Accessibility to sleep health education has been significantly limited by online discourse. This is mainly due to the abundance of health articles that push fear-mongering narratives about sleep by misrepresenting research findings and excluding key context. In my previous post I posit the question, ‘Why have I never been taught how to sleep?’, and while there are a number of factors that can answer this question, the misrepresentation of sleep health undoubtedly plays a key role.
From mainstream publications to social media content, the conversation around sleep is one that is almost always dominated by fear. I can still recall the sensationalised edit used to introduce sleep academic Matthew Walker on The Diary of A CEO podcast. The combination of dramatic music and health risk claims – that, for example, sleep deprivation causes muscle loss before fat loss – instantly spiked a level of stress and anxiety that had me craving answers and hanging on every word (though I am not sure Walker’s words dispelled even a small percentage of the fear that had been originally incited). While these choices and discussions make for more engaging and emotionally stimulating content, the audience, or at least certain members of the audience, are left feeling tense, anxious and without clear direction.
The same is true for sleep health articles. Searching the internet for help on sleep issues is readily bombarded by articles that fail to recognise their audience. It is important to remember that the way we present information about health can vastly impact the way it is interpreted. For example, the Telegraph recently posted an article titled ‘What happens to your brain when you go without sleep’ outlining the ways the cognitive function of the brain is disrupted by sleep-deprivation and the severe long-term health risks that may come as a result.[1] The author begins by acknowledging the average of 7 hours and 4 minutes that Britons sleep per night – ‘not terrible’, as they describe, but ‘there’s certainly room for improvement’. This average, as the author identifies, means there are a number of people getting ‘significantly less’ than the amount of sleep recommended by NHS guidelines. The article goes on to detail the severe short- and long-term consequences of sleep deprivation before quickly running through a list of, suffice to say, half-hearted sleep hygiene rules.
Whilst reading this article, I couldn’t help but wonder who is being targeted. I find this to be an issue with a number of articles I read on the topic of sleep. There are (roughly) two groups here: those who don’t prioritise sleep and those who can’t sleep. In the former’s case, we’re not dealing with a group of people who have sleeping problems. Actually, they are sleeping pretty decently. Anyone might deduce that this isn’t a sleeping issue but a lifestyle issue. People are choosing to sleep less because they are over-worked and want longer evenings, otherwise known as ‘Revenge Bedtime Procrastination’. In this case, scrolling on electronic devices in bed instead of prioritising an extra hour of sleep is the kind of habitual issue we should be focusing on. On the other hand, if you want to teach people how to sleep, then you are more likely to be addressing those with serious sleep issues, in which case, listing vague instructions like ‘Protect at least 7 hours of sleep each night’ and ‘Wind down before bed’ is not going to cut it.
Having established the short-term consequences of sleep deprivation on cognitive performance, this article, like many others, goes on to describe the ‘detrimental’ long-term health consequences of lack of sleep: dementia, strokes, heart disease, diabetes and certain types of cancer. The author loosely claims a ‘growing body of evidence’ to support this, but it is important to note the limitations of research into the relationship between sleep and long-term health risks. For starters, there are very few large, prospective, cohort studies, which would allow for observation of selected participants over time, and in turn, permit analysis of disease progression and relative risk. This is important in order to turn associations into more concrete cause-and-effect relationships as well as picking up on the more dynamic and nuanced connections between sleep and health. Furthermore, studies face the problem of constructing participants’ sleep profiles. Markedly, many studies fail to consider both sleep duration and sleep quality, which are both essential to obtaining the full picture of an individual’s ‘sleep architecture’. Some methods even rely on self-assessments of sleep quality by participants, making the construction of sleep scores quite subjective. This is particularly problematic as it has been found that there is often a discrepancy between how much sleep insomniacs believe they have had and the amount of sleep they have actually had.[2] Sleep indexes can offer a more reliable way of calculating sleep quality as they cover several important criteria, each of which is tested and then summarised together to produce a final score. However, these sleep indexes can also be subjective. The Pittsburgh Sleep Quality Index, for example, calculates via a self-reported rating system, which, as mentioned previously, may be unreliable and thereby produce invalid conclusions. Sleep tests, such as polysomnography and actigraphy monitors, are not used in prospective studies as they are not practical nor financially viable to use over long periods of time. It is also particularly important during prospective studies that sleep profiles are regularly obtained throughout as they are likely susceptible to change. I have come across a number of studies that took only one sleep assessment at the beginning, which omits a massive amount of data and is by no means a representation of an individuals sleep over the course of their life.
