Are you tired? I am – exhausted. And we're not the only ones. According to sleep experts, four in 10 Australians are getting inadequate sleep. This seemed a big number, until I mentioned it at dinner with friends. Suddenly, everyone began to talk at once: desperate tales of small children and work stress and late-night Instagram and possum feet and, as one friend put it, "the endless 3am film reel of all the ways I'm a terrible person".
It was the same with everyone I spoke to – at work, at the local sushi joint, in the school yard. Everybody had a sleep tale to tell. And I mean everybody. Oscar Wilde is said to have identified the most frightening sentence in the English language as "I had a very interesting dream last night". Surely running a close second must be the statement: "Let me tell you about the terrible sleep I had last night." Like our dreams, our sleep – or lack thereof – is endlessly fascinating. At least to us.
A lot of insomnia is based, not on any physical affliction, but on our unique individual ability to freak ourselves out.Credit:Getty Images
We're especially riveted at the moment, because as a nation we've reached a high point of panic about sleep. Everyone seems to have a sleep tea they swear by, or a sleep podcast so boring it's driving them crazy, or a sleep app that's keeping them awake. Many of these apps, moreover, especially those that purport to analyse sleep and predict optimum wake times via movement, are not scientifically robust. They're inaccurate, say experts, and can lead to both false confidence and unnecessary anxiety about sleep. And yet, if you include Fitbit, three of the top five free health and fitness apps downloaded from the App Store in Australia this year have been sleep apps.
According to the country's leading sleep advocacy organisation, the Sleep Health Foundation, sleep should be the "third pillar of health" alongside exercise and diet. And yet we've neglected it to the point that we're now in the midst of "a dire sleep epidemic that is damaging the mood, health and safety of the nation".
Things are so bad even politicians have noticed. In February, a House of Representatives committee established by health minister Greg Hunt held the Inquiry into Sleep Health Awareness in Australia. It travelled to four states, took testimony from more than 60 experts, and received 130 submissions to tackle the country's "looming sleep crisis". And it's not just a crisis of health. In 2016-17, inadequate and disrupted sleep cost the Australian economy $66.3 billion: $26.2 billion in financial costs and $40.1 billion in loss of wellbeing. This equates to about $9000 of lost shut-eye per sleepless person.
So that's the state of the nation. Now let me tell you about the terrible sleep I had last night. It began, as it almost always does, with our six-year-old daughter, who wakes most nights. She, in turn, wakes everyone else in the house, including the cat. And though my daughter goes back to sleep pretty quickly, I remain just awake enough, back in bed, to hear the persistent feline voice from the sitting room suggesting that since she (the cat) is now awake, this might be a good time for someone (me) to get up and give her breakfast (even though it's 3am). At some point, her voice is joined by the one inside my head, telling me that my daytime assumption that I'm an okay person leading an okay life is in fact a terrible mistake and that actually I suck. Last night, for example, I lay for what seemed like hours, cataloguing all the ways I was not like Michelle Obama, and thus had failed as a human being. I only wish I were joking.
This, the experts tell me, is insomnia, the most common of all sleep disorders. All I know is it's motherhood, not Macbeth, that has murdered sleep for me. In the interests of full disclosure, I should add that I also have a condition known as restless legs syndrome, which, despite sounding like an Elvis Presley dance move, is actually a common disorder stemming from the nearly uncontrollable desire to kick and twitch your legs at night. I can resist this urge while I'm awake, but once I'm asleep my legs move, I'm told, like someone in a Jackie Chan movie. This is actually a second, separate problem, known as periodic limb movement disorder, or PLMD. In my case, it's actually a problem by proxy: it doesn't keep me awake, but it wreaks havoc on my partner's sleep. So I often lie there not wanting to fall asleep until I'm sure he's asleep, so that when I go to sleep I don't keep him awake. Confused? I know I am. If I weren't already, I'd be exhausted just thinking about it.
In the midst of contemplating all this, a message arrived in my inbox. It was, of all things, an invitation to a "sleep cleanse". A three-day sojourn in a luxurious country house, surrounded by yoga teachers and naturopaths and organic food and herbal tinctures, all in the name of improving my sleep. Thinking of the ravaged faces of all the non-sleepers I've been talking to, there seemed only one thing to do. In the name of research, I would have to attend a sleep retreat.
As it turned out, this invitation arrived not a moment too soon. Today, we know more clearly than at any point in history that not to sleep is, quite literally, to hasten death. As University of Berkeley academic and global sleep guru Matthew Walker puts it, "Short sleep predicts a shorter life. It predicts all-cause mortality." Epidemiological studies across millions of people have shown that virtually all disease becomes both more likely, and more serious, in the absence of good sleep. "The main message is that every single organ in the body – and in fact every single cell in the body – stops functioning properly if you don't get adequate sleep," says Professor Danny Eckert, director of the Adelaide Institute for Sleep Health at Flinders University. "Every part of the body is affected."
