We had steadily become obsessed with sleep long before lockdown. Google searches in the UK for “can’t sleep” have been climbing over the past 15 years. Illustrations: Priya Mistry

How a global industry sold us a lie about sleep

Can't sleep during lockdown? You're not alone. But a $76bn industry trying to help us get more shut-eye could actually be making things worse
May 5, 2020

There is an old trick of which I used to be a master: half waking up, then snoozing my alarm and pushing myself back down into sleep for another five, 10, 50 minutes. Suddenly, though, it has become a lot harder. I now need to sink back into the Land of Nod fast enough to avoid remembering the existence of the global pandemic—only then am I free to return to dreams of normal life, populated by a dizzying array of people in buildings that aren’t my own home.

I recently ordered a new alarm clock so I could move the mobile phone that had been doing this job away from my bed, believing that the distance from the news apps and the climbing death tolls could allow me to sleep more deeply—escape more thoroughly. When the clock arrived, I assembled it, but realised that I didn’t seem to be able to snooze it. I downloaded a manual in many different languages, squinting at diagrams to find the button that would allow me to earn, like a rat tapping at a lever in a Skinner box, my hit of pandemic-free slumber, all the sweeter because I was almost pulled out of it.

At the heart of my fixation is that golden number: eight hours, a figure that has little basis in science, but which has embedded itself culturally as the optimum amount of sleep for adults, regardless of age or temperament. I sleep deeply once I manage to, but often lie awake for hours first, pushing back my alarm, or snoozing as long as I possibly can in the morning to get closer to the magic eight.

Sleep is disrupted by stress, obviously, and there is an abundance of that right now, as well as a controlling fixation on our daily routines, because this is a time when so much that matters is out of our hands. However, we had steadily become obsessed with sleep long before lockdown. Google searches in the UK for “can’t sleep” have been climbing over the past 15 years (since, perhaps not coincidentally, roughly the time when Googling became a daily activity for people other than nerds). And sleep disorders do appear to be on the rise: the number of tests carried out by the NHS in England for sleep apnoea, in which your breathing starts and stops during the night, doubled between 2007 and 2016.

But the growing interest doesn’t appear limited to those suffering from diagnosable sleep issues. Instead, sleep seems to have entered the realms of “wellness”: as with food or exercise, even if we are healthy, there is always room for improvement.

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Brands have rushed to populate this new area of the market. CBD oils, marketed with images of the cannabis leaves they are derived from, despite the fact there is no evidence of them having a psychotropic or any other effect; expensive sleep masks; special glasses and apps to block out sleep-destroying light from your devices—you name it, you can buy it. A wave of new start-ups are flogging £900 miracle mattresses with a money-back guarantee (resulting in waste mountains at landfill and recycling sites). This spring, publishers have put out book after book promising quick fixes: Learn to Sleep Well: Exercises and Advice for a Deep and Restful Sleep; Ways to Fall Asleep: 100 Hacks for When You Can’t Get To Sleep; 222 Ways to Trick Yourself to Sleep: Scientifically Supported Ways to Fall Asleep and Stay Asleep (the advice includes “eat two kiwis”).

Stylist magazine has launched “Restival”—“a festival for the shattered woman”—in partnership with M&S, and also put on a series of sleep workshops sponsored by toiletries brand Rituals. At the end of last year, the US website of women’s publication Refinery29 published a series of sleep-themed Christmas gift guides including “The Absolute Best Gifts For Anyone Who Didn’t Get Enough Sleep In 2019” ($99 cashmere socks, a $68 CBD candle) in collaboration with retailer Bed Bath & Beyond. In 2019, the global sleep industry was projected to hit $76bn. We’re desperate to improve our sleep, and brands are desperate to sell us products to help.

This explosion in interest (and cash) is all the more intriguing because 70 years ago, we didn’t care much about sleep at all. Until the 1950s, it was understood to be the brain switching off, or resting, a little like the “sleep mode” we activate on the laptops and smartphones that they didn’t yet have. No one realised that there were different phases of sleep, and therefore that sleep had a clear neurological purpose and could vary in quality. It was only in the 1970s that it began to be recognised as a part of medicine.

