We have slept badly and little. Thus, without half measures, Carlos Egea, pulmonologist and president of the Spanish Federation of Sleep Medicine Societies (FESMES), speaks just a few days after scientific, health, management and patient association societies, all grouped in the Alliance for the Dream, asked the government for a “national dream strategy” at a conference held at the Congress of Deputies. The way out of the crisis, say the organizers, involves legislating to “change the culture of sleep.” “And that involves the hours we have and how much we work,” explains Egea.
Sleep remains buried in a “highly stressed and hyperconnected” society that has no time for anything other than production, that thinks that we can do without hours of sleep without consequences and that has the mistaken idea that sleeping badly will pass and there is no need to consult a specialist, according to the expert’s analysis.
Eating healthy and exercising are starting to be socially accepted as two pillars of a healthy life. What about sleep?
From a scientific point of view, sleep is another pillar, along with diet and exercise. Exercise is gaining momentum because citizens have culturally integrated it as an activity that counteracts the effects of cortisol, the stress hormone. We know that it makes us live longer and better. However, with sleep, we are in the scientific phase. We have documents that link the total duration of sleep to life expectancy, although it has always had a magical and unknown part. Sometimes it has even been interpreted as a time that could be done without.
Science has demonstrated its relevance as a time of brain organization, hibernation of the system and elimination of substances produced during the day. All this is gradually becoming political and decision-makers are realizing that sleep disorders and lack of sleep can be a gateway to mental health disorders.
Do we sleep poorly or little?
The first thing is that the time we fall asleep is completely out of sync with what corresponds to solar time. We eat dinner between eight and eleven at night, while in other European countries they do it between six and eight. It seems reasonable that each time we move, from a scientific point of view, towards our natural sleeping habits, but for this we have to change the school or work schedule; or if we want to stay in winter or summer. These are decisions that we have to make if we want to move forward.
Added to this is the fact that we have no time to do activities other than work and therefore no time to sleep. Not having time to live and rest at night culturally leads to little sleep. 60% of people spend less than seven hours on this activity from Monday to Friday. If we know that the time we spend sleeping is linked to life expectancy, we are clearly in danger.
This week they held a conference at the Congress of Deputies that ended with the request for a national sleep strategy.
The strategy is not only about talking about dreams, but also about how we bring citizens closer to scientific knowledge and how professionals can homogenize their response. We have to look at the needs of each population group. I would say it is a matter of training, education and legislation. In other words, we are asking governments to legislate to change the culture of sleep in this country. This involves the hours we have, the length of our work, the way we educate adolescents at school… This requires very profound changes that collide directly with the way society lives its daily life. The system in which we live influences everything about how we sleep. The percentage of people who sleep well from Monday to Friday is very low and this is due to work and the speed at which we go. In the case of night work, it is much worse.
So poor sleep is not an individual matter?
Poor sleep is a cultural problem in this country. And in terms of public health, the WHO says this, because only 5% of those who have sleep problems go to the doctor because they think it will go away or that it’s life, or stress or that pills will fix it.
Only 5% of people who have sleep problems see a health professional because they think the problems will go away or that it’s life, or stress, or pills will fix them.
When should you consult a specialist?
If a person has problems sleeping between one and three months and it has consequences during the day, they should consult them. Every hospital has sleep units and primary care is becoming more and more specialized over time. The solution does not lie in the advice of the neighbor or in the pills that a friend gives you. There is a certain idea that, in the health network, only certain diseases have regulated channels and highways of care. And that does not include sleep problems. It is still thought that if you do not sleep, you will sleep.
Are we underestimating the health consequences of a bad dream?
There is an idea that continues to float in the air that it is bad for us to sleep because these are hours that we could devote to other things. But the omnivorous mammal that we are forces us to sleep between seven and nine hours as adults. In adolescents, there are nine and for babies, almost 22.
What are the characteristics of quality sleep?
It is necessary to sleep between seven and nine hours with between three and six sleep cycles (superficial, deep and paradoxical) that are repeated throughout the night. When it is quality, we wake up feeling refreshed the next morning. It would be a healthy sleep and you can add the nap, a tool that we use because we do not have enough time at night. Complete the schedules.
Is any type of nap healthy?
Napping is linked to our circadian rhythm. It is normal to feel sleepy after eating and since we are all sleep deprived, a short nap can be used, avoiding entering a deep phase, to prolong the night. A period of between 20 and 30 minutes gives us a boost and refreshes us. From a neurological point of view, it has been shown to delay brain shrinkage. However, if you take long naps, you may wake up groggy and your nighttime sleep could also be disrupted.
Insomnia affects many people, around four million people in Spain. In your consultations, do you notice that the prevalence of the problem has increased?
The prevalence has increased. Insomnia affects 15% of the population. Sleeping little causes dizziness the next day, difficulties in social relationships, increases the risk of accidents at work and on the road… Conversely, there is sleep apnea, which fragments sleep and affects 10%. Insomnia and apnea have increased since the coronavirus. We are moving fast and stress takes hold of each of us. It is the firewood that makes a hyperconnected society sleep poorly and little, super armored and very stressed. In fact, the first thing that falls when we are sick is sleep.
In the case of apnea, the incidence is higher because we are also more aware. Partners or family members of people who snore no longer put a pillow on them or wake them up, but warn them and go to the doctor if they detect the absence of snoring.
Do all people who snore have sleep apnea? Is it a warning symptom?
50% of men and 36% of women snore but only 10% have sleep apnea. So not all snoring needs to be treated, but yes, as a warning symptom it needs to be investigated. Detecting and treating apnea contributes to a better quality of life and reduces cardiovascular risk. It is about eliminating the balls from the Russian roulette of life risks.
50% of men and 36% of women snore but only 10% have sleep apnea. So not all snoring needs to be treated, but yes, as an alarming symptom you need to look into it.
Are sleeping pills being abused?
Pills are useful and we use them as professionals, but for chronic insomnia the most effective thing is to change the consultations. In bed, you have to be positive: it is to sleep and have sex, not to read or watch TV or go consult anything on the pillow. All this gradually leads us to deprive ourselves of sleep.
Are children and adolescents sleeping less well than before?
One in four children go to school without sleeping. When they have a continuous day, they arrive early and leave with the jet lag of the weekend. This is worrying because at these ages it leaves traces forever because the brain is maturing. They need to sleep two hours more than adults and it is not positive that they consume screens before going to sleep because of the stress it causes them. This is a concern for pediatricians and those of us who are dedicated to sleep. It must be explained to families and teachers so that they know it.
Are there still misconceptions about sleep?
There are always myths about dreams that repeat themselves or people who think that sleeping a lot is reserved for cowards. I remember there was a time when some tapes came out to learn English while you sleep. It seems that we are also putting productivity to sleep.
Finally, give us some basic tips for sleeping better.
It is about applying logic: sleeping a minimum of hours, not having so many differences between work days and holidays, exercising and not taking the bed as a place to solve your problems. Thinking that tomorrow will be another day and things will be better.
