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Will we sleep better in 2021?

Indians slept worse than usual in 2020, as the covid-19 pandemic disrupted work-life balance, among other routines. Can the emerging field of circadian science put us back on track?

‘The Siesta (After Millet)’ by Vincent van Gogh, circa 1890. Time clocks for wakefulness and sleep are embedded in our DNA, the building blocks of life that regulate the functioning of different internal organs.
‘The Siesta (After Millet)’ by Vincent van Gogh, circa 1890. Time clocks for wakefulness and sleep are embedded in our DNA, the building blocks of life that regulate the functioning of different internal organs. (Wikimedia Commons)

Neha Tiwari, a 35-year-old bookstore-café owner in Pune, was already suffering from insomnia and post-traumatic stress disorder when the covid-19 pandemic broke out and her sleep routine went out of whack. “The pandemic has been rough for a lot of people, and it has definitely affected me, especially since I run a small business,” she says. “But it wasn’t too much of a difference, since I have always had trouble sleeping.” Millions of others were less prepared to be ambushed by a sudden spate of sleeplessness.

As the novel coronavirus raged across the globe, an epidemic of sleep disorders also spread its insidious influence. It left people awake at night, anxious about contracting the disease, worrying about the health and safety of their loved ones, fretting over loss of job and income—apart from the stress of working from home, often for much longer than usual, getting children to adapt to online schools, and keeping the kitchen fires burning in the absence of domestic help. As early as March, there was a name for this condition: coronasomnia.

“The pandemic has increased our struggles with sleep manifold,” says Manvir Bhatia, director of the Neurology Sleep Centre in Delhi, a sleep specialist with over 25 years of experience, and author of the book The Sleep Solution: Secrets For A Good Night’s Sleep (2016). “People across all ages who have never had sleep problems have come to see me in the last few months.” And there is far more than anecdotal evidence to validate this trend.

In April, Wakefit, a sleep solutions company headquartered in Bengaluru, conducted a survey of 1,500 respondents from all over India to understand their sleeping habits during the covid-19 lockdown in March. Around 67% claimed that working from home had altered their sleep schedules, while 50% said their sleep patterns had been disrupted during this period. Half of them said that working from home made them sleepier during work hours, and 81% were hopeful that their sleep schedules would improve, even return to normal, once the lockdown was lifted.

“The demand for our sleep products went up by 70% during the pandemic,” says Chaitanya Ramalingegowda, co-founder of Wakefit. “People are spending more time than ever at home these days, so conventional mattresses are simply not enough.” The bedroom is no longer a place to rest and sleep. It is also the refuge where people carry work to escape ambient noise in other parts of their home. They retire to the bedroom to attend an online work meeting, as someone else in the family may be having theirs in the living room, or as the children are going to Zoom schools at the dining table. Unsurprisingly, Wakefit also saw a huge uptick in the sales of ergonomic chairs and multifunctional furniture like a sofa-cum-bed, which can help expand the sense of space in otherwise cramped apartments that much of urban Indians are forced to live in.

These trends are consistent with the Great Indian Sleep Scorecard (Giss) report Wakefit publishes annually. According to the 2020 Giss report, 19% of Indians, or roughly one in five of the 50,000-plus who were surveyed across the country, claim that they are “insomniacs”. Ninety per cent of the people said they woke up one-two times each night, and 30% woke up feeling unrested. No wonder Wakefit managed to raise 185 crore in December as part of its Series B funding round led by European investment firm Verlinvest, apart from its existing investor, Sequoia Capital India.

Sleep, which Dr Bhatia describes as a primary “pillar of wellness”, is predicted to be the next big phenomenon in the wellness industry all over the world—especially in India, which is the second most sleep-deprived country after Japan, according to a survey conducted by fitness solutions firm Fitbit in 2019. But treating sleep conditions with the conventional tools and wisdom that experts have used so far may not be enough.

The bed is no longer a place to rest and sleep. Working from home during the pandemic has turned it into a workstation.
The bed is no longer a place to rest and sleep. Working from home during the pandemic has turned it into a workstation.

The sleep whisperers

According to the Global Wellness Trends: The Future Of Wellness 2020 report, the global wellness economy is valued at $4.5 trillion (around 333 trillion); the sleep market constitutes $432 billion of this. The latter is projected to grow to $585 billion by 2024. Across cultures and societies, people seem to be more obsessed than ever with tracking their sleep. We track our sleep with gadgets, in bullet journals, and through apps. In order to lull ourselves to sleep, we put on white and pink noise videos on YouTube, listen to meditation and relaxation techniques or sleep stories.