The study of sleep is therefore a very young discipline, but scientific interest in it is skyrocketing: medical journal the Lancet published 95 articles referencing sleep in 2011, and over four times as many—439—in 2019. All this research has begun to point to the dramatic negative effects of poor sleep. The NHS now warns that regular poor sleep “puts you at risk of serious medical conditions, including obesity, heart disease and diabetes—and it shortens your life expectancy.” The TV health evangelist and blockbuster diet-book writer Michael Mosley has just released a book promising to fix your sleep through diet and other techniques, warning that “too little sleep can devastate your body, brain and [gut] microbiome.” The microbiome is another zeitgeisty worry that had enjoyed a starring role in his Clever Guts tome on “revolutionary” weight loss a year or two before. The Mental Health Foundation chose sleep as its theme for Mental Health Week 2020 (though plans have now changed due to the pandemic), because, as chief executive Mark Rowland put it, “sleep is the unsung hero for our mental health.”

All this research about exactly how much sleep matters redoubles our desire for restorative rest, but like an injunction to “be spontaneous” or “look natural,” the command to “sleep well, or else…” risks self-defeat. Besides, 70 years isn’t all that long a time in science, and the line between causation and correlation is hard to tread when it comes to poor sleep, given that not only is it a potential cause of or contributor to many health and mental health conditions, but it is also a sometimes integral feature of them. Are we right to put so much pressure on our sleep? Is this collective obsession justified? And if not, who does it benefit?

Dubious science

“Scientists have discovered a revolutionary new treatment that makes you live longer,” wrote Matthew Walker, a British neuroscientist, in his 2017 book Why We Sleep. “It enhances your memory, makes you more attractive. It keeps you slim and lowers food cravings. It protects you from cancer and dementia. It wards off colds and flu. It lowers your risk of heart attacks and stroke, not to mention diabetes. You’ll even feel happier, less depressed, and less anxious. Are you interested?”

Walker’s book was an international bestseller. He argued that we must “reverse our neglect” of this vital activity, because “the shorter the sleep, the shorter the lifespan.” In support of his thesis, Walker cited the fact that the World Health Organisation (WHO) had declared a “sleep-loss epidemic throughout industrialised nations,” and that it recommended that adults get eight hours of sleep a night.

Except that it hadn’t. Alexey Guzey, who describes himself as an “independent researcher,” published a long blog post in November 2019, challenging these and other claims in Walker’s book. Walker eventually admitted that the WHO had never declared an epidemic of sleep loss. The organisation has also never recommended publicly that adults get eight hours of sleep per night. Walker also asserted that the amount we sleep has fallen steadily since the 1940s, yet there are other respectable-looking surveys suggesting that Brits now sleep for 40 minutes longer a night than we did in the 1970s. Patterns could be complicated by changing demographics (different age-groups may have different needs) and changing habits of work and exercise, and there is no single clear picture across the industrialised nations: one study found that there were fewer short-sleepers (who get less than six hours) in the UK, US and Sweden since the 1970s, but that their number had increased in Italy and Norway over the same period.

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The evidence around sleep is conflicted at best, but we are all too ready to accept generalisations about how we’re getting less of it than we used to. Claims such as the “epidemic of sleep loss” and the WHO’s supposed recommendation of eight hours of sleep per night were repeated by reputable publications following the publication of Why We Sleep. Perhaps sleep matters so much that it is necessary to frighten people into taking it more seriously. Yet it’s not only intuition but scientific evidence which suggests that, perhaps uniquely among lifestyle factors, excessive concern about sleep actually prevents us from getting it.

In the recently published The Shapeless Unease: A Year of Not Sleeping, writer Samantha Harvey documents 12 months of brutal insomnia. She contrasts her own understanding of the underlying roots of her condition—deaths in her family, anguish about Brexit—with a robotic doctor who repeatedly suggests that she try meditation. Harvey writes that sleep, when you don’t have enough of it, looms larger and larger, beginning to look like the solution to all your problems. She fantasises that the hoped-for cure—whether pharmaceutical or psychological—will “let the whole tower of my egoic and troubled self fall through, taking with it my weaknesses, shortcomings, terrors and unhelpful tendencies, among them my insomnia.”

