Sleep loss — whether due to insomnia or sleep deprivation — is a global epidemic. | Getty Images
A new law will require the school day to start later in California — and other states may soon follow.
In California, a new law went into effect July 1 that will probably make a lot of teenagers happy. It delays school start times, requiring public high schools to start at 8:30 am or later — half an hour later than the US average — while middle schools will start at 8 am or later. The result: Teens get to sleep in more.
This is the first law of its kind in the US and it’s a big step in the right direction.
Sleep loss is such a common problem that the Centers for Disease Control and Prevention (CDC) has declared it a public health epidemic. It can be the result of insomnia, when you can’t fall asleep despite having the chance to do so, or sleep deprivation, when your schedule robs you of the opportunity.
Columbia University researchers say teenagers in particular are in the midst of a “Great Sleep Recession.” The share of American adolescents who get sufficient sleep has plummeted over the years. Adults aren’t doing much better: We need at least seven hours of sleep a night, but only 35 percent of Americans report sleeping between seven and nine hours on average, according to Gallup’s State of Sleep in America 2022 Report.
It wasn’t always this way. According to Gallup polling data from 2013, only 11 percent of us were sleeping six hours or less per night in 1942, but that figure had risen to 42 percent by 1990.
Sleep loss is a huge problem because it may increase our risk for diabetes, high blood pressure, heart disease, obesity, and even early death. It can also cause a lot of emotional suffering, from loneliness to anxiety. Plus, low-income people and racial minorities get less sleep than others, which makes this an equality issue as well as a health issue.
Research shows that losing sleep can even lead us to behave unethically. When we’re sleepy, our ability to resist temptations decreases, so we tend to act more selfishly and less cooperatively. Sleep-deprived people vote less, donate less, and are less likely to sign petitions.
So, what can be done to cure the sleep-loss epidemic? The solutions we tend to throw at it — devices, drugs — often come with serious drawbacks (more on that below). What’s more, they target the individual. As a widespread public health problem, the sleep loss epidemic calls for a solution that will help everyone, not just those who have the time and money to be able to access individualized treatments.
“I think governments should get involved”
Experts blame the sleep-loss epidemic on a number of factors, including longer work hours, longer commuting distances, immoderate alcohol and coffee consumption, insufficient sunlight during the day, and excessive artificial light at night. The invasion of technology into the bedroom harms us, both because the blue light from our screens tells our brains to stay awake, and because playing with our phones induces us to push off sleep (just one more scroll!).
An apparent rise in anxiety — it’s one of the most common mental illnesses in the US — may also be a culprit here; it’s one of the main drivers of insomnia.
Then there’s the fact that sleep has an image problem. In many developed countries, the reigning cultural assumption is that sleeping very little means you’re hardworking, and sleeping a normal amount means you’re lazy.
“That’s a terrible stigma for us to have to fight in society,” said Matt Walker, a professor of neuroscience at the University of California Berkeley and the author of Why We Sleep. “There’s this sleep machismo attitude, this braggadocio, where we like to wear our insufficient sleep as a badge of honor.”
The association of sleep and laziness has trickled into family life, with parents often pushing their teens to “rise and shine” rather than “wasting the day” in bed, Walker said.
But teens need more sleep than adults — eight to 10 hours per night — and they have a natural tendency to fall asleep later and wake up later due to a shift in circadian rhythms that starts at puberty. To give them enough of an opportunity to sleep, the American Academy of Pediatrics and CDC say schools should start at 8:30 am or later. Yet most US high schools and middle schools still start earlier.
Now that California has enacted a law delaying school start times, it may galvanize others, like New York and New Jersey, which are considering similar legislation.
That would be great: Research has shown that teens’ school performance and mental and physical health improve when they’re allowed to sleep in. It can even be lifesaving: One study found that later school start times are associated with a drop in teen car crashes.
Once students get to school, there’s more that can be done to teach them about the importance of a good night’s sleep. Just as we have sex ed, maybe we should have sleep ed.
“Why don’t we work with the World Health Organization to create a standardized educational toolkit for sleep, translated into many languages for many nations?” Walker suggested, adding that hospitals should also put up posters with recommendations about sleep, just as they put up posters about getting flu shots and exercise.
“I think governments should get involved,” Walker said. “The first thing they can do is make people aware of the importance of sleep, with an announcement or public policy offering. There’s no memorable set of information, visual or otherwise, that has been gifted to the public.”
By contrast, lots of us have seen the US Department of Agriculture’s iconic picture of a plate showing how much of each food group we should be eating.
The government should be motivated to make sure we’re all sleeping enough — if not out of concern for our health, then out of concern for the economy. Because sleep loss takes a toll on our well-being, it decreases our productivity at work, which comes with economic costs.
A Rand Corporation report seeking to quantify these costs found that the US is losing $411 billion a year, or 2.28 percent of its GDP, due to insufficient sleep. And yet small changes could really help: If Americans who sleep under six hours started sleeping six to seven hours, it could add $226.4 billion to the economy. Surely that’s an investment worth making.
Therapy, apps, pills: Will they get you a better night’s sleep?
For people suffering from insomnia, cognitive behavioral therapy can help. CBT focuses on challenging maladaptive behaviors or negative thought patterns (in the context of sleep, that might be, “I couldn’t sleep last night, so I bet I won’t be able to sleep tonight!”). Its spinoff, CBT-I, has been developed over the past 20 years to target insomnia in particular. It’s so effective that it’s now “usually recommended as the first-line treatment for insomnia,” according to sleep physician Guy Leschziner.
But therapy can be expensive, time-consuming, and hard to access. So recent years have seen an explosion of apps, such as Sleepio, that purport to cure our sleep problems with gamified exercises mined from CBT. Yet just because CBT exercises work in a clinical setting doesn’t automatically mean they’ll work when delivered through gamified apps. The apps need a deeper evidence base.
A host of other technologies purports to help with our sleep, like Fitbits, Apple Watches, and other wearable sleep trackers. But experts say these can paradoxically make our sleep worse by increasing our anxiety and making us obsessed with achieving perfect sleep, an actual condition known as orthosomnia.
And then, of course, there’s the bevy of sleeping pills on the market.
Unfortunately, many prescription sleep aids are less effective than many people believe, and they can be addictive. Melatonin, marketed as a naturally produced hormone, has become a popular alternative, but like many other dietary supplements in America, it’s not well-regulated, it’s sold in too-high dosages, and the risks of long-term use haven’t been assessed.
That’s not to say there are no conditions under which it makes sense to take melatonin or some other sleeping aid. But as a solution to our global sleep loss epidemic, they’re inherently limited.
There are broader social conditions driving sleep loss. Low-income people and racial minorities get less sleep than others. So do people who live in noisy neighborhoods and who work odd shifts. In fact, night shift work has been classified as a probable carcinogen because of how it disrupts circadian rhythms.
Scientists have found that feeling stressed or unsafe — due to anything from racial discrimination to the Covid-19 pandemic — often translates into poor sleep because it signals the brain to stay vigilant.
The ethical implication here is that, if we really want to help all people get the sleep they need, we can’t just say “there’s an app for that” or “there’s a pill for that” and place the burden on the individual to fix the problem. We need to change the social conditions that are keeping us awake in the first place.