A Blissful Slumber

Understanding Sleep Hygiene

John is living in the prime of his life. He is 40 years old, but feels like he is in his 20s. John is a family man with a promising career. He observes a healthy waking lifestyle with a balanced diet and he exercises regularly. John also undergoes regular screening for chronic diseases and colorectal cancer. He even practices daily meditation for mindfulness. The mid-day shut-eyes are periods of rejuvenation for him and the caffeine rush from his third expresso of the day makes him feel half his age. The waking hours of his life are simply perfect, and the loud snoring at night is a testimony to his hard day’s work. Or is it?

Unfortunately, some high-level professions come with a set of demanding requirements. Irregular sleeping hours and late-night screen access have left his nights pretty undesirable. Insomnia is not uncommon. In fact, John wishes that the last third of his days can be different.

What is missing in John’s quest for good health? In short: healthy waking and healthy sleeping contributes to healthy living.

Importance of healthy sleep

Nearly a third of our lives is spent sleeping. Thus, unhealthy or improper sleep will inevitably sabotage all our efforts at achieving a healthy lifestyle. Poor sleep often results in poor health outcomes. The quote “I’ll sleep when I’m dead” may be blatant ignorance of the importance of sleep, or a visionary insight of premature demise due to sleep deprivation.

Adequate sleep

Jawbone, a maker of smart watches with sleep tracking capability, reported in 2014 that Singapore is the third most sleep-deprived city of 43 cities profiled. Singaporeans average 6 hours and 32 minutes of sleep a night, beating only Tokyo and Seoul where people average less than 6 hours of sleep.

Five years later, Fitbit user data from 18 countries revealed that Singaporean users get the least amount of nightly sleep at an average of 7 hours and 5 minutes. Another study in 2016 by Jurong Health Services showed that 1 in 3 Singaporeans suffers from moderate to severe sleep apnoea, while 1 in 10 suffers from severe sleep apnoea. Up to 90% of moderate to severe sleep apnoea subjects in the study were previously undiagnosed. To put it simply, Singaporeans can do better when it comes to sleep.

Causes and consequences

In recent times, it has become increasingly challenging to practice good sleep hygiene. Post-pandemic hybrid work schedules are both a boon and a bane to sleep hygiene. Working from home allows one to save peak hour transit time and sleep in longer. However, poor sleep hygiene due to increased screen-time, obesity from a sedentary lifestyle, circadian misalignment from a lack of outdoor time, sunlight exposure and irregular hours tip the balance against our favour.

In general, children require a longer duration of sleep i.e. a child aged 3-5 years requires 10-13 hours of sleep a day compared to an adult aged 18-60 years, who will need around 7 hours of sleep. This, coupled with early school start times, can lead to sleep deprivation in most, if not all, children of school-going age.

Inadequate sleep can lead to behavioural and mood issues, poor academic performance, predisposal to cardio-metabolic diseases and poor immunity - things that we need to protect our children from.

Sleep hygiene

There is a series of preventative steps that can be undertaken before sleep to ensure good sleep onset and continuity. In fact, practice of sleep hygiene is like doing warm-ups before performing strenuous exercises - it can help to facilitate better sleep for us.

You can assess your level of sleep hygiene using the Sleep Hygiene Index - the higher your score, the worse your sleep hygiene. Poor sleep hygiene often results in poor sleep quality and increased daytime sleepiness. About one-third of Singaporeans complained of poor sleep quality in the National Mental Health Survey.

Improving your sleep hygiene can be as simple as following the following tips from the American Association of Sleep Medicine. You do not have to wait until insomnia strikes before taking action.

Poor knowledge and awareness

In general, there is poor knowledge and awareness of sleep-related disorders in our local population. Symptoms of sleep-related disorders are often ignored or accepted as habitual norms. Snoring patients will usually attribute their symptoms to exceptionally rare, tiring days - only to be contradicted by their spouses who have had daily restless nights because of their partner’s snoring. Sleepwalkers will claim that their habit starts from young but strangely, it has increased in frequency recently and is clearly related to sleep deprivation. Most will not proactively seek treatment.

Common to the groups of patients listed above is a state of “relative sleep deprivation”. Even after they are given the opportunity to sleep for more than 7-8 hours, they remain unrested and unrefreshed. This is because such patients may be experiencing - not uncommonly - cortical arousals up to 50 times an hour due to their underlying sleep-related diseases.

Seek help

Thus, if you still do not have restful sleep or have trouble falling asleep despite consistent practice of good sleep hygiene, you should seek help from a sleep physician.