Sleep Awareness Week: How India’s sleep debt is rising
Indians have always been poor sleepers but our sleep debt soared during the pandemic—and we are still trying to catch up
Night owl or morning lark? In today’s world, chances are high that you are both.
The pressure to work more, squeeze every ounce of productivity from the day and sleep less is driving a massive sleep deficit, with worrying consequences. Doctors, nurses,police officials, pilots, cabin crew, mothers, students, truck drivers…the list of sleep-deprived people who continue to go about their business as usual is long. India has never slept well, and after experiencing the anxieties of the pandemic, we have racked up even more sleep debt, or long-term sleep deprivation.
Indians are the second-most sleep-deprived people in the world, with an average nightly sleep of seven hours and one minute, according to a 2019 study conducted by the US-based firm Fitbit across 18 countries. They rank after the Japanese, who report an average sleep duration of six hours and 47 minutes.
That was before the pandemic. Sleep scientists and doctors, both in India and other parts of the world, say the quality of sleep—which includes the number of hours a night, uninterrupted sleep and waking up refreshed—has deteriorated further since, and we are only beginning to recover.
One-third of Indians experience severe dyssomnia—a term for a variety of sleep difficulties, including insomnia, having trouble falling asleep or staying asleep, waking up tired and a need to sleep excessively—and these symptoms were worsened by the pandemic, found researchers at the Centre for Consciousness Studies, department of neurophysiology, National Institute of Mental Health and Neurosciences (Nimhans), Bengaluru.
It’s a trend observed by researchers across the world. “Individuals reported worse overall current sleep health, with lower ratings across the six dimensions of sleep health (sleep regularity, satisfaction, alertness, timing, efficiency and duration) compared to their ratings…before COVID-19 infection,” wrote a group of 11 experts who authored an international study on post-covid sleep health, published in the journal Sleep Health in December. They followed 1,001 people to study the impact of long covid on sleep health. Disrupted schedules, increased stress, increased screen time, disruption in physical activity and dietary habits and increased feelings of isolation are known to influence sleep quality—and over the past three years, we have all experienced this and more.
I should know about the late nights, early mornings and everything in between. Over the years, I have done a variety of shifts. Early morning, afternoon, evening, night, graveyard…and in the process, botched up my circadian rhythm. Sleep, to be honest, didn’t seem all that important as I am among those who consider it (especially in the afternoon) a “waste of time”. Now, as mother to a tween, I often hit the bed early to inculcate the importance of good hygiene but that doesn’t mean I am sleeping—lights off becomes a licence to whip out the phone and start scrolling. Or sitting up to read a book or watch a few shows. This time of the night, when I am awake and on my own at home, is when I get to do what I want to do.
Turns out I am not the only one. Revenge bedtime procrastination has become routine for people who are busy all day and decide to sacrifice sleep for a few hours of leisure and entertainment. The 2023 Great Indian Sleep Scorecard, an annual nationwide survey that has been published by the sleep solutions startup Wakefit.co for six years, confirms this—87% of Indians use their phones before bedtime, with 78% of people in the age group of 25-34 staying up late browsing social media. It also reports a 38% increase in the number of people staying up late at night worrying about their future.
Not surprising, then, that there has been an 11% spike this year in people not feeling refreshed after waking up. About 67% of women reported feeling sleepy during work hours, against 56% of men. “Overall, the year saw a 21% increase in people feeling sleepy during work hours as compared to last year,” the report said.
Janavi Iyer, programming head and RJ at Red FM, feels she’s “perpetually sleepy”. A busy work life with a busier home life—managing a baby, a seven-year-old and a household—means there’s always something on her to-do list. Naturally, in a bid to fit 48 hours in the 24 available hours, sleep has to take a back seat. Work from home, she feels, allowed for periods of rest, but things are back to normal now. “I may be in bed for about seven hours but it’s quantity, not quality. Getting up twice or thrice a night and sleeping with one ear open means my sleep is definitely hit and I bear the effects of it, for days, weeks and months,” she says.
