Research conducted since the 1990s has demonstrated that maintaining work and sleep schedules that conflict with one’s internal circadian settings often exacts a hefty cost: persistent fatigue, digestive issues, and weight gain. Many shift workers rely upon caffeine and sleeping pills, cigarettes and alcohol, to force wakefulness and sleep, further aggravating their social jet lag. A few years on rotating shifts puts them at greater risk of developing obesity, heart disease, depression, and ulcers. To top it off, in 2007, the World Health Organization listed “shift work that involves circadian disruption” as a possible carcinogen. It is now clear that forcing oneself to fit into social schedules of school, work, and play against the grain of one’s internal time will exact a price, sooner or later.
Being a lark, an owl, or a hummingbird that flits between the two is not a problem in itself, but ignoring internal rhythms to accommodate social clock time is a serious one. Since the turn of the twenty-first century, the American Academy of Sleep Medicine has identified a slew of new disorders: shift work disorder, advanced sleep phase disorder (when we fall asleep and wake up before the proper social time), delayed sleep phase disorder (when we fall asleep and wake up later than our jobs and schools request), jet lag disorder, excessive daytime sleepiness, and irregular sleep-wake rhythm. As these manifestations of the tensions between individual biology and institutional regimes get labeled as medical disorders, the burden shifts from society at large onto the backs of individuals whose job it becomes to fix their so-called problems. Patients are given names for the difficulties they encounter with sleep, encouraged to get help, and the sleep industry swoops in to meet the ever-expanding need, offering everything from sleep concierges in high-end hotels to pharmaceutical wonder drugs.
While sleep medicine professionals have been adding new disorders to their list, researchers have been analyzing epidemiological data and publishing estimates of how much untreated sleep disorders cost society as a whole in terms of lost productivity, increased medical expenses, accidents, and mistakes. The results have garnered a great deal of attention in the press, justifying the need for sleep medicine and catching the eye of a few large employers, such as Nike, Google, and Continental and British Airways, who now provide rest areas for their employees to improve performance. While it is sad to realize that the economic toll of sleep problems attracts more attention and response than the toll they take on our collective emotional and physical health, the issue has been gaining traction in the public arena.