Lack of sleep, for instance, has been linked to a greater risk of dementia, Alzheimer's and Parkinson's. Says Professor Sharon Naismith, clinical neuropsychologist and chief investigator at CogSleep, a new centre of research excellence into sleep in older people at the University of Sydney, "We now know that when you're awake, you produce lots of sticky protein [called beta amyloid] in your brain. This protein, plus various other substances, are implicated in many forms of dementia. But when you're asleep, especially when you're in slow-wave sleep, quite a sophisticated plumbing system begins operating, which flushes all that stuff away. But it only works when you're sleeping."
There are also specific risks from bad sleep for different age groups. Adolescents seem especially vulnerable: a study in the British Medical Journal last year of more than 120,000 UK 15-year-olds showed that sleep has a greater impact on adolescents' mental wellbeing than bullying, physical activity or screen time. And in research underway at Sydney and Monash universities, scientists have discovered what appears to be a link between sleep patterns and serious mental disorders such as major depression and bipolar. "Historically, we've tended to think that the sleep problems experienced by some of these young people are a consequence of their disorder," says Ian Hickie, the co-director of health and policy at the University of Sydney's Brain and Mind Centre. "But our preliminary research now suggests that disordered circadian clocks are actually causing the disturbed sleep, and thus the disease itself."
Professor Sharon Naismith heads CogSleep, a university centre investigating sleep in older people.Credit:Louie Douvis
The list goes on and on. "If you take an average 20-year-old, restrict his sleep to five hours a night, five nights in a row, and measure his blood glucose on night one and at again on night five," Eckert explains, "he will have gone from being completely healthy to being in a pre-diabetic state. If you do the same thing with testosterone, it's as though he's aged at least a decade. Your blood alcohol concentration equivalent is .05 after those five nights, which means your cognition and reaction times are no longer optimal. Actually, if you miss an entire night's sleep, for just one night, your blood alcohol equivalent is 0.1 [the limit in Australia is 0.05], which means you shouldn't be doing things like driving a car at all. Added to which, your [emotion processing] amygdala is up to 60 per cent more reactive after just one night's sleep deprivation. You just can't think or make sensible decisions in that state."
As well as endangering ourselves and others, and raising our risk of serious illness – which also includes stroke, heart attack, obesity, diabetes and some cancers – bad sleep simply makes life less worth living. "I am not convinced that it is possible to be psychologically healthy and not sleep when we are designed to sleep," explained Emeritus Professor Dorothy Bruck, international sleep researcher and chair of the Australian Sleep Health Foundation, during the sleep inquiry. "Speaking as a psychologist, I know that if you disturb someone's sleep in their 20s, they have a fourfold increase in the risk of depression. We know that suicidality increases with poor sleep. It can permanently impact your attention, problem-solving, memory, ability to learn and study, relationships – everything."
Nor should we console ourselves with the thought that, although the science is clear that almost all adult humans require between seven and nine hours of sleep a night, those rules don't apply to us, and that somehow we, with our superhuman powers of wakefulness, are miraculously going to avoid these dire consequences – just like Donald Trump, who frequently points out that he only sleeps four hours a night. Maggie Thatcher used to boast of a similar sleep schedule – and she contracted dementia in later life. According to Matthew Walker (who is, admittedly, viewed by some in sleep research as an alarmist), "Based on the science, the number of people in the world who can survive on less than six hours' sleep without impairment is zero."
Let's be honest. Thrilled as I am to be here, my first thought about The Goodnight Co's sleep retreat in Bowral, in the Southern Highlands of NSW, is to wonder what use it can possibly be. Yes, it's in a beautiful location – an idyllic rural property called Springfield Farm, complete with gravel drives and clipped hedges and Manchurian pear avenues – but will I really sleep better with a stand of silver birches and an espaliered fruit tree outside my bedroom window?
Yes, say the founders of The Goodnight Co, Shea Morrison and Danielle Knight. They launched their company in 2015 as an online boutique of sleep products – silk pillowslips and aromatherapy room sprays and herbal teas – all aimed at "helping make a good night's sleep easier to come by". These days, their company is endorsed by self-proclaimed sleep evangelist and Huffington Post founder Arianna Huffington, who's quoted in their ebook giving the (by now painfully self-evident) advice that "sleep is the foundation of our wellbeing". Springfield Farm is their first foray into sleep retreats; their second is planned for September.
