Is Addis Abeba Sleep Friendly City?

Feb 4 , 2023
By Henock Taddesse

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The evidence speaks strongly to the critical role of the curious activity we call “sleep.” Like most public health efforts, it is not just individual efforts but structural as well as policy decisions that create opportunities for good health, including regulating noise levels, housing standards, school start times for young adults, and availing counselling and therapies, writes Henock Taddesse. He can be reached at taddesehenock@gmail.com

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If social media is anything to go by, Addis Abeba seems to have woken up to the importance of physical activities for maintaining a healthy body and mind. Many people of different ages and gender are often seen in well-synchronised mass-sport rituals. Formal meetings tend to kick off with a healthy dose of aerobic exercises. Yoga is in vogue too, and it is not uncommon to see “workshoppers” rolling out their yoga mats in the place of the old cookie-and-coffee break.

A mere campaign or real, sustained behaviour change.

That, of course, could be hard to tell without research. But the trend is still very encouraging, particularly the much-needed message around the need to ‘move more’ to stave off the fast-exacerbating epidemic of non-communicable diseases and associated socio-economic problems.

Sedentary behaviour is a well-established risk factor for the most common and devastating chronic diseases, such as coronary heart disease, stroke, type-2 diabetes, hypertension, cancer, and mental illnesses such as dementia and depression. The World Health Organization’s (WHO) latest report on the ‘Global Status of Physical Activity’ finds that almost one-third of the world’s population does not meet the weekly recommended physical activity.

For adults physical inactivity tends to be more prevalent among older people and women.

Without a change to this trend of physical inactivity, the WHO warns that nearly half a billion new cases of preventable non-communicable disease will occur in the decade to 2030. Its treatment costs are projected to reach 300 billion dollars. The trend towards routine physical activities should be welcomed, indeed.

However, I want to pose an equally weighty challenge to Addis Abeba: Is it a sleep-friendly city?

The rampant levels of noise pollution get in the way of a sound slumber for many. The sprawling disco bars that are increasingly opened in residential neighbourhoods and the early morning loud prayers from churches and mosques are far too common a culprit for this. The loud prayers and hymns from a nearby church truncated my sleep to the point of forcing me to reluctantly abandon my family’s home for a few days during my recent visit. I got a respite in a hotel.

I asked family and neighbours why this had not been brought up with the churches.

“Can they not keep the sounds within the perimeters of the church during the very early hours,” I pleaded. “Surely, that’s not too much to ask.”

The neighbourhood had sought to negotiate with the Church but to no avail. Rather than offend the sensibilities of the Church and the faithful, the neighbours thought it better to make do with their fate. There are stories of people going to great lengths to salvage their sleep in this situation – including parents bunking with their young kids in basements during times when early prayers were anticipated. Others had moved out of the area altogether.

Sleep is so central to our health and well-being that it should be seen as the foundation for good health, while exercise and good nutrition are the pillars. Good sleep provides the foundation for optimal health, says Mathew Walker, professor of Neuroscience & Psychology at the University of California, Berkeley.

Walker authored a widely acclaimed book titled, “Why We Sleep.” He argues that sleep could be the default state in which life manifested itself first, with wakefulness following sleep rather than the other way around. By implication, even single cellular bacteria manifest a sleep-like state, further bearing out the prescient observation by the Nobel Laureate Biologist Jacques Monod.

Says Monod: “What is true for E. coli is true for the elephant.”

Living beings are similar but for varying levels of complexity. Whilst sleep is universal, the rest of each species exhibits unique characteristics–defined by the length of sleep, when they sleep (nocturnal or diurnal) and what the sleep session constitutes.

Humans are advised to sleep for eight-hour due to the calibration of the internal clock that is unique to the species – the ‘suprachiasmatic nucleus.’ Conversely, lions sleep for 16 hours.

We spend approximately one-third of our lives asleep, a curious state of apparent inactivity. We lie unaware of and unbothered by the world during times of sleep. Despite the seemingly limited benefits and potential dangers associated with lying unconscious for a period, evolution has retained this necessity across the animal kingdom. No animal can afford to forgo sleep for long. Some sleep as long as 18 hours.

Sleep is universal and is present in all life forms. Current perspectives proffer that it manifested very early in evolution with the advent of single cellular life.

Even during the long and arduous transoceanic migrations, birds make time for ‘power naps’- mid-flight. Aquatic animals also indulge in sleep, one brain hemisphere at a time. They cannot afford to shut down the whole brain underwater to maintain essential body functions. Scientists once thought that sharks did not succumb to this universal rule; as it happens, they do sleep, except that they lack eyelids, making them appear awake when they are asleep.