She describes, too, the singular way in which sleeplessness interacts with the brain’s fear response. As lack of sleep is a real threat, once we begin to suffer from it, the thought of it prompts a fear response from our body—elevated heart rate; the release of adrenaline—thereby keeping you awake. “Here,” she writes, “is where insomnia becomes intractable... insomnia is almost unique in giving rise to a fear that then causes the external threat.”

Harvey describes her growing obsession with a genetic condition, Fatal Familial Insomnia, the sufferers of which are perhaps the only people who can be described as having died from sleeplessness. The condition is incredibly rare, yet crops up fairly regularly in sleep literature, including Walker’s book, perhaps because it draws that clear, frightening connection between lack of sleep and death. It terrifies Harvey, whose growing obsession with the rare illness seems to fuel her own insomnia.

The rise of sleep-tracking devices and smartphone apps over the past decade or so also play into this cycle. A case report in the Journal of Clinical Sleep Medicine in 2017 coined the term “orthosomnia,” a condition suffered by “a growing number of patients who are seeking treatment for self-diagnosed sleep disturbances… due to periods of light or restless sleep observed on their sleep tracker data.” In other words, worrying about their sleep data robbed them of sleep.

A panacea for other problems

Brands have a clear stake in ramping up the obsession. But the idea of sleep as panacea also plays a handy role after austerity has laid waste to many mental health and other support services. The idea that your problem is sleep, especially with its new aura of wellness and optimisation, places that problem squarely back in your court. If you could just sleep a little better, you’d be able to cope with your poor work environment, abusive partner or mammoth caring responsibilities. If you could only doze off more easily, your depression and anxiety would clear up. It’s your problem to fix, not your boss’s, or the public health service’s. Try a new mattress. Try meditation. Try a bit harder.

”But the idea of sleep as panacea also plays a handy role after austerity has laid waste to many mental health and other support services.”

In Why We Can’t Sleep, released in January, US author Ada Calhoun actually talks about sleep very little. Instead, she depicts what she describes as “Women’s New Mid-Life Crisis” which she and the many women she interviews have experienced. She argues that “Generation X” women are tending to have children later, so are more likely to be juggling care for both children and aging parents at once, as well as a career. Some or all of these pressures could also coincide with the menopause, which itself can cause a lack of sleep. And almost every woman she interviewed, she tells me, “had trouble sleeping.” They had tried all the tricks: “When I’m having drinks with girlfriends, so many of them will say ‘Oh, this is what I’m trying for sleep now’ and it’ll be a new diet or a sleep mask, or not drinking. A lot of them work for a little while but it seems like it’s very elusive to find the one thing that works for everybody all
the time.”

In the book, Calhoun describes lying awake in the middle of the night, unable to stop worrying about her responsibilities, furious that her husband is able to sleep peacefully next to her. By the book’s end, she is able to fall back to sleep again when she wakes in the night, not because of a fancy mask, or because her problems were solved, merely because she’d faced up to them: “I wasn’t staring at the ceiling thinking ‘Why am I anxious?’ Now I know why, and that really cuts the sleeplessness short.”

Women are twice as likely as men to try over-the-counter sleep medication. This points to another aspect of sleep in developed societies: it interacts with privilege. Those with less money and more grinding responsibilities tend to sleep less well. Shift work has been described by the WHO as a probable carcinogen because of its disruptive effects on routines. Surveys have suggested that over half of those claiming Universal Credit lose sleep worrying about money, and workers on zero-hour contracts report poor sleep and other health problems. Even as we are told that sleep is the great healer, those at the bottom of the ladder are being robbed of it by their circumstances—then sold the idea that if they buy the right book or CBD oil, everything will be OK.

