The pace of modern life may not give many of us the time to stop, rest and recover with a good night’s sleep, yet sleep is as important for good health as diet and exercise. Regular healthy sleep improves brain performance, mood and health. Poor sleep hygiene is associated with increased risk of heart disease, stroke, obesity, impaired immune and cognitive function.

Sleep consists of two distinct states as shown by EEG: REM sleep (rapid eye movement sleep), where dreaming occurs, and non-REM sleep, which is divided into 4 stages. Sleep is cyclical, with four or five REM periods during the night, accounting for about 1/4 of total sleep. Initial REM periods are shorter than later ones. During REM sleep, information is believed to be cemented into memory.

Stage 4 sleep is the deepest, during which blood pressure, heart rate and breathing slow, muscles relax, and both growth and repair processes are believed to occur. Stage 4 usually occurs in the first several hours of sleep. Variations in sleep may be due to shift work, travel or individual patterns. Creativity and responsiveness to unfamiliar situations are impaired by sleep loss.

Alcohol, smoking and stimulants such as caffeine, cold remedies and cocaine can reduce sleep time. Benzodiazepines tend to increase total sleep time with variable effects on non-REM sleep. Antidepressants tend to decrease REM sleep, with rebound on withdrawal in the form of nightmares.

For most adults, 7–9 hours of uninterrupted sleep is recommended — a little less for older adults and more (8–11 hours) for teenagers, with even more needed for infants and toddlers. Sleep dysfunction is common and includes short sleep (less than 6 hours for under 65s, or 5 hours for older adults), long sleep (longer than recommended), poor sleep quality (frequent waking, difficulty falling asleep), and disorders such as sleep apnoea, restless leg syndrome and insomnia.

Doctor-diagnosed sleep disorders affect about 1 in 5 adults, and 48% of adult Australians report at least two sleep-related problems. Up to 19% report not getting enough sleep. Shift workers (around 16% of the Australian workforce) are at higher risk, with 1 in 3 experiencing sleep disorders, including falling asleep at work and having a 60% higher risk of accidents compared to non-shift workers.

An Australian survey of 1,050 adults revealed that sleeping pills were being used by 37%, 14% were using melatonin, and the majority were taking a range of hypnotics, including benzodiazepines and non-benzodiazepine products (e.g. Zopiclone from the cyclopyrrolone group or orexin receptor antagonists).

I wondered if this high level of prescribing indicates that our general approach to advising patients on sleep should change in favour of promoting more natural ways of achieving sleep hygiene. To satisfy my curiosity and gain insights into healthy sleep patterns and how to achieve this naturally, we are joined by senior research scientist Josh Leota from Monash University’s School of Psychological Sciences.

Josh is actively involved in sleep research, especially regarding the effects of sleep on athletic performance, and is currently studying a cohort of elite female athletes competing locally and after travelling through time zones interstate. I was very pleased to welcome Josh to share smart insights into understanding sleep cycles, how poor sleep may impact health, and advice on achieving sleep without pharmacological assistance.

References:

Josh Leota, Research Fellow. School of Psychological Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill, Vic 3168

Sleep problems as a risk factor for chronic conditions: www.aihw.gov.au

https://www.nature.com/articles/s41467-025-58271-x