Getting a good snooze seems to be a difficult thing to achieve in overachieving Singapore.

It is not for lack of awareness – most adults know that they should be clocking at least seven hours of sleep daily, and that a long-term sleep deficit can be bad for health.

Yet Singaporeans are among the most sleepless in the world.

A study of 43 cities worldwide found that Singapore is the third most sleep-deprived, behind only Japan and South Korea.

The general population in Singapore averaged six hours and 32 minutes of sleep every night, according to a 2014 study by Jawbone, the maker of a digitised wristband that tracks its users’ sleeping patterns.

More recently, a poll by SingHealth Polyclinics last year showed that 44 per cent of Singaporeans had fewer than seven hours of sleep on weekdays.

These statistics may not be surprising, but the problem of sleep does not seem to be going away.

More patients are seeking help at the Singapore General Hospital (SGH) for sleep-related problems.

The hospital handled 1,741 new cases last year – double the number in 2013, when it saw 819 cases.

The problems ranged from medical conditions like obstructive sleep apnoea (OSA) to parasomnia, which is a category of sleep disorders that include abnormal behaviour like sleep talking.

The National Sleep Foundation recommends that teenagers get at least eight hours of sleep daily; and adults, at least seven hours. Children aged six to 13 require at least nine hours of sleep.

Inadequate sleep, say experts, can lead to health complications and impaired cognitive abilities in the long run.

WHAT’S KEEPING US UP?
Poor sleeping habits in Singapore are largely due to the culture here, said Professor Laura Palagini, a psychiatrist in the department of psychiatry neurobiology, pharmacology and biotechnology at the University of Pisa, Italy.

She said people in Singapore lead a much more stressful lifestyle than those in her home country of Italy because of Singapore’s work-oriented culture, which causes an imbalance of time allocated to sleep.

This applies especially to professionals like Madam Joanna Tan, who has to juggle obligations to both her work and family.

Work is such a priority for her and many other colleagues that they are willing to sacrifice their sleep, said Madam Tan, who is in her early 40s.

“When there is a problem at work, I cannot sleep through the night. I will wake up a few times between midnight and 6am to check on the situation,” she said. The nature of her work in the technology industry also disrupts her sleep. For example, conference calls can take place at 5am, as her company is headquartered in the United States.

On top of that, she is a mother of three. Her youngest child, aged one, would wake up several times in the night, and she would have to put him back to bed. As a result, she averages only five hours of sleep a day.

Many teenagers find themselves in the same situation – sleeping late due to time spent on electronic devices, in addition to school work.

This could lead to delayed sleep phase syndrome – which is most common in teenagers – and affect the circadian rhythm of the body. Student Irriena Ezrynn, 15, for example, finds herself tied up with schoolwork until late at night. She would sleep at midnight and wake up at 5am the following day to go to school, which starts at 7.30am.

She admits, however, that her lifestyle habits also contribute to poor sleeping hours. “When I get home at 4pm, I feel tired from school, so I use my phone until about 6pm. I do my work then because I can focus better at night,” she added.

But she feels that nothing can be done about her sleep situation – many of her friends are the same way, she added.

Another group who tend to have poor sleeping habits are those who work through the night. Their quality of sleep is especially compromised, said Prof Palagini.

Nurse Devon Chng, 27, said many of her colleagues who do the night shift, from 9pm to 8am, are exhausted and find it difficult to sleep the next day. It is especially tiring for those with consecutive night shifts, she added, as they “cannot function as efficiently”. “I’m quite okay with the night shift, but I will have to drink three to four cups of coffee to stay awake,” she said.

However, some night-shift workers, such as 18-year-old Suzuki Tomoe, attribute their tiredness to the long hours of the shift instead.

Ms Suzuki has been working as a waitress at a rooftop nightclub for almost a month, having completed her A-level examinations last year.

Occasionally, she does the night shift, which lasts from 7pm to 5am. “It’s just socially disruptive because I can’t make plans for the mornings after my shift,” she said.

Lifestyle or work habits are, however, not always to blame for poor sleep. Some people have health conditions that disrupt their rest, such as OSA. This is when the airway is blocked repeatedly overnight, causing oxygen levels in the body to drop and sufferers to wake up at night.

