Saving sleep saves lives…and a whopping $66 billion in health dollars – so why isn’t government doing more?

“Lack of sleep affects pretty much every system in the body and therefore it seems entirely logical to me that you would want to treat one of the primary drivers of ill health rather than just dealing with the consequences.” Michael Mosley

Rahni Sadler chatted with Michael Mosley about a clinical trial at Flinders University he participated in and documented in the SBS series Australia’s Sleep Revolution beginning on March 6th.

Q. What percentage of Australians suffer moderate to severe sleep issues and how much is it costing the Australian economy?

The estimate is 40%, that’s nearly half of Australians experiencing sleep problems at a cost to the economy of $66 billion.

Q. As a society do you think we take sleep issues as seriously as we should?

Absolutely not. That really is the theme of the series. Individuals take it seriously because it affects them so badly but governments on the whole don’t prioritise it. They don’t see it as something that they should action or do anything about or indeed encourage ways of preventing insomnia.

Q. As compared to severe health issues like smoking, diabetes and heart disease where does sleep fit in the degree of seriousness?

I think that sleep is one of the drivers of most of those chronic conditions. We know that if you aren’t getting good quality sleep, then that massively increases the impact on your brain – anxiety, depression, it accelerates the risk of dementia, type two diabetes, you name it.

Q. How do you think that sleep has fallen through the cracks?

I think because it’s something we all kind of take for granted. One of the things I discovered making this series is that politicians seem to be enormously sleep deprived, so perhaps they regard it as a perfectly normal thing. The other thing is obviously that doctors and health professionals enter the profession and are often chronically sleep deprived themselves because they’re put through horrible regimes. In many ways when I was doing my medical training it was regarded as a rite of passage. You know, if you were tough enough then you could survive on three or four hours sleep a night.

Q. What are the long-term implications of not taking action to address sleep issues, not just for those who suffer from insomnia but for our health dollars?

Treating anxiety, depression, dementia, type two diabetes etc. are all incredibly expensive and if you sleep badly you are more vulnerable to all these chronic conditions. I think the long-term consequences of not dealing with sleep issues are going to be humongous. I think that you are going to be paying the consequences of today’s inaction in the future. And that’s something that you hope would focus politicians’ minds.

Q. As you have mentioned, sleep issues are something sadly many doctors are all too familiar with. Do you think the nature of taking on a career in medicine is in a way sentencing you to a shorter life?

I think it’s probably sentencing you to a life which is likely to be beset by chronic insomnia. Most of the medics I know struggle with their sleep. Some of them recover a lot of them don’t. It’s very clear that some people are much more vulnerable, mentally and physically, to lack of sleep than others. It’s not only the effect on them but also on their patients. Maybe that should be sort of a part of the standard when you apply to medical school. Sleep deprive people for a week and see how they react!

Q. Do you think there is still work to be done in terms of the way doctors are rostered on and the way their shifts work?

Absolutely. I mean my hope is that it has improved a lot already. When we were part of the European Union there were various rules and regulations brought in to limit the hours that doctors in the UK can work, but to be honest an awful lot of doctors go outside those norms because they see it as important for their career and they can be hanging around the hospital for insane amounts of time.

Q. What advice do you have for all the doctors who work extraordinary hours or do demanding shift work?

I think one of the things is for example, if you’re doing shift work, it’s important to bring healthy food with you to the hospital. You might consider bringing a lightbox because when you’re feeling lonely, feeling tired, rather than drinking huge amounts of caffeine, one way to brighten yourself up is with exposure to bright light. You can buy sort of portable lamps for modest amounts of money, they’re called sad lamps, and those will perk you up in a similar way to caffeine but without the long-term side effects. Also watch out when you’re driving home because an awful lot of car accidents happen the morning after a long night shift.