There are “sleep robots” to cuddle you and regulate your breathing to help you sink into a peaceful slumber. In case you are craving a midnight snack, fret not. You can get yourself a “sleep ice cream” that won’t keep you awake with a surge of sugar and dairy, like ordinary ice creams do. So invested are we in getting the right amount of sleep that doctors say many of us are suffering from “orthosomnia”—anxiety over sleep tracking which, ironically, results in a lack of sleep.

Tiwari, for instance, is cognisant of this last problem and is wary of using sleep trackers. “High-functioning anxiety and depression are part of my condition,” she says. “So the more I try to sleep on time or discipline it, the more it fuels my anxiety. With time, I have accepted the problem; there are nights where I refuse to look at the time of my sleep.”

But the pandemic has deepened such anxieties all around. “Over 40% of our users will have sleep issues,” says Jo Aggarwal, co-founder of Wysa, a Bengaluru-based mental health startup. “When you can’t sleep, you roll this way and that way. The next thing you know, you have switched on Netflix.” When we are anxious, Aggarwal says, our bodies are perpetually prepared for “danger” and remain in a fight-flight-freeze mode. “Even our basic coping mechanisms, like hugging someone for comfort or being touched by someone as a sign of love, became fuelled by anxiety this year due to the nature of the coronavirus transmission,” she adds. “Our bodies have become so wired for signs of anxiety that we can’t go to sleep even after we have retired to bed.”

The problem may be exacerbated by the self-fulfilling prophecy that is contemporary technology. Sleeplessness can cause people to become bored and fidgety, leading them to pick up their mobile phones, which emit blue light and inhibit the production of the sleep-inducing melatonin hormone. According to the Giss 2020 report, 92% of Indians said they looked at their phones before dozing off at night, 54% engaged with social media and OTT platforms late into the night, and 32% admitted that avoiding a digital device would improve their quality of life.

During the lockdown, though most sleep clinics were shut in India, telemonitoring of patients went on at full steam. “Apart from high levels of depression and panic over not being able to meet others, people’s learning of the digital medium was nascent at the time,” says Sibashish Dey, head of medical affairs, ResMed India and South Asia. People were figuring out the dynamics of working from home.

A company specialising in medical equipment, especially for sleep-related pulmonary conditions like sleep apnea (which isn’t talked about as much as insomnia), ResMed has noted a delay of 50-60 minutes in waking up, and 40-60 minutes in going to bed, among the average office-goer during the pandemic. “Someone who used to wake up at 7am to get to work by 8.30am is now sleeping in for longer hours because they are working from home,” Dr Dey says. “Since there is no commute any more, they can go to bed whenever they like, which has led to disruption of their work-life rhythm.”

Such radical shifts in sleeping and waking hours may have a silver lining, though. Verena Senn, master neuroscience expert at Emma—The Sleep Company, a Germany-based sleep wellness firm that does business in India, says that during the early days of the pandemic, there were reports of “vivid, bizarre dreams and often nightmares” from around the world, though the effect of such experiences may not be as dire as it may seem.

The increase in sleep duration due to work from home has led to a longer duration of REM sleep, Dr Senn says. “REM sleep is characterised by rapid eye movements, mostly related to vivid dreams, and predominates in the early hours of the morning. This is actually a good trend,” she adds. “During dream sleep, the release of the stress-related, anxiety-triggering chemical noradrenaline is blocked off within the brain, while the emotion- and memory-related structures of the brain (amygdala and hippocampus) are reactivated. This means that while our brain is activated, ready to reprocess the events of the past, and especially the feelings associated with them, we are in a stress-free state.”

In the last two years since Emma entered the Indian market, its sales increased twofold in the quarter ending September. Now the company is planning to invest €100 million (around 897 crore) in India and the Asia-Pacific to meet the rising demand for bed-in-a-box products. “We work closely with the Indian customer and modify our products based on Indian preferences,” says Harun Kukukhel, country manager for India at Emma.

While these trends augur well for sleep entrepreneurs, the wellness industry, as a whole, is projected to move in a more complex direction, beyond the paraphernalia of beds and sleep aids, in 2021.

There are now robots that cuddle you to help improve the quality of your sleep and breathing.
There are now robots that cuddle you to help improve the quality of your sleep and breathing.

The circadian shift

According to the Global Wellness Trends report, one of the prime culprits of bad sleep in the 21st century is the growing menace of “lightmare”—that is, inappropriate exposure to blue light and darkness due to “light pollution”. Our 24x7 always-on lifestyle is playing havoc with our body clocks—or circadian rhythm, in scientific parlance—causing us to sleep, eat and exercise at the wrong hours. “We have known this phenomenon intuitively for a very long time,” says Dr Dey. “There’s a reason why people living in the villages wake up with the first light and retire at sundown.”

