Attacking the Sleep Conspiracy

JULIA KIRBY: Welcome to the HBR IdeaCast from Harvard Business Review. I’m Julia Kirby, one of the editors of the Harvard Business Review, and I’m joined today by Russell Sanna. He’s executive director of the Division of Sleep Medicine at the Harvard Medical School. Russell, thanks for joining us today.

RUSSELL SANNA: Julia, it’s a real pleasure to be here. Thank you for having me.

JULIA KIRBY: I first got to know Russell through a corporate gathering that he recently hosted at the Harvard Medical School. It was called “Attacking the Sleep Conspiracy.” And while there, I learned a lot about a new movement that he and his colleagues are trying to get going around creating greater awareness of sleep health and changing a lot of behavior around it. So Russell, I guess what are you trying to accomplish in terms of improving lives with this movement?

RUSSELL SANNA: It’s pretty clear that the world, in general, is sleep deprived. Sleep is one of those things that touches everyone. And so the reaction that you got from your piece is pretty illustrative of how it does generate feelings among everybody. What we’re about is trying to get to sleep recognized as the third pillar of health, along with diet and exercise. And to get it ingrained into everybody’s daily life as a priority.

So in the short term, we want sleep health to become part of the public health discussion. This country has many examples of taking on big public health problems, and the sleep is one that needs– its time has come.

So in the long term though, what we’re interested in seeing is the change in trend lines. We’ve lost an hour and a half sleep on average over the last 30 years. That needs to change, because simultaneously what we call the comorbidities of sleep– those are the associated disease categories that come along with sleep deprivation, all based in science– obesity, diabetes, hypertension, cardiovascular disease, depression, stroke– those trends are all increasing. So we want those trends, the bad trends, to decrease, and we want the good trends, ie sleep, health, to increase.

JULIA KIRBY: So there’s a lot that has to be accomplished in terms of behavior change to start to reverse some of those trends. And I love this idea that the way you’ve realized you need to do that behavior change is to start a movement. Maybe you can tell us, what does it take to start a movement of social change? And also, in particular, why should Harvard Medical School take the lead on this one?

RUSSELL SANNA: Well, sleep is pretty complex as opposed to other public health problems. For example, the polio that was recently featured in your June issue of Harvard Business Review. Situations with communicable diseases, there’s a vaccine.

Well, there’s no magic solution to sleep problems. They are complex medically and socially in this country. And so when situations like that have arisen in the past, there have been organizations which take a lead in bringing about collaborations. and partnerships, so you can have collective impact on the multiple levels and the multi-facets of a problem as big as sleep health.

This was done, if you look back with anti-smoking campaign. So it’s a good example because there is compelling research and science that said smoking is not a good idea. But at the same time, there was huge cultural normative support of the smoking industry. And there’s layers of detail that go on into that.

But if you look at the process since the 1940s, there is a movement, which then got traction, and part of that was understanding that as soon as anti-smoking was focused on helping children avoid smoking altogether, you got collective action. And of course, more involvement, et cetera. So we have to come up with processes and solutions that are similar to that in terms of engaging the entire public in this debate.

JULIA KIRBY: It’s really interesting to me that in that kind of early thinking about how you’re going to start this movement, that you thought, gee, we have to really get the business community on board with this. Now, why is that? What’s the particular role of business in this movement?

RUSSELL SANNA: Well, our assessment is that if you look at corporations and why they should care about sleep, the interesting thing about– and from what you’ve asked the person on the street, why should a corporation be involved with my sleep? It’s my private behavior.

Well, sleep is a private behavior, but it has public consequences when there is sleep deprivation. And in terms of work, corporations have three bottom lines that are directly impacted by sleep and sleep health.

First, there’s productivity. And we’ve heard the term “presenteeism.” So sleep is critically essential for cognitive performance. So the lack of sleep impairs cognitive performance, which has a direct impact on productivity.

Second bottom line, health care costs. Those comorbidities that I talked about increasing, those are big ticket items in health benefits, not just by the employee but the employee’s family, and everybody on the particular plan.