In a 2016 study by JurongHealth Services, one in three Singaporeans was found to suffer from moderate to severe OSA.

Severe cases of OSA can lead to heart attacks due to the lack of oxygen in the body, and eye diseases like normal-tension glaucoma, which is damage to the optic nerve that could result in vision loss.

When retiree Wesley Cheah, 67, visited SGH for his heart problems, he was surprised to find out that OSA was one of the causes.

Mr Cheah thought that his heart palpitations and feeling of heavyheadedness in the mornings were just slight discomforts, and did not seek medical help. He said: “I used to sleep sideways but I got a blocked nose easily. Then over the years, I changed to sleep with my face up.”

He understands now that this caused his tongue to fall back and, due to ageing, the weakened throat and neck muscles also collapsed, thus blocking his airway and contributing to his sleep apnoea.

WHAT’S THE IMPACT?
There are no signs that the problem of sleep will be alleviated, especially with the increasing use of technology and pace of life.

“The use of smartphones and tablets is increasingly prevalent, and many people do not realise its effects on sleep quality,” said Dr Michael Lim, a consultant at the division of paediatric pulmonary and sleep, National University Hospital.

As habits begin to set in, people are less willing to change, as they see no immediate need to do so.

But Prof Palagini believes that there is still a lack of awareness about the long-term consequences of chronic sleep deprivation.

Besides irritability, moodiness and poor concentration, lack of sleep can lead to several medical conditions in the long run.

Dr Toh Song Tar, who heads the SingHealth Duke-NUS Sleep Centre, said sleep deprivation is linked to a higher risk of diabetes, obesity and a poorer immune system. Dr Toh is also director of the sleep disorders unit at SGH.

The lack of sleep can impair our body’s metabolism and disrupt blood hormone levels, which results in a higher risk of the above conditions, according to the National Sleep Foundation.

Patients with chronic sleep deprivation also tend to have slower reflexes and impaired cognitive abilities, said Dr Kenny Pang, an ear, nose and throat specialist at the Asia Sleep Centre.

Children, in particular, require adequate good-quality sleep, as it is vital for repairing of their bodies, and for the growth and development of their brains, said Dr Lim.

Lack of sleep can negatively impact a child’s academic performance and motivation. There is also a higher risk of depressive symptoms, anxiety and withdrawal in sleep-deprived children, added Dr Lim.

However, Dr Lim Boon Leng, a psychiatrist at Dr BL Lim Centre for Psychological Wellness, cautions against being overly paranoid about getting a good night’s sleep. Being overly anxious about the consequences could perpetuate sleep difficulties, he said. “Most of the time, a few days of poor sleep is not related to any long-term problems.”

Get your sleep facts right

1. Naps are bad for you.

2. It is okay to sleep less on weekdays as I can recover sleep during the weekends.

Fact: In the short term, it might be possible to repay your sleep debt. However, most studies show that this is uncertain in the long term. Weekend sleep does not fully reverse the damage done over the week, especially over time.

3. Taking medication for sleep is the fastest and best solution for my sleep problems.

Fact: Not always. Doctors and professors alike would caution against taking medication as the first solution.

Medication is only temporary relief and you risk becoming overly reliant. It is advisable to first adjust your sleep cycle and lifestyle habits naturally before turning to medication.

4. It is all right to use my phone near bedtime as long as I have the blue light or night filter on.

Fact: Doing so will still disrupt your sleep, regardless of the filter. While the blue light filter does alleviate strain on the eyes, light from the phone tricks the body into thinking that daytime has been extended.

This affects the secretion of melatonin, which controls our sleep and waking cycles. It is best to avoid using electronic devices two hours before bedtime.

You should also avoid heavy exercise, meals and doing work two to three hours before sleep.

Sources: Dr Toh Song Tar, head of SingHealth Duke-NUS Sleep Centre and director of the Sleep Disorders Unit at Singapore General Hospital, and Dr Kenny Pang, ear nose and throat specialist at Asia Sleep Centre.