Early to bed and early to rise, as the proverb tells us, makes people healthy, wealthy and wise. This is not merely a moral injunction, but hard science, for which three researchers were awarded the Nobel Prize for Medicine in 2017. Jeffrey C. Hall, Michael Rosbash and Michael W. Young were recognised for their pioneering investigations into the molecular mechanisms controlling circadian rhythm. In 1984, Hall and Rosbash isolated a gene in fruit flies that regulates the daily biological rhythms of a protein called PER. The latter is built up in cells during the night and degrades in the course of the day.

In humans, too, exposure to the blue light of the sun (blue light from its natural source is not harmful, but it can be so when emitted by electronic devices) causes a drop in melatonin, which is mostly released by the pineal gland. As the day winds down, the sun sets, and the body is deprived of blue light in the dark hours, the level of melatonin rises and triggers the need to sleep (unless it is disturbed by the artificial blue light of gadgets).

Such time clocks are embedded in our DNA, the building blocks of life that regulate the functioning of different internal organs. Our liver, heart, kidneys, brain follow a cycle of operations determined by this circadian rhythm. “The blood pressure, for instance, tends to rise between 4-6am,” Dr Dey explains. “That’s why we see a high incidence of heart attacks and strokes during the early hours.”

Going out during daytime to get some air and exercise may sound like your grandma’s antidote to lack of sleep, but the science behind the idea is unimpeachable. “There’s a biological clock to each part of the body that affects everything—from the brain to our bowel functions,” says Dr Bhatia. Sleep affects two hormones that regulate hunger—ghrelin (which stimulates it) and leptin (which suppresses appetite). Before intermittent fasting became a new-age dietary fad, it was always meant to be suited to our circadian rhythm. Eating during the day and stopping in the evening is the system to which our bodies have adapted through evolution.

The sun plays a central role in our overall well-being. “Although people may not be going out frequently during the pandemic, we are urging them to at least expose themselves to natural light in their balconies, keep the windows open, have ‘a date with the sun’, as someone put it recently,” Dr Bhatia adds. While this is supposed to be one of the factors that helps us sleep, there are people who simply cannot fall asleep at the right time or get enough rest, no matter how scrupulously they follow every rule in the book, the doctor’s advice, or the latest wellness trends in vogue.

Kalyani Prasher, a 40-year-old writer and editor based in Delhi, says she struggled to sleep for years, until she left her day job in 2013 to work freelance. “It was only when I started working from home at my own hours that I realised I sleep perfectly well, for seven-odd hours daily, but only at the wrong time,” she says.

Prasher exhibits the behaviour of a person who is colloquially called a night owl—clinically speaking, she suffers from delayed sleep phase syndrome. “For most of my working life, I have had huge fights with my reporting managers for not showing up on time,” she says. “Although I work flexi-hours now, I still can’t make it to breakfast or lunch meetings. Early morning flights are a nightmare.” While research has established that circadian rhythm may be disrupted due to genetic make-up, Prasher believes her problem may be the result of not forming good sleep habits as a child.

Then there are extreme cases like Aparna Jain’s—a biological quirk that is the reverse of the Rip Van Winkle syndrome. The 50-year-old leadership coach based in Delhi says she has not had good sleep for over 20 years. “People are tired when they don’t get enough sleep, but that’s not my experience,” she says.

A high-functioning individual who worked in intensely exacting corporate roles in her 30s, Jain suffers from chronic mixed insomnia, which makes it difficult for her to fall asleep or maintain sleep. From CBD oil to meditation apps to prescription drugs to pre-sleep rituals, she has tried all and sundry remedies—but nothing has worked so far.

Genetic night owls, Dr Bhatia says, suffer from social and work-related “jet lag”—their life spans and overall health may be affected by their sleep patterns. “The trouble is that most people try and push themselves to become night owls, acting against their natural biology,” she says. In any case, aligning your body to the circadian rhythm can only be done through a change in lifestyle. “It’s not a switch you can put on and off. Sadly, your body can compensate and make you get used to odd sleeping hours,” Ramalingegowda explains.

As we enter 2021, the Global Wellness Trends report predicts a shift towards using light as the key ingredient to treat sleep-related disorders. In 2017, the worldwide market for circadian lighting was $400 million—it is expected to grow to a staggering $4 billion in 2024. Tuneable biodynamic lighting—along with bulbs using technology developed by the US space agency Nasa to help astronauts at the International Space Station keep the circadian rhythm—is likely to be at the cutting edge in the hospitality and travel industries.

Apps like Timeshifter and Circa Solar are going to be embraced by an increasing number of frequent long-haul travellers to deal with jet lag. Fancy pillow menus and aromatherapy massages are likely to be overtaken by smart mattresses, tuned to adjust their temperature to suit a sleeper’s optimal needs.

But all said, none of these new-age technologies stands a chance before the age-old panacea offered by sunlight and fresh air.

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