“Increasingly, our attention is our greatest commodity—and sleep represents a huge chunk of time in which we cannot be marketed to”

Meanwhile, many modern products and some modern corporates seem almost explicitly bent on eating into rest: Netflix’s CEO called sleep his company’s “biggest competitor.” Increasingly, our attention is our greatest commodity—and sleep represents a huge chunk of time in which we cannot be marketed to.

In Ottessa Moshfegh’s 2018 satirical novel My Year of Rest and Relaxation, the protagonist is an orphaned, troubled young woman, who decides that the solution to her problems is to sleep as much as she can, refusing the troublesome aspects of modern life—work, friends, relationships—that might otherwise keep her awake. As for many of us during this pandemic, sleep is an escape from the day-to-day: “Reality detached itself and appeared in my mind as casually as a movie or a dream. It was easy to ignore things that didn’t concern me. Subway workers went on strike. A hurricane came and went. It didn’t matter.” And she summarises our secret hopes about securing the perfect night’s sleep: “I would risk death if it meant I could sleep all day and become a whole new person.”

She visits a doctor who gives her increasingly powerful drugs to knock her out but then, annoyingly, she starts to get up and do things in her sleep: buying clothes, going out and about in New York, living a life, all while sleepwalking. As much as she tries to use sleep to erase herself, she can’t seem to manage it. She is still the same person: her problems are still her problems.

Symptom, cause, and cure

As with depression and anxiety, there is a temptation to answer sleep problems with medication, rather than with therapy. Those who struggle to sleep are led to believe their sleep is broken, when it may be that something else is wrong. The notion of a single, identifiable, quantifiable and fixable complaint masks what is so often the reality: that some, if not most, may instead be suffering from a broken society, or a life broken by pain or bereavement or poverty.

When we chase the perfect eight hours, we are treating sleep as symptom, cause and cure, rolled into one, and sometimes creating or exacerbating insomnia in the process. We could learn from William C Dement. The Stanford professor often regarded as the father of sleep studies doesn’t approve of excessive monitoring. He told NPR in 2017 that he doesn’t “keep track of [sleep] too closely.” He also argued that there was a healthy range of six to nine hours for most adults, as opposed to a need for a rigid eight hours.

Of course sleep is important, but the idea everyone always needs to sleep the same amount in the same way is misguided, and suggestions we can simply buy costly rituals, products or other tools to succeed is a delusion, intimately linked to the explosion of the “sleep industry” that sells them.

James Wilson, who brands himself as the “Sleep Geek,” is a sleep therapist who works with organisations including football teams and big corporations like Coca-Cola. Part of the industry, in other words. But even he argues that the idea of a “one size fits all” solution has led some to despair. What if you’re a shift worker? What if you feel fine on six hours a night, but are convinced you should be sleeping for eight? As a former mattress salesman, he tells me that some brands also seem to be warping sleep research to suit their ends. He speaks to many women going through the menopause, during which uncomfortable hot flushes can keep you up: “So many of them have been sold memory foam mattresses, because they’ve been told they keep you cool. But they do the opposite. They’re actually making their sleep worse.”

With my new alarm clock set up, snooze button finally working, and my phone stashed safely away from my bed, I didn’t sleep better—in fact, it felt like I was sleeping worse, giving up the charade sometime after 1am and collecting my phone, cradling it as I scrolled as if it were a comfort blanket. Eventually I realised how ridiculous it was to imagine I could erase a global pandemic from my mind by putting my phone six feet away and investing in a
new clock.

It is no wonder that we have become obsessed with sleep, and not only because a serious want of it really can make us ill. It also represents the ultimate escape from over-stimulated, over-stressed lives; and from those forces that compete for our attention. There is a powerful allure both in the promise of escaping this grave new world—and in imagining one might be able to wake up refreshed enough to deal with it.

Anxiety and wakefulness are irritating, but they are also intensely human: they are our body and mind responding to what can be, especially at the moment, very real threats. So now I sleep, or don’t sleep, after reading the news, or watching TV, or whatever else I feel like doing. After all, which is stranger: to lose sleep over a global health crisis, or to sleep deeply through it?