At first glance, the retreat program looks suspiciously light on science and long on lavender. On arrival, I'm given my equipment for the weekend, which includes not only three kinds of essential oil perfumes and two kinds of sleep tea, but also a daytime herbal mouth spray, a night-time homeopathic tincture, and a room mist. Plus a pillow, a silk pillowcase and a silk sleep mask. Lying on my bed with my sleep mask pushed up like Joan Crawford, I marvel over my loot and peruse the timetable, which seems to consist of a great many yoga classes, nutrition consultations and opportunities to eat cashews (which, I learn, contain tryptophan, "nature's Prozac").
There is, however, little information on how sleep itself actually works. Luckily, I've already talked to an expert about this. "Sleep is a whole-brain exercise," explains Dr Ron Grunstein, professor of sleep medicine at Sydney's Royal Prince Alfred Hospital and head of the sleep and circadian research group at the Woolcock Institute of Medical Research. "But in basic terms there are two major sleep systems in our body: the homeostatic and circadian systems." The homeostatic system is the one that, the longer we've been awake, produces a greater and greater drive for sleep. It's thought this drive is largely controlled by adenosine, a substance which builds up in our brains in the course of the day. (Fun fact: caffeine blocks adenosine production, which is why coffee keeps you awake.) Once we fall asleep (and specifically, once we enter deep, or slow-wave sleep), adenosine dissipates.
Our circadian clock, meanwhile, "is a biorhythm that increases our alertness during the day, dips in the post-lunch period, rises again, then decreases in the evening," explains Grunstein. "That signal is innate to some extent, but can be influenced by light." Light levels are sensed by special receptors in our eyes (these receptors are unrelated to our vision: blind people can have perfect circadian light perception) and sent to the suprachiasmatic nucleus (SCN), a kind of circadian master clock, in our brains. If light is low or absent, the nucleus orders the production of melatonin, which aids sleep. Conversely, if light is bright – and especially if it's blue – the SCN does the opposite, suppressing melatonin production and, basically, waking us up. Herein lies the danger of the phone screen at night: some research suggests five minutes of blue light can disrupt our circadian system for 40 minutes.
Dr Ron Grunstein, professor of sleep medicine at Sydney’s RPA Hospital.Credit:Daniel Munoz
There are several stages to healthy sleep: light sleep, deep or slow-wave sleep, REM sleep, and brief wakings. Deep or slow-wave sleep is the phase that restores and repairs the body by clearing toxins, releasing hormones, repairing muscles and generating new brain cells, and it mostly occurs in the first half of the night. REM sleep, conversely, is when we do most of our dreaming and emotional memory consolidation, and REM sleep happens mostly in the second half of a regular eight-hour sleep pattern, as we move towards waking.
Sleep phases are important because they may help us figure out (in a very DIY way) what we're missing with poor sleep. As Professor Peter Eastwood, president of the Australasian Sleep Association and director of the Centre for Sleep Science at the University of WA explains, "If you only get five hours' sleep total, you'll have got a fair bit of slow wave, but not much REM." Which, since REM sleep is thought to aid emotional regulation, might – at last! – be one scientific excuse for being "tired and emotional". We're not petulant and selfish – we're merely lacking adequate emotional memory processing from the night before. Conversely, if we get a full eight hours, but it's repeatedly disrupted or restless, we may be losing slow-wave sleep, because we're not actually reaching those deeper phases at all. And this means we heal less swiftly, upset our endocrine system and interfere with clearing proteins from our brains.
Sometimes, of course, sleep disruption is caused by things beyond our control – the obstructed airways of sleep apnoea, the limb movements of PLMD (ha!); even the plaintive cries of felines in the middle of the night. But we're also capable of destroying the quality of our sleep – like Darth Vader in the Death Star – via the mighty power of our minds alone.
Up to 80 per cent of people suffering from a sleep disorder have insomnia. And according to experts, a lot of insomnia is based, not on any physical affliction, but on our unique individual ability to totally freak ourselves out.
The technical term is "hyperstimulation". It's the age-old story of the sabre-toothed tiger and our flight-fight response. We may go through our days producing adenosine, melatonin and all the intricate chemical architecture of sleep perfectly normally. But at some point during our sleep process (when we first lie down; halfway through the night; an hour before we're due to get up; or all of the above) our brains suddenly kick into gear, presenting us with a potent cocktail of fears and worries, threats and terrors. Our fears may be big or small. They may be of pellucid clarity or gnomic vagueness, but their sum effect is to fire up our sympathetic nervous system. Obeying the ancient evolutionary survival imperative, our body is then flooded with stress hormones such as cortisol and adrenalin, readying us to fight to the death or run for our lives. And sleep flees like a thief in the night. "You just can't calm yourself down," concludes Grunstein, calmly.