“Earlier, people slept longer as there were not so many distractions,” says Nileena N.K.M., a specialist in psychiatry and sleep medicine at the Chennai-based Nithra Institute of Sleep Sciences. “Evolution, electricity, gadgets… each of these has shortened sleep cycles significantly.”
The Wakefit scorecard indicated a 100% increase in people going to bed before 10pm during the peak of the pandemic (2020-21). It suggested most sleep parameters improved amid the pandemic. However, the next report revealed sleep-related challenges had resurfaced. Chaitanya Ramalingegowda, co-founder of Wakefit.co, says: “Our 2023 survey reveals that almost one in three Indians believe they have insomnia, with 90% waking up at least once or twice at night. The report highlights a 42% increase in people who have slept in places other than their beds. Not maintaining a dedicated sleep space can cause disturbed sleep, thus promoting sleep depravity.”
DREAMS AND NIGHTMARES
At Nimhans’ Centre for Consciousness Studies, seven experts and researchers have been studying dreams for two years. They found that people who tested positive for covid-19 had more nightmares, and were more distressed by these, than those who had not been affected by the virus. The dreams included fears of loss, grief and vivid nightmares about family and friends being affected. “This supports the notion that sleep, dreams, and affective states were disrupted during the pandemic…. Our study highlights the impact of psychological stress on human sleep, and emotionality,” they write in a paper titled Covid-19 Pandemic, Sleep Quality, And Emotional Tone Of Dreams, which will be published in the International Journal Of Dream Research in April. It set out to understand the relation between sleep quality and emotionality in people impacted by the pandemic through a survey of over 900 people in October-November 2020. “Sleep quality also deteriorates with an increase in the intensity of emotionally charged dreams…. Subjects who reported to be Covid-19 affected had an increased frequency of nightmares and were more distressed by nightmares, compared to those reporting not affected. This supports the notion that sleep, dreams, and affective states were disrupted during the pandemic,” the paper notes.
Gulshan Kumar, lead author of the study, tells Lounge: “We found that daytime trauma and anxiety because of the pandemic was impacting people’s sleep and dreams. The more severe the emotional impact—in terms of losing a loved one or falling seriously ill themselves—the more they experienced intense dreams and nightmares. The level of distress caused by these dreams was also heightened. All this has a direct impact on the quality of sleep.”
Anyone who has woken up in terror after a nightmare, or “emotionally charged dreams”, as researchers describe it, knows how hard it is to fall asleep again. They also know that bad dreams affect the quality of sleep. This study found that the younger the person, the worse their nightmares and after-effects on emotions were likely to be. “Given the fundamental role of sleep in health and well-being, it is important to study the impact of Covid-19 on sleep quality, dream content and emotionality. This has not been studied among Indian population,” they write. “According to the study findings, we suggest that monitoring sleep, dreams, and emotions may help in developing effective interventions to restore sleep quality, prevent sleep disorders, and manage affective behaviour in pandemic like situations.”
RISK OF ILLNESS
Being in a prolonged state of sleep debt or sleep deprivation on a regular basis increases the risk of diabetes, hypertension, heart disease, and stroke. In an email interview with Lounge, US-based Elizabeth B. Klerman from the division of sleep and circadian disorders, department of medicine, Brigham and Women’s Hospital, and professor of neurology at Harvard Medical School, says people who sleep less than recommended have “short-term problems with learning, memory, mood, and safety with increased errors in performance and accidents. They are also more sensitive to pain and may be more likely to contract some infectious diseases”. In the long term, she says there is an increased risk of obesity, mood/psychiatric disorders, dementia and other neurological disorders.
