How much sleep did you get last night? It’s a personal question, perhaps, but sleep is just that, personal. It’s shaped by our individual circumstances, routines, and challenges. And yet, while it's a vital part of daily functioning, for many people across Europe, sleep has become a privilege rather than a necessity. But this is not okay. Sleep deprivation is not just a health issue, it’s also a social and economic one.
Anja Strmšek and co-authors from NIJZ in Slovenia discuss why sleep is crucial for wellbeing, what changes are needed and how a wellbeing economy, focused on improving quality of life, can address sleep inequality, benefiting both individuals and society.
Sleep health is fundamental to all aspects of human functioning, essential for optimising heart and metabolism health, as well as immunity, brain, and mental health. It underpins the biological functions that enable the body to adapt and function, from our genes to our behaviour.
Sleep is not a luxury for those with too much free time; it is a biological necessity. Yet, sleep deprivation and disorders are widespread, affecting both adults and children, and represent a significant public health burden. Poor sleep is associated with adverse health outcomes, including cardiovascular disease, obesity, diabetes, hypertension, depression, and all-cause mortality. Getting less than the recommended seven hours of sleep for adults increases these risks. The impacts of sleep deficiency also manifest in declines in cognitive function, affecting attention, reaction time, working and long-term memory, motor and decision making skills, verbal function, response inhibition and motivation. In fact, around 20% of all serious motor vehicle accidents are thought to be associated with sleep deprivation.
Night shifts could be carcinogenic to humans
Many of our biological functions, such as our sleep-wake cycle, appetite, digestion, body temperature, and overall mood, follow daily patterns known as circadian rhythms. These rhythms are regulated by the circadian clock genes found in nearly every cell of our body, with our brain’s master clock ensuring they work in synch. This harmony is essential for optimal health. However, when our sleep patterns or light exposure are disrupted, such as through night shift work, jet lag, or light exposure during normal sleep hours, it can lead to circadian disruption. The consequences include impaired performance, a higher risk of poor health, and a greater likelihood of dangerous mistakes.
Around one in five workers worldwide are engaged in night shift work, a critical part for guaranteeing round-the-clock production and activities. The World Health Organization’s International Agency for Research on Cancer (IARC) Working Group has classified night shift work as “probably carcinogenic to humans”, based on evidence linking it to cancer in animals and limited evidence in humans. Despite this, sleep health has yet to be included in the IARC's cancer prevention recommendations.
Social inequalities and their impact on sleep health
Poor sleep health often reflects broader social deprivation and exclusion. Sleep is not solely determined by internal biological factors, but also by external as environmental ones such as light, temperature, noise, air quality, and even the seasons, which can either hinder or improve our rest. These environmental factors are often determined by social conditions, with disadvantaged communities more likely to face poorer air quality, neighbourhood disorder, higher crime rates, and limited access to green spaces. Alongside biological and environmental influences, sleep is also affected by psychological and financial stress, such as being able to put food on the table, security threats, facing the pressures of modern technology, and the demands of a workforce expected to be available at all hours. The stress of environmental and social stress, such as eco-anxiety over climate change also negatively affects sleep.
Economic and social costs
Disadvantaged social and physical environments, together with individual vulnerabilities, can amplify economic costs. Take, for instance, a person suffering with post-traumatic stress disorder (PTSD). Because of their PTSD, they may also experience sleep deprivation and poorer daytime functioning, resulting to increased absenteeism from work and higher healthcare costs.
Addressing sleep health equity is crucial, especially for vulnerable groups such as women, children, those with lower socioeconomic status, and minority racial and ethnic communities. Sleep health equity should be understood as providing equitable opportunities for all individuals, regardless of age, gender, race, geographic location, or socioeconomic status, to achieve the recommended amount of satisfactory, efficient sleep at the right time, sleep that supports both physical and mental health, and overall wellbeing.
The health benefits of good sleep, and the harmful consequences of sleep deprivation, are sufficiently clear and well researched. This should prompt immediate action to foster a culture of sleep health at local, regional, and global levels for improved health outcomes for all. We must promote health education and awareness on sleep health and circadian functioning, standardise sleep and circadian data collection across countries, and integrate sleep health initiatives into public health agendas to promote over all wellbeing and advance public health.
Education alone is unlikely to drive lasting change. More interactive, behaviour-focused approaches to sleep, ones that go further than just advice, but are grounded in theories of behavioural change. Tools and techniques that involve people more actively, such as setting goals, tracking sleep habits, and getting feedback. These might include addressing social cognitive processes such as self-belief, facilitating social support. They can also include providing practical resources such as time, personnel, and educational materials like relaxation strategies, sleep hygiene tips, and other tools, to support healthy sleep behaviours.
Incorporating sleep health into broader health promotion efforts, such as those focussed on diet and physical activity, offers a practical and cost-effective way forward.
Promising solutions to improve sleep health
A precision, personalised population health approach is essential to achieve sleep health and overall health equity at the community level, ensuring that all individuals benefit equally.
At the societal level, some promising approaches are emerging to improve sleep health, such as the abolition of daylight-saving time, the systematic elimination of precarious work, and limitations on overtime. In today’s world, where constant digital availability has become the norm, the pressure to be always accessible is taking a toll on workers’ safety and health, particularly their sleep.
The COVID-19 pandemic dramatically shifted work patterns, as remote and telework became a lot more common across Europe. This sudden shift prompted the EU to act for clearer boundaries as many people began to blur the lines between home life and work life. In 2024, the European Commission launched its first-stage consultation of social partners on fair telework and the right to disconnect.
Here, in Slovenia, the government took a pioneering step by enacting the right to disconnect, with an amendment to the Employment Relationships Act in November 2023. The essence of this right is simple. After a certain hour in the afternoon or evening, we should have the time for ourselves, our family, and friends–an essential component of a wellbeing economy.
In the coming years, Slovenia will focus on a multilevel approach to ensure sleep health for all, adopting a life-course perspective. Measures are needed not only at the individual, community and broader societal levels, but also within broader societal frameworks, balancing sleep health advocacy with social demands. Acknowledging the importance of international collaboration, Slovenia is leading efforts with the European Joint Action PreventNCD to prepare a roadmap for joint strategic action on sleep with European partners.
Anja Strmšek
Anja's primary area of research is sleep as a determinant of health. Anja participates in national and international projects, and works in the field of strategic planning of healthy and caring communities (at the level of Slovenian municipalities).