The good news is, there are drugs! No, no, no. Well, actually there are drugs – an entire pillar of the multibillion-dollar pharmaceutical industry is based on helping people woo themselves artificially into the arms of Morpheus. And in fact, the average sleeping tablet provides a reasonable quality of sleep. "The problem," says Eastwood, "is that they're not designed for long-term use. Some are addictive, many have a pretty long half-life, so you're groggy for a long time, and some have some pretty interesting side effects." These can include dizziness, confusion, impaired memory and seizures, to name but a few of the milder possibilities. Far safer in the long term – and in the majority of cases, extremely effective – is insomnia-specific cognitive behavioural therapy. Which essentially means changing the ways we think, and behave, about sleep. As Grunstein puts it: "Changes in behaviour have impacts on physiology."
Ergo, the sleep retreat. I spend a wonderfully silent first night in Bowral, during which, despite the absence of child or cat, I wake at 3am and roll around on my silk pillow for an hour in the dark, thinking dark thoughts. I am, I realise, now caught in the classic bad sleeper's dilemma: I'm catastrophising about not sleeping, and that in itself is stopping me from sleeping.
The next day, bleary-eyed but determined, I'm surprised to hear that getting a good night's sleep starts first thing in the morning. As soon as we wake, according to Shea Morrison (who is happy to acknowledge she has no formal sleep qualifications – "I've just been thinking about it for a really long time!"), we should "ground ourselves" by walking outside in the fresh air with no shoes on. (If it's raining, standing by a bright window is permissible, says Morrison.) During the day we should eat lots of green vegetables and lean protein and iron-rich foods. In the early evening we should light candles, drink herbal tea and take the time to write down our thoughts, before retiring to bed when we are tired, calm and ready to sleep.
Yeah, right, I find myself thinking. Who has time to light candles and drink tea amid the average commute-dinner chaos of early evening? And even if I could find the awesome organisational skills to surround myself with tea lights and camomile-infused hot beverages, I find it hard to imagine that writing down my thoughts is going to help me knit up the kid-and-cat-ravelled sleeve of care.
But of course, according to the research, this is exactly what I need to do. All the things recommended by Morrison and Knight are examples of the kind of behavioural change that is proven to help sleep. Yoga, meditation and breathing exercises are all gold standard tools for calming the mind and engaging the parasympathetic nervous system – which, in turn, reduces stress hormones, relaxes muscles and decreases heart rate. Journalling, meanwhile, is an excellent way of calming fears. As Grunstein himself puts it: "Writing down a list of things that are bothering you can help you let them go when you're actually trying to sleep."
What the sleep retreat is, in fact, is an effort to create a healthy sleep routine, which is, for very many of us, what good sleep is all about. So just do it. Go outside in the morning sun to help set your circadian rhythm. Lower the light around you at night to increase melatonin production. Stop watching screens in the evening. Write down – and try to release – your worries. Breathe. Go to bed, and get up, at the same time each day. It's not rocket science, people.
Oh – and stop watching addictive TV series. "The CEO of Netflix [Reid Hastings] has actually been quoted as saying: 'Our biggest competitor is sleep,' " points out Grunstein, so don't get caught in that contest. You know very well that if it comes down to a contest between your sleep and a Handmaid's Tale series-three binge, you will lose.
Want to know what happened to me when I did all this (well, mostly) for three nights in a row? I had the best night's sleep I can remember: nine peaceful hours. The next morning, I felt alert, and calm, and as if my brain was working faster and more clearly than usual. At 11am I remembered a word I'd been trying to think of for weeks (long story) – "occulta". The next day, instead of having some spectacular meltdown when my daughter forgot her school lunch and covered our outside table in paint in the course of just six hours, I was able to stay calm and sympathetic, and even talk rationally about how we might avoid these sorts of incidents in future. I was a maternal goddess, in other words. I could hardly believe it.
"It's a surprise, isn't it?" says Perth-based sleep physician Professor David Hillman, founding head of the Sleep Health Foundation. "In my clinical practice I see many people with sleep disorders, and the disorder gets confused, in some circumstances, with 'Oh, I'm getting older, I'm getting a bit foggy, it's inevitable.' And I say, 'Well, improve your sleep.' And they do, and suddenly they feel younger. You sort of rediscover yourself, and that you're rather better and more alert than you thought you were.
"Sleep is a very interesting process," he concludes. "It's recuperation, of course, and restoration and repair: all of which is vital. But your sleeping brain is also quite capable of creative activity. It really is possible to go to sleep with a problem and wake up with a solution, for instance. That happens quite frequently."
Imagine not only waking refreshed, and repaired, and with less chance of illness than when you went to bed – but also with fewer problems than you had the night before. That sounds like a dream to me.
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