Adequate sleep filled with dreams has healing and restorative powers, especially ones filled with images and emotions about traumatic experiences. People with post-traumatic stress disorder who dream about their painful experiences are shown to improve over time.

“It’s not just time, but time spent dreaming that heals all wounds,” says Walker.

A dream is not just about emotions but fuelling creativity. There are historical references to famous people who credit dreams for breakthrough innovations and creativity, such as the discovery of the Periodic Table by Mendeley; Paul McCartney’s songs “Yesterday” and “Let it be”; and, Rolling Stones’ “Satisfaction.”

Sleep is vital as its deprivation could be consequential and damaging. The Guinness Book of Records has suspended records for extended wakefulness based on evidence of the deleterious effects of sleepless nights on the body.

In rare conditions such as Fatal Familial Insomnia and inability to fall asleep due to abnormalities in the part of the brain called the thalamus, patients experience extreme mental and physical deterioration. They could die within about 10 months.

Insomnia is a serious issue, a qualified definition of lack of sleep for at least three nights a week, lasting for three months. It usually precipitates due to unregulated emotions such as worry, anxiety, and stress. It is further divided into two types: Onset insomnia, which relates to having difficulty falling asleep, and sleep maintenance insomnia, which is about the difficulty of staying asleep.

Even with this firm definition, insomnia is prevalent among people; one out of nine people experience insomnia at any one time. It is more common amongst women than men and Africans and Latinas than Caucasians.

People with insomnia fail to achieve the metabolic adjustments necessary to facilitate sleep: cooling down the body’s metabolism, including a drop in core temperature. The mind stays overactive, ruminating about the day’s happenings.

However, it is not just the complete inability to sleep that kills; chronic suboptimal sleep (below about eight-hour) is known to curtail life expectancy significantly.

Population-based studies and experimental evidence presented in Walker’s book highlight strong links between sleep deprivation and common diseases that plague populations worldwide: cardiovascular diseases, cancer and mental as well as psycho-behavioural and metabolic disorders.

Studies conducted in North America and Europe have looked into the effect of daylight saving, which adjusts the clocks backwards in March, effectively shaving off an hour from everyone’s sleep. Hospital incidence data from different countries have shown that the incidence of heart attacks rises sharply in the days following this shortening of sleep time.

The reverse is also true; heart attack rates decline when the clock is wound forward in October in anticipation of the shorter winter days, affording everyone an hour-long sleep.

The association between chronic sleep deprivation and cancer is also ‘well established’. So much so that in Denmark, the government has agreed to pay compensation to public sector workers who have developed cancer following prolonged shift work.

Walker discusses how chronic lack of sleep disrupts the routine immune response mechanisms that keep cancerous cells in check.

Sleep deprivation encourages more aggressive types of cancers and metastasisations (spread). The evidence for links between obesity and diabetes is also discussed in great detail. A series of experiments in humans and mice reveal the changes in diets precipitated by lack of adequate sleep and the effects on how the human body responds to food.

When under-slept, we are more likely to eat more, crave high sugary foods, and maintain high blood sugar as the body grows resistant to insulin. Even a few days of sleep disruption can result in high blood sugar that mimics a pre-diabetic state.

Walker’s book showcases experiments that prove that sleep disruption, either before or after learning new information, decimates memory; no amount of ‘catching up on sleep’ after that would salvage optimal memory. The author rails against the neglect of much-needed sleep for children and young adolescents, often robbing them of this physiologically critical nourishment for neurodevelopment.

Young children and adolescents need morning sleep badly, which early school start times and societal misgivings curtail.

The links with mental illnesses are compelling: from mood swings, impulsiveness and lack of focus to anxiety, depression, bipolar disorders, psychosis, and dementia. The book discusses a range of experimental evidence that shows the impact of even brief sleep disruption on the affective and emotional responses of otherwise healthy young people.

This makes me think of families who must wake their kids early in the morning just to beat the traffic in Addis Abeba. The sleep cycles of children and adolescents are wired differently to adults; they are much disadvantaged by early rises in their cognitive capacities.

The evidence speaks strongly to the critical role of this curious activity we call “sleep.” Maintaining good sleep habits is a foundation for healthy and productive lives. Like most public health efforts, it is not just individual efforts but structural policy decisions that create opportunities for good health, including regulating noise levels, housing standards, school start times for young adults, and availing counselling and therapies.

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PUBLISHED ON Feb 04,2023 [ VOL 23 , NO 1188]

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