How Can We Help People Get More Sleep?

Feb 12, 2014, 8:00 AM, Posted by Lori Melichar

Hairdresser takes a break during work. Image courtesy of epSos.de. Hairdresser takes a break during work. Image courtesy of epSos.de.

How’d you sleep last night?

Like many Americans, I’m a mother of small children. And like many Americans, I have a full time job with a long commute, from New York City to Princeton, New Jersey. Like too many Americans, I don’t always get as much sleep as I need to do a good job as a mother or as a program officer here at the Robert Wood Johnson Foundation.

So when WNYC recently asked me to participate in a roundtable discussion about sleep with Dr. Shelby Freedman Harris and Dr. Carl W. Bazil, I hesitated; clearly, I’m no expert on the subject. But I’ve spent a large part of my career in the Foundation’s Department of Research and Evaluation, where we support research into the root causes of poor health and explore how we can accelerate improvements in health and health care. And as I thought about the studies we’ve supported over the years on behavior change and other research I’ve encountered, I realized that much of it might shed light on the national challenge of sleep deprivation.

What follows are the thoughts I shared at the WNYC panel. I’d be thrilled to hear what you think might work.

Influencing People’s Habits

At RWJF, we are increasingly realizing that, as critically important it is to produce irrefutable evidence that something is bad for us, it’s just as important–if not more important–to pay attention to how people are influenced to change their behavior.

Our health is highly dependent on what we do–not what we think or believe we should do. So the Foundation has been supporting the exploration of the cutting edge of behavior change and thinking a lot about influence.

So, when it comes to helping more Americans get a good night’s sleep, what specific behaviors are we trying to influence? For me, I know it helps when I avoid eating or drinking too late in the evening, watching too much TV, reading on backlit devices, or engaging in stressful conversations (or email exchanges) too close to bedtime.

To change the amount of sleep I get, I’d need to approach each of these micro behaviors one by one...and all together. So, how should I go about that? Here are some influence tactics we’ve learned about from work we’ve supported in recent years.

1. Leverage Social Networks

Nicholas Christakis’ work has shown that eating, exercise and smoking behaviors travel through social networks. This suggests that efforts to change the behavior of one are influenced by (and can influence) the behaviors of many.

Seeking to influence behavior by influencing others in a social network is a strategy that another of our grantees, Microclinic International, is employing. Microclinic International has shown that delivering support for healthy behaviors in and through small, close-knit networks of people in communities has led more individuals to engage in activities that prevent, instead of lead to, diabetes.

To apply what we’re learning about influence through a social network, we might turn to Facebook as a partner. What if I signaled to my friends that I was going to sleep? