more, to live while we’re alive, seize the moment, grab hold of opportunities, engage, interact and celebrate. But this call is not to choose, to ‘live while you’re alive or be boring and you might live longer’. It is possible to live while we’re alive and live longer, healthier and happier lives, and science tells us that one of the ways in which we can do it is to simply get enough sleep. If nothing else it leaves more time for seizing the moment, grabbing hold of opportunities, engaging, interacting and celebrating.

Resources

  1. Gradisar, M., Gardner, G., & Dohnt, H. (2011). Recent worldwide sleep patterns and problems during adolescence: a review and meta-analysis of age, region, and sleep.Sleep medicine12(2), 110-118.
  2. Luyster, F. S., Strollo Jr, P. J., Zee, P. C., & Walsh, J. K. (2012). Sleep: a health imperative. Sleep, 35(6), 727.
  3. Magee, L., & Hale, L. (2012). Longitudinal associations between sleep duration and subsequent weight gain: a systematic review. Sleep medicine reviews, 16(3), 231-241.
  4. Shochat, T., Cohen-Zion, M., & Tzischinsky, O. (2014). Functional consequences of inadequate sleep in adolescents: A systematic review. Sleep medicine reviews, 18(1), 75-87.
  5. Kamdar, B. B., Needham, D. M., & Collop, N. A. (2012). Sleep Deprivation in Critical Illness Its Role in Physical and Psychological Recovery. Journal of intensive care medicine, 27(2), 97-111.
  6. Spiegel K, Leproult R, L’hermite-Baleriaux M, Copinschi G, Penev PD, Van Cauter E. Leptin levels are dependent on sleep duration: relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab. 2004;89:5762–71. [PubMed]
  7. ‘It’s bedtime’ , the Safefood intitiative for promoting healthy sleep habits for children is described here, and includes a number of tips of promoting good sleep habits.   http://safefood.eu/sleep/sleep.html)