Earlier this year we published our report, At a tipping point? Workplace mental health and wellbeing. In conducting our research, and since publication, we have engaged in numerous conversations on how perceptions around mental health and wellbeing are shifting. While it is inspiring to see the many initiatives that are underway around raising awareness of the importance maintaining both mental and physical health, what matters more is that all of us engage more effectively in our own health and wellbeing, including understanding our own trigger points and what measures we can take to manage our own mental resilience. My trigger has always been the length and quality of my sleep, and given this week is Deloitte's Clients and Markets' mental health awareness week, I thought I would use this week's blog to share the evidence available on sleep hygiene, wellbeing and performance.
During my previous career as a psychiatrist and psychotherapist I held many discussions with patients who were preparing to go back to work after having suffered from mental illness about their perceptions of wellbeing and the steps they could take to help them maintain their physical and mental health and wellbeing. These discussions often included advice on the importance of physical activity, nutrition, sleep and social activities in helping them stay well and perform well at work. More often than not, the need for quality sleep was a key consideration, and luckily there is an abundance of evidence-based good practice on this.1 Ironically, as is often the case for doctors, I have not always acted on my own advice.
The evidence on the link between high quality sleep and physical and mental wellbeing, including cognitive performance, is irrefutable.2 Most of us will know the feeling of performing below our best, after a night of too little sleep. Indeed, following a very difficult experience during my medical career, I experienced an episode of clinical insomnia, lasting several weeks. I remember vividly how draining the lack of sleep was on my ability to concentrate, engage with my team and enjoy my work. I also remember the anxiety created by constantly worrying whether I would be able to sleep the next night. This experience led me to research the underlying biochemical, physiological and psychological triggers, and how our behaviours can directly shape the quality of our sleep.
I'd therefore like to share the following strategies that all of us can use to improve our sleep:
- Maintaining a regular routine: most adults need between six to nine hours of sleep. However, many of us can struggle to establish a regular routine in our busy working lives. This can be exacerbated if their work involves different shift patterns, constantly changing diary commitments, regular late nights or onerous travel schedules involving overnight stays. In these circumstances it can be difficult to allow enough time to wind down, which is crucial to improving the quantity and quality of sleep. While the right timing and quantity of sleep will differ for everyone, a common tactic is to identify the best ways of wrapping up the day, be it by a warm bath, light relaxation, reading or listening to the radio, all aimed at distracting or relaxing our minds. Similar to the tactics parents use with their children.
- Protecting your bedroom as a sleep-friendly environment: as there is a strong psychological association between sleep and the sleeping environment, expert advice is for a dark, tidy, calm and importantly quiet, area to sleep. This includes keeping your bedroom as free as possible from work-related things and electronic gadgets, most importantly our smartphones. The Deloitte Mobile Consumer Survey 2016: The UK cut, found that over half of smartphone owners check their phones within 30 minutes of turning in for the night, a quarter check them five minutes before, and a tenth immediately before sleep. Moreover, just over a quarter of smartphone owners interrupt their sleep to check for social media updates or email. Unsurprisingly, nocturnal smartphone usage is concentrated among younger age groups with about half of all 16–24 year olds checking their phone in the middle of the night, directly impacting the quality of sleep. A study of 10,000 16-19 year olds found that their quality of sleep was related to the quantity of time spent in front of a screen before going to bed, with the author's recommending that screens be turned off at least an hour before turning out the lights.3
- Finding the right time for exercising: Regular exercise increases the release of endogenous antidepressants and improves confidence as well as overall physical wellbeing. It can also relieve tension built over the day and help with sleep. However, vigorous exercise too close to bed can have the opposite effect, due to the stimulation of adrenalin and other regulatory mechanisms impacting our body.4
- Cutting down on caffeine: One of my favourite stories from my work as a doctor is of a patient who came to see me for insomnia, and on taking her history, we were both rather surprised that the amount of strong coffee she consumed between 7:30 am and 9:30 pm totalled two and a half litres, far exceeding the daily recommendation for caffeine intake. Even when imbibed mid-afternoon, caffeine in coffee, black or green tea, energy drinks or colas can interfere with sleeping patterns, preventing deep sleep.5 So, if you need a hot drink in the late afternoon or at night, have cocoa or herbal tea!
- Taking a closer look at alcohol and nicotine consumption: While drinking alcohol can help you fall asleep, too much alcohol will disrupt sleep during the night, hindering the quality of sleep, rest and recuperation. So can nicotine, another natural stimulant.6,7
- Beating rumination: This one has always been the most relevant and most difficult issue for me. Don't stress if you can't sleep. For most of us, the odd night of reduced sleep is less dramatic than it might feel at the time. If you tend to lie in bed thinking about all the things you have to do the next day(s), get up! Don't ruminate - which means tossing and turning your thoughts just as you are tossing and turning in bed. Leave your bed, do something you find relaxing, write down the things that bother you and go back to bed, when you are sleepy again. This will help your body to understand that lying in bed is the key signal to go into sleep-mode.
- Identifying underlying causes: Engaging in our own health means understanding our individual health patterns and needs. Be mindful when a lack of sleep is persistent and starting to affect your daily life or when you observe a colleague suffering from sleeping problems. Sleeping problems are a symptom of and a risk factor for mental ill health, requiring early identification and preventative actions.
During my clinical practice I often recommended keeping a sleep diary. Today, the ubiquity of digital technology is helping more people monitor their sleeping patterns in an unobtrusive way. Indeed, there are an increasing number of health apps and wearables which can help people overcome long-term sleep problems. One such example is Sleepio, a digital programme that offers a six weeks CBT (cognitive behavioural therapy) based course to assess and help people overcome long-term sleep problems. The programme assesses sleep patterns, diurnal and nocturnal activity and creates a personalised sleep course.8 Currently, the programme is available on the NHS in some areas in the UK.9
For once, I intend to practice what I preach. Writing this blog after a long day and with busy times ahead, I'm switching off my screens, writing out my to do's for tomorrow morning, picking up my novel and having some chamomile and lavender tea before going off to bed!
Footnotes
1 https://cks.nice.org.uk/insomnia#!scenariorecommendation:1
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449130/
3 http://bmjopen.bmj.com/content/5/1/e006748?sid=2b46ea72-843f-4ed1-baf5-a1a0cd61685a
4 https://sleep.org/articles/exercise-time-of-day/
7 http://www.smrv-journal.com/article/S1087-0792(08)00132-9/fulltext
8 https://www.sleepio.com/cbt-for-insomnia/
9 http://www.nhs.uk/Conditions/online-mental-health-services/Pages/sleepio.aspx
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