There is then, of course, the very possible risk of intervening factors. It is very difficult to find hard evidence that poor sleep is the direct cause of a particular disease or disorder. There are so many variables over a person’s lifespan that can contribute to disease progression. In fact, poor sleep could very well be a symptom of underlying health problems, rather than the cause of them. This could explain why sleep studies have found an association between participants with poor sleep quality and health problems. It is not that the sleep quality is causing the health condition, but that the health condition is causing the poor sleep.
In short, these health articles are referring to studies that are only able to claim associations, not causations. In other words, it has not been proven that there is a concrete relationship between sleep quality and disease progression. Furthermore, as outlined above, closer inspection of these studies reveal major methodological issues that jeopardise the validity of the findings.
As you can see, these health articles eliminate so much context so as to make the individual feel out of control of their life. This fear-inducing approach to health is one used across the internet, from YouTube to podcasts to short form content like TikTok.
Once again, I wonder who is being targeted in this Telegraph piece. Those who do get about 6-7 hours of sleep a night are unlikely to care much about these claims. After all, no one is going to stop a bad habit that might result in a health issue years and years down the line, particularly if you are already getting a functionable amount of sleep each night. This is where I think the focus on cognitive dysfunction is more effective. As the author describes, memory loss, brain fog and attention deficit are all symptoms of sleep deprivation that the average Briton should self-identify and subsequently value their sleep duration and quality more. Then there are those with serious sleep issues whose anxious relationship to sleep is only fuelled by these fear-inducing statements. To cite evidence for associations between, for example, dementia and lack of sleep, and present them as cause-and-effect relationships is an extremely damaging misrepresentation. Any fellow/former insomniac understands what it’s like to encounter these claims, particularly when they dominate discourse around sleep and make it difficult to access helpful information.
Providing context when referring to a body of research is absolutely essential in order to improve understanding and avoid misinterpretation. This issue arises because people often mistakenly equate the quantity of research with the level of validity. In this case, a ‘growing body of evidence’ supporting, for example, the relationship between sleep quality and heart disease is easily interpreted as a growth in, or confirmation of, validity. This is particularly risky when it comes to health as individuals who are by no means experts in the field are extremely susceptible to interpreting such statements as absolute and making lifestyle choices correspondingly. In the case of an insomniac, the anxiety and depression caused by poor sleep is significantly heightened in the face of such articles. This makes a case for educating the public on the scientific process and the integral steps that come between theory and real-world application. Health articles must be sensitive to language and their audiences, and resistant to pushing particular narratives to increase viewership.
Whilst we can acknowledge that there are potential links to health issues down the line, the focus should not be on the fear of what might happen but what is happening: a poor quality of life. Improving sleep quality is about being happier, it’s about feeling alive and being able to participate in day-to-day life without the painful experience of sleep-deprivation, it’s not about the fear of potential diseases and disorders that may never even happen, a fear that’s going to have the opposite effect, only exacerbating problems with sleep in the long-term.
[1] Roberts, Ceri, “What happens to your brain when you go without sleep”, The Telegraph, 2024, How long can you go without sleep?
[2] Trimmel, Karin et al, The (mis)perception of sleep: factors influencing the discrepancy between self-reported and objective sleep parameters, Journal of Clinical Sleep Medicine, 2021, https://doi.org/10.5664/jcsm.9086.