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The Gap in Sleep Equality

Sleep is crucial to mental and physical health. As the pandemic has made clear, it's also a scarce resource — one of which key workers are increasingly deprived, with dire consequences.

Modern life can sometimes seem characterised by long working hours and limited leisure time. A report by the Resolution Foundation shows an approximate 40-minute and 75-minute reduction in average daily leisure time for men and women respectively since the 1970s, despite the leaps in automation.

To that shift, the pandemic has added new dimensions. Anxiety about health and the state of the world more generally has caused a spike in people suffering from sleeping problems; pent-up energy from staying in all day is likely to have a similar effect.

Despite that, YouGov polls show that since April 2020, 10 percent more adults report getting a consistent seven to eight hours of sleep. It’s not coincidental that the same month saw 46.6 percent of people (57.2 percent in London) shift to working from home.

One office worker who has worked from home for the last year told me that during the first lockdown, their sleep got worse. ‘I slept five to seven hours max a night, with a lot of loo breaks and tossing and turning,’ they said. ‘As the year went on, though, my sleep actually improved – perhaps because I wasn’t worrying about my morning M1 drives, and I was able to have a more leisurely awakening.’

For many, mandatory working from home means extra time in the day that would previously have been spent on commuting: time for family, for exercise, and, crucially, for more sleep.

But not everyone has benefited. The majority of frontline workers—medical staff like doctors and nurses, as well as refuse workers, postal workers, care workers, and many others—are unable to work from home, which means continuing to commute alongside long working hours. As a consequence, social inequality is increasingly compounded by inequalities in the way people sleep.

The negative consequences of lack of sleep have long been apparent: in the short term, sore eyes, irritability, distress, and cognitive and memory issues; long-term, increased chance of high blood pressure, heart disease, diabetes, and even cancer.

A good night’s sleep has been shown to improve brain health by ridding the brain of waste and toxins, and to improve the health of your heart and immune system. UC San Francisco published a study in 2015 that showed participants who slept six hours or less were more prone to developing a cold after being exposed than participants who slept seven hours or more. Back in 2000, the European Court even recognised sleep as a fundamental human right.

For mental rather than physical health, the relationship with sleep is more cyclical. When one suffers, the other usually follows. For key workers, the mental health consequences of the pandemic have been substantial. The Covid Trauma Response Working Group recently published the results of a study of frontline health and social care staff during the pandemic: from over 1000 people surveyed, 47 percent met the criteria for a diagnosis of anxiety, 47 percent for depression, and 22 percent for post-traumatic stress disorder. A majority (58 percent) had at least one of these issues. With such high numbers of key workers struggling with mental health during the pandemic, problems with sleep are inevitable.

One key worker—a carer—told me that before the pandemic, they were getting seven hours of good-quality sleep per night. ‘Now I average four or five hours; that’s remained consistent into 2021,’ they said. ‘Sleep isn’t a priority, but I try to find an hour in the morning or afternoon to sleep. Free time is essentially non-existent. I can’t shut off: I’m always thinking about work. The responsibility to keep people healthy can become quite heavy.’ 37 percent of key workers have said that they are struggling to sleep due to stress.

It’s important to note that the key worker/non-key worker distinction is not just one of occupation. Many of the jobs designated ‘key’ by the government are more likely to be low-paid; in April 2020, the IFS reported that key worker wages were on average 8 percent lower than those of the rest of the population. The food and necessary goods sector, which includes delivery drivers and supermarket employees, are most represented in the lowest-paid tenth of key workers; 9 percent earn under £146.26 per week. BAME people and women are both overrepresented in key roles.

Combined with the physical and mental consequences of lack of sleep, these statistics show that sleep inequalities do not just amount to collective tiredness. Instead, they represent a widespread public health risk—on top of the virus itself—directed specifically at many of the country’s poorest and most vulnerable.

After the pandemic, pressure on key workers may very slightly ease – but the transition to more flexible working for office jobs is here to stay. A YouGov poll shows that 57 percent of people want to work from home full- or part-time after the pandemic, compared to 32 percent who were doing so before the pandemic. That means sleep inequalities are here to stay, too.

Over time, these inequalities are likely to become more apparent. We have heard many times that key workers risk being ‘burned out’ by the end of the pandemic, and we know that it is the low-paid workers that will feel the economic downturn the most. We need to act now to ensure that they are not disproportionately affected: an improved quality of life for some must not come at the expense of others.

The measures that could improve sleep inequality are also those that could improve inequality more generally. They include welfare provisions, like childcare and food, a reduction in working hours, an improvement to the quality and availability of council housing (overcrowding and noise and light pollution are also factors in poor sleep), and a public sector pay rise, funded by taxes on the wealthiest.

Self-help books tout good habits as the key to better sleep: we’re told to reduce screen time, to eat the right food, and to get sufficient exercise during the day. For many, it’s not that simple. Sleep is affected, like every other part of life, by the structural injustices that frame our world, and cannot be put down to individual shortcomings.

Key workers, who have ensured that our society continues to function, are being asked to work harder, to work longer, and to put themselves in the firing line of a deadly disease. That is already too much. They should not be expected to give their lives through exhaustion, too.