And then the third bottom line for a corporation is safety. So when cognitive performance is impaired, people make judgment errors. So we think that bringing the agenda of sleep health to corporation aligns with their own self-interest. Plus, we also know that corporations are very important to the lives of individuals. So you’ve got a couple of factors that will help accelerate the change in attitudes and behavior around this.

JULIA KIRBY: That all makes a lot of sense. Of course, managers have a lot of things to worry about, so I’m curious what kind of traction you’re getting. What’s been the response from the business community?

RUSSELL SANNA: Pretty good, I’d say. It’s also mixed. We’ve been at this notion of focusing on corporations for just about a year now, it’s come to us. And so the summit that you attended is an example of the first sort of collective response to this. And among the 35 people in the room, there’s this understanding when you present the science, it’s very clear that people say, I get it. But then to actually act on it is the next big challenge.

And that’s similar to the public perception of sleep as well. If you ask the man or woman on the street, is sleep important? You will more often get, yes is the answer than not. But then, you ask them about their sleep behavior and they’re not acting in terms of keeping sleep as a priority. So corporations are a big, cultural, complex phenomenon that needs leadership, and needs tools and examples. And so the more we get corporations together to help each other in collaboration with the science, we’re going to be able to get some traction on this.

JULIA KIRBY: So is part of helping people change behavior– I have some awareness you’re trying to create a sleep health standard of some kind. Maybe you can say a few words about that?

RUSSELL SANNA: That’s exactly right, Julia. You there’s no plug and play solution to this. So what’s going to work for the Harvard Business Review is not going to necessarily work very well for Delta Airlines.

You’ve got to be able to– by standards we mean, what are the principles that are involved in terms of promoting sleep health? And that could be a range of things, from a leader talking about the good aspects of sleep health and their expectation that people shouldn’t do all-nighters before they are coming into major business meetings, to something very technical, like maybe requiring health insurance providers to provide sleep health screening in all of their annual physicals. And so the notion is that we can come up with these statement of principles. But then, on an individual basis, meet with corporations to tailor those principles to put them in operations in specific places.

So you’ve got big examples of issues around connectivity and people working online, both at home and at work. That needs to be a little bit managed quite a bit more carefully to support sleep health.

JULIA KIRBY: So on the assumption that movements kind of start locally, what would be your advice to a company, a set of managers who wanted to do something internally to change their own corporate culture around sleep?

RUSSELL SANNA: I can give you an example of a company, a small company in the Midwest, that decided to become involved with us. And what we did was we administered a basic, simple questionnaire among a sample of its employees, which teased out this notion of, what are the attitudes and beliefs and behaviors around sleep health? And in particular, to look at where the company’s operations either supported or impinged on sleep health. And that basically held the mirror up to that company. And from that, they learned their employees were probably doing too much email overnight and outside of work hours, and they decided to get together. So they convened top-level management and invited the employees to help solve that problem. And they’ve figured out a way to administer that.

That’s also part and parcel of the example that Leslie Perlow came up with in her book Sleeping with Your Smartphone about how important it is for productivity for employees have predictable time off.

JULIA KIRBY: So you’re also looking for companies to kind of lend their support to the broader movement, not simply look inside but also be involved with the widespread change that has to happen?

RUSSELL SANNA: That’s exactly right. In the same way that corporations are doing a great job of looking at their own operations in order to become excellent places to work as part of their recruitment process, if you put sleep into that equation to help support those good places to work, they’re also becoming a good corporate citizen, and supporting this larger movement will bring about just a tremendous amount of public good for our society.

JULIA KIRBY: Russell, that’s all we have time for today, but thanks for joining us.

RUSSELL SANNA: Thank you for having me.

JULIA KIRBY: Listeners, I’ve been speaking with Russell Sanna, executive director of the Division of Sleep Medicine at the Harvard Medical School. If you’re interested in learning more about the new movement toward greater sleep health, you can check out www.hbr.org, where we’re publishing a continuing series of blog posts on the topic.