Policy recommendations to help the UK rest easy
Sleep should be acknowledged as a key public health issue, which is as crucial for our wellbeing as diet or exercise. Promoting good sleep and removing the barriers to it should be mainstreamed within health care; but also integrated within education, housing, employment, inclusion, and the range of policy agendas which influence sleep issues.
We know that sleep deprivation can lead to:
- increases in the stress hormone cortisol, which is linked to:
- impulsive behaviours and lack of empathy
- negative effect on sense of humour, mood and relationships
- poor mental and physical health (e.g depression and link with obesity)
- lack of concentration
- impaired wellbeing.
The following evidence-led recommendations target policy makers, commissioners, health practitioners, employers, educators and housing specialists.
National and local public health campaigns should promote the importance of sleep for both mental and physical health. New and accessible online self-help resources should be made available to advise people on what they can do themselves to improve their sleep as part of a national sleep strategy. As power and budgets continue to devolve, increasingly this responsibility will sit with local authorities.
Research funders should investigate the link between social inequalities, poverty, sleep and mental health; and the sleep-related interventions that can effectively improve outcomes for disadvantaged groups.
Improving Access to Psychological Therapies (IAPT) should consistently consider and respond to the specific needs of people with sleep problems, especially regarding access to cognitive behavioural therapy (CBT). One way to achieve this consistently is ensuring all IAPT staff are trained to recognise and support sleep issues, as these may emerge during sessions and not be the main presenting issue on referral.
Clinical commissioning groups should ensure provision of the digital CBT programme, Sleepio, which has been shown to help 75% of participants to achieve healthy sleep through its randomised control trial, as a way in which CBT for insomnia and sleep issues can be more accessible.
NHS Trusts should distribute self-help publications across primary and secondary care settings, looking to our How to sleep better guide and Southern Health and Social Care Trust's guide Sleeping problems: a self-help guide as an example of good practice.
The Royal College of GPs should provide up-to-date, evidence-based training and information for its members highlighting the benefits of sleep for both physical and mental health.
GPs should have access to a diagnostic tool for use in recognising sleep problems in primary care settings, such as the sleep condition indicator, which has been recommended by sleep expert Dr Colin Espie. This is consistent with the NHS Constitution's Making Every Contact Count initiative, encouraging early intervention and prevention across a variety of public health issues.
The Health and Safety Executive should be held accountable for its duty to enforce night work limits and health assessments for night shift workers, and resources on how to remain mentally healthy whilst working night shifts should be made available to all employees.
Employers should limit out of hours contact with employees to allow people to fully 'switch off', a practice that has been legislated for in France.
Schools, colleges and universities should be take a ‘whole-school’ (or whole-institution) approach to mental health and should be supported to encourage good sleep habits and greater knowledge of mental health issues, particularly around exam time.
School governing bodies should consider introducing later school start times for older adolescents (e.g. year 10 upwards), whose naturally shifting circadian rhythms often mean they are chronically sleep deprived by having to get up too early for school.
Mental health experts should be invited to input into education policy decision-making, so that new policies and initiatives are scrutinised with a sleep and mental health lens and opportunities to improve outcomes are not overlooked.
Architects, designers and planners should consider sleep and mental health issues as they create housing and the built environment. For example, taking steps to minimise external noise and consider the nature of street lighting, eliminate damp and mould, and improve low-quality housing.
Housing associations, policymakers and charities should partner with mental health organisations to mainstream sleep and mental health issues within their work.