Rebecca Robbins, sleep researcher and co-author of Sleep For Success, says the most common sign of sleep deprivation is fatigue. “People become so accustomed to feeling chronically tired that they accept it as normal. Other symptoms include mood swings, irritability, anxiety, and difficulty concentrating, remembering, learning, and interacting socially,” she writes, stating that most of us “need one more hour’s sleep a night”.
Social jet lag—staying up later than usual on Friday and Saturday nights and getting up later on Saturday and Sunday mornings—also impacts sleep schedules. Till Roenneberg, professor of chronobiology at the Ludwig Maximilian University in Munich, Germany, and former research associate at Harvard, who coined the term, says social jet lag’s effect on some people’s body clocks is similar to flying from “Frankfurt to New York every Friday and back again on Monday”.
Dr Klerman’s research, based on a 2018 survey of US high school students, indicates that young people are most affected when they are short of sleep. “The less sleep they obtained, the more likely they were to engage in risky behaviours, including violence and drug use, and to have adverse mood,” she says.
Dr Nileena says adolescents are the most sleep-deprived, and end up impacted physically, psychologically and emotionally. “This is the stage where the brain goes through final pruning. Young people who forego sleep tend to be more prone to depression and substance issues. Sleep debt can also be a predicter for neurological issues in later life,” she says.
A research article, Study Of The Incidence And Impact Of Chronic Sleep Deprivation In Indian Population With Special Emphasis On Neuropsychology Testing, published in the Indian Journal Of Sleep Medicine in 2019, observes that the “incidence of sleep deprivation is the highest in the 31-50 age group at 47.9%” but it remains worryingly high at 31.6% for those between 16-30 years. The authors, Vanita C. Ramrakhiyani and Sanjay V. Deshmukh from the department of life sciences, University of Mumbai, say these high numbers indicate “chronic sleep deprivation among Indian youth, possibly due to changing lifestyle”.
TACKLING THE DEFICIT
“On an average, humans need six to eight hours; this has recently been revised to seven-nine hours. It’s important to listen to your body and pay heed to the sleep urge, which usually peaks by 10-11pm,” Dr Nileena advises.
Sleep specialist Chris Winter, author of The Sleep Solution and The Rested Child and host of the Sleep Unplugged podcast, believes we are raising a generation of sleep-deprived children. “They certainly have many more items distracting them from simply going to bed,” he says, adding that tackling sleep debt starts with education. “We are all responsible. Schools need to ensure that the workload is evenly distributed so that kids are not up late doing work. Parents must prevent over-scheduling and limit technology access. Students must learn to prioritise sleep,” he says.
Experts are unanimous on how to deal with sleep deficit: healthy daytime habits, a set sleep schedule, a nightly routine and a conducive bedroom environment.
In an indication of the scale of the problem, sleep tourism is on the rise, with people planning sleepcations, or holidays designed to help you get the shut-eye you need. The idea is to take an extended break—from a couple of days to a week or more—and use the time to repay your sleep debt. Hotels big and small are offering customised sleep experiences—pillow menus with foods that enhance sleep, sleeping in nature, and retreats that piggyback on scientific research and separate you from your devices, provide supplements and optimal ambience and lighting.
If all this doesn’t work, seeing a sleep specialist is necessary, says Dr Klerman. “Sleep is good for you, is free, and doesn’t need special equipment or training,” she says, “but you might need to consult a specialist if you still feel tired after getting enough sleep (about eight hours) or if your bed partner says you snore loudly, kick, or act out dreams”.
Decades ago, inventor Thomas Edison said, “Sleep is a criminal waste of time, inherited from our cave days.” An always-on-the-go society seemingly took his words to heart. In today’s hectic, 24x7 world, many of us consider sleep a luxury, a waste of time, or a weakness. It’s time we stop thinking of sleep as a luxury and accord it the status it deserves: that of a necessity.
With inputs from Shrabonti Bagchi.
Teja Lele is an editor and writes on travel and lifestyle.
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First Published:18 Mar 2023, 06:46 AM IST
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