Recommendations for a National Sleep Policy in India

The National Health Policy of India, revised in 2017, fails to address the critical issue of the requirement of adequate sleep for the population as a whole, which may influence the public health statistics of India. A comprehensive national sleep policy is a need of the day.

Impaired sleep and a high incidence of sleep disorders adversely affect adults as well as children. Inadequate and restricted sleep affects mood, cognition, decision-making ability and is a cause of obesity and increased cardiovascular mortality. Driving while being drowsy contributes to vehicular accidents. In such a scenario, India needs a national sleep policy with 5 and 20 years’ goals in public health.

The National Health Policy of India, 2017^[1] was revised after nearly 15 years (the last health policy was formulated in 2002). It aims to achieve the highest possible level of health and well-being for all citizens at all ages without placing anyone under financial constraint. The 2017 policy marks a shift in focus from selective to comprehensive primary healthcare and covers major issues of non-communicable diseases, mental health, geriatric health, palliative care and rehabilitative services. The major allocation of funds has been to primary healthcare. However, what it fails to address is the important subject of adequate sleep. The policy has overlooked the impact of sleep restriction, sleep deprivation and sleep disorders on public health and consequently its health implications for the nation.

India is a growing economy with a large population. The health outcome of lack of sleep in quality and quantity has not been paid much attention so far. Getting sufficient quantity and good quality sleep is quintessential for good health^[2] and longevity. The recommendation for adults is at least 7-8 hours of sleep every night^[3] and for children 10 hours of sleep every night.^[4] However, the population does not get enough sleep. The prevalence of sleep disorders in India is high. A study has pegged the percentage of insomnia to be as high as 33% among adults in India.^[5] The impact of sleep deprivation on health is deep and extensive. Daytime sleepiness in adults can lead to reduced productivity. Sleep deprived people are less effective in making quality decisions and are more likely to experience distress,^[6] develop obesity and are more likely to get coronary heart disease.^[7]

Drowsy drivers can cause fatal accidents.^[8] Insufficient sleep in schoolchildren hampers their mood significantly,^[9] and causes daytime behavioural impairments.^[10] Even a small amount of sleep loss produces measurable outcomes. For example, if only 5 hours of sleep is provided for 4 consecutive nights, it impairs task performance to the same degree as a blood alcohol level of 0.6%.^[11] First, awareness about sleep disorders is abysmally low in the country, which affects treatment-seeking behaviour. Second, any intervention in this area will lead to a large impact. We recommend a national sleep policy to address the following aspects.

1. Increase in awareness of the general public regarding importance of sleep in health and disease by creation of a comprehensive plan for dissemination of information using mass communication and through public lectures. The adverse effect of electronic devices on sleep, including the harmful effect of blue light on circadian rhythm must be highlighted.
2. Establishment of a regulatory body to determine adequate work hours.^[12] Strict guidelines to be created, especially for shift workers in surface transport and aviation industries, hospitals, armed forces, law enforcement and every sector that needs shift work. There should be a provision for deterrence.
3. The perils of drowsy driving must be elucidated for the public. A module on drowsy driving may be made mandatory before a driving licence is issued. The continuous driving time should be subjected to regulation as well as maximum time on wheels in a defined period of time should be fixed.
4. Training of healthcare personnel must be ensured, particularly in primary health centres, to ensure early identification of sleep- related disorders and referral to higher centres for management. Subsidized professional and technical education on sleep should be provided in government institutions.
5. The priming of medical students towards importance of sleep must begin early, i.e. during training years. This calls for inclusion of sleep medicine-related curricula in undergraduate and postgraduate medical courses.
6. The availability of good quality equipment related to diagnosis and treatment of sleep disorders must be ensured. To meet this end, higher depreciation in equipment related to sleep medicine, and tax incentives for import of equipment should be provided.^[12] Establishment of sleep centres must be facilitated, which may include initiatives such as provision of tax rebate. Insurance companies must provide coverage for diagnosis and treatment of sleep disorders.
7. An expert body should be established to identify key areas for sleep research for India. Setting 5 and 20 years’ goals in public health is important. Increase in government-sponsored research funding in sleep in both public and private sectors is required.

Conflicts of interest. Professor Hrudananda Mallick is President of the Indian Society for Sleep Research and President of Asian Society of Sleep Research.