Q. As practitioners do you think doctors have enough in their toolkit to deal with serious long term sleep issues?

Absolutely not. Unfortunately, doctors get very little training in sleep, and they’re not really equipped to deal with it. So, the natural inclination is to prescribe medication. Doctors have long been encouraged not to do that because we know that all sorts of sleeping drugs…the old ones used to be very addictive, the newer ones less so, generally, the effect wears off as you become used to them. So, they’re good for dealing with somebody who maybe has lost a loved one i.e. they’re in short term distress but not for dealing with chronic long-term problems. The trouble is doctors are not equipped to actually deal with insomnia, they don’t understand it, they don’t know how to treat it and they don’t have the time to treat it, which is why you need referrals to specialist sleep clinics and psychologists who can give you CBTI but the trouble is there just aren’t very many of them. That’s because they’re not funded and I don’t altogether understand how the Australian insurance or health care systems work, but my understanding is it is quite difficult to get proper sleep treatment paid for by someone else. You probably have to pay for it yourself and that can be expensive and therefore inaccessible to many people.

Q. In your tv series the issue is raised that maybe we are treating things the wrong way round?.

When I was at the Flinders institute coaches said quite often, they find that people who came in with depression and anxiety, if you treat their sleep then the depression and anxiety go away. So, there’s a sort of circle going on there. Quite often you think, oh well, the reason that they’re sleeping badly is because they’re depressed and anxious. But it could be they’re depressed and anxious because they have had to endure many weeks, months or indeed years of poor-quality sleep. So, it can be more cost effective to treat the insomnia than to treat the depression and anxiety which anyway is quite often resistant to treatment.

Q. What advice do you have for doctors which might help them treat patients with chronic insomnia?

It starts with the diagnosis because as you know, sleep is a complex thing. So, you need to know the reasons why and they’re not always obvious and that’s one of the things I discovered while making the series and then there are staged treatments that you can do which range from sleep hygiene, which most people know about – cool dark rooms and stuff like through – to bedtime restriction therapy which is incredibly effective. It’s part of cognitive behavioural therapy for insomnia and that often means done by cognitive behavioural psychologists. It can be done by GPs as well. You just need to know how to do it. I do include information which I believe doctors will find very helpful in the tv series.

Q. Are there countries where they’re dealing with sleep in a better way than we are in Australia?

Well, it’s difficult to measure that. There was a study done recently where they looked at the data from smartwatches. This was 220,000 people over 35 countries. And they measured for example how much sleep they got but also a key concept which is sleep efficiency. How much time do you spend in bed asleep as opposed to tossing and turning? On that metric, Finland came top closely followed by Sweden. Perhaps no coincidence that these are two of the happiest countries in the world. Australia was down at 26 just behind New Zealand and the UK.

Q. What advice do you have for the Australian government?

I hope that this documentary series will shame them into action or at least encourage them into action. You had this parliamentary inquiry held in 2019. You had this full report, filled with recommendations, at least 11 of them – none of them implemented as far as I know. We went to Canberra to confront politicians, both with their own appalling sleeping behaviour but also the fact that nothing’s happened and although they said “Ooooh, yes we must do something” I don’t think there’s any evidence that they have done so.

Q. Can you tell us about the nature of the trial and what you were hoping to achieve?

Flinders University were very interested in doing a clinical trial in which I would be a participant in and which we would film. The idea was 30 chronic insomniacs with a range of sleep problems and eight weeks for the Flinders team to try to sort it out. It’s a multidisciplinary team; psychologists, doctors, sleep scientists, technicians, data analysts etc. and what they want to do is create an effective program which can be rolled out, so it wouldn’t be dependent on having a specialised team, this was a kind of trial of concept if you like and the results as you will see in the series were just outstanding and I believe they’re hoping to publish soon.

Q. When you say rolled out, it’s something people will be able to access easily?

Absolutely. It’s something possibly that could be done online, could support doctors delivering it. It was a trial of the tech involved and other things. Initially it’s about the diagnostics then it’s about the delivery and then it’s about assessing the impact of the various interventions in a sleep lab. But once you’ve done all those things, you can start to put together a program which could be extremely cost effective, which could genuinely deliver a sleep revolution in Australia. I would love to see Australia at the forefront of doing this sort of thing and zooming up the charts when it comes to sleep efficiency and sleep quality that civilians will enjoy in the future.

Michael Mosley is a science presenter, journalist and executive producer. He studied medicine at the Royal Free Hospital Medical School intending to become a psychiatrist. After graduation he became disillusioned with psychiatry and joined the BBC. He is best known for his advocacy of intermittent fasting and low-carbohydrate diets. In 2021 he presented Australia’s Health Revolution for SBS, a series which helped eight Australians to reverse their type 2 diabetes with a low-calorie diet and lifestyle changes.