Sleep Matters The impact of sleep on health and wellbeing Mental Health Awareness Week 2011 Address Mental Health Foundation Sea Containers House 20 Upper Ground London SE1 9QB United Kingdom Telephone 020 7803 1100 Email [email protected] Website www.HowDidYouSleep.org £10 IBSN 978-1-906162-65-8 Registered charity number England 801130 Scotland SC039714 © Mental Health Foundation 2011 Contents 04 Executive summary 08 Introduction 12 Part 01 – Sleeping and sleep patterns 28 Part 02 – Poor sleep 48 Part 03 – Sleeping well 62 Conclusion 66 Useful resources 68 References 72 Appendix: Sleep diary 76 Acknowledgements 01 ‘The main facts in human life are five: E. M. Forster Executive We spend approximately a Poor sleep over a sustained period One of the most widely used and – The new Public Health Outcomes third of our lives asleep. Sleep leads to a number of problems which successful therapies is Cognitive Framework should include a specific Summary are immediately recognisable, including Behavioural Therapy (CBT). This is outcome on reducing sleep problems is an essential and involuntary fatigue, sleepiness, poor concentration, useful even for people who have across the whole population. process, without which we lapses in memory, and irritability. had insomnia for a long period of time. Sleep should also be reflected in cannot function effectively. A full course of such a therapy with new national mental health outcome It is as important to our Up to one third of the population may a sleep specialist is potentially costly, indicators, including improving bodies as eating, drinking suffer from insomnia (lack of sleep and is most appropriate for people sleep for people who experience and breathing, and is vital for or poor quality sleep). This can affect with severe sleep problems. Still, some significant sleep problems requiring mood, energy and concentration levels, CBT principles can be appropriate specialist help. maintaining good mental and our relationships, and our ability to stay and easily practiced for anyone who is physical health. Sleeping helps awake and function during the day. experiencing a sleepless night. – The National Institute of Health to repair and restore our brains, and Clinical Excellence (NICE) not just our bodies. Sleep and health are strongly related, Key points: should develop guidance for the poor sleep can increase the risk of – Sleeping poorly increases the risk of management of insomnia using During sleep we can process having poor health, and poor health having poor mental health. In the same non-pharmacological therapies, information, consolidate memories, can make it harder to sleep. Common way that healthy diet and exercise can to complement existing guidance and undergo a number of maintenance mental health problems like anxiety help to improve our mental health, on using pharmacological therapies. processes that help us to function and depression can often underpin so can sleep. during the daytime. Sleep is crucial sleep problems. Where this is the case, – People with sleep problems should to the health of individuals within the a combination approach to treating – There is no universal answer to be recognised within the Improving UK and to the public health of the UK the mental health problem and sleep the question of how much sleep Access to Pyschological Therapies population. problem in tandem is often the most a person needs. This varies from (IAPT) programme, especially effective. person to person. What is important regarding access to Cognitive We all need to make sure we get the is that people find out how much Behavioural Therapy (CBT). IAPT staff right amount of sleep, and enough It is essential for us to better sleep they need and ensure that should be suitably trained on sleep good quality sleep. There is no set understand the sleep process in they achieve this. issues. amount of sleep that is appropriate order to ensure that we get a regular for everyone; some people need more amount of good quality sleep. Sleepio, – The consequences of poor sleep – Further research should be carried sleep than others. Our ability to sleep co-founded by Professor Colin Espie, should be taken seriously in out to establish the effectiveness is controlled by how sleepy we feel and Director of the University of Glasgow healthcare, education, family life, of low cost, non-intrusive CBT- our sleep pattern. How sleepy we feel Sleep Centre, is a new organisation and society at large. based interventions for sleep relates to our drive to sleep. The sleep that is dedicated to raising awareness problems, such as self-help books pattern relates to the regularity and of the importance of sleep. Sleepio We recommend that: and online courses. timing of our sleep habits; if we have collected data from a large-scale, – The importance and benefits of got into a pattern of sleeping at set national survey on sleep habits; some sleep for both mental and physical times then we will be able to establish of these revealing new data appear health should be highlighted in a better routine, and will find it easier throughout this report. national and local public health to sleep at that time every day. campaigns, including in schools and We can all benefit from improving the workplaces. New and easily accessible Sleep is a more complex process than quality of our sleep. For many of us, it resources should be made available many people realise, much of it is still may simply be a case of making small advising people on what they can do a mystery to scientists. During sleep, lifestyle or attitude adjustments in themselves to improve their sleep. the body goes through a variety of order to help us sleep better. For those processes and sleep stages. Good with insomnia it is usually necessary – The Royal College of GPs should quality sleep is likely to be the result to seek more specialist treatment. provide up to date, evidence-based of spending enough time in all of the Sleep medication is commonly used, training and information for its stages, including enough deep sleep but may have negative side effects and members on the importance which helps us feel refreshed. is not recommended in the long-term. and benefits of sleep for physical Psychological approaches are useful and mental health. GPs should also for people with long-term insomnia have access to a diagnostic tool for because they can encourage us use in recognising sleep problems to establish good sleep patterns, in primary care settings. and to develop a healthy, positive mental outlook about sleep, as well as dealing with worrying thoughts towards sleeping. 04 05 ‘Sleep is the best meditation.’ Dalai Lama Introduction We spend, on average, approximately a third In Part II, we review the literature on sleep problems of our life asleep. Along with eating, drinking and explain what can happen if we don’t sleep and breathing, sleeping is one of the pillars for properly. In Part III, we describe ways in which maintaining good mental and physical health. we can improve our sleep and explain possible Ultimately, we would die if we did not sleep. treatments for those who find achieving good quality sleep difficult. The primary focus of this Despite its obvious importance, sleep remains report is sleep and mental health; both how mental a mysterious realm that has fascinated us for health can affect our sleep, and how sleep can thousands of years. For example, in the Greek affect our mental health. pantheon sleep is represented by the winged god Hypnos, himself the son of Nyx, goddess of the The report includes primary data from the Great Night. Closely related to Hypnos were Thanatos British Sleep Survey, developed by Professor Colin (god of death) and Morpheus (god of dreams). Espie at the University of Glasgow in association As human beings, most of us cross the bridge with Sleepio Ltd. between the conscious to the unconscious on at least a daily basis. Yet, we seldom give a second The survey has been available online from March thought to the countless physiological and 2010, and aimed to take a snapshot of the UK’s psychological processes that occur within our sleep habits. By December 2010, there had been bodies and brains when we are deep in slumber. 6708 responses to the survey. This survey is still online: you can take part by visiting the Sleepio The aim of this report is to raise awareness about website, www.sleepio.com. the importance of sleep and its crucial role for our health, both physical and mental, just like diet and exercise. In Part I of this report, we provide information about sleep, why we need to sleep, and what happens during sleep. 08 09 ‘A good laugh and a long sleep are the best cures in the doctor’s book.’ Irish proverb Sleeping and Sleep Patterns 12 13 Sleep affects our ability to use What is Sleep? language, sustain attention, Sleep is often seen as time understand what we are reading, when the body is inactive. and summarise what we are In fact, the opposite is true. hearing03. If we compromise on Sleep is an active, essential our sleep, we compromise on our performance, our mood, and our and involuntary process, interpersonal relationships. Sleep without which we cannot has also been shown to protect function effectively. Sleep is the immune system04. not a lifestyle choice; just like breathing, eating or drinking, Animals have evolved to sleep it is a necessity. in many different ways. Dolphins can sleep using only one half of their Sleep is a complex process during brain at a time. Even hibernating which our body undertakes a number animals have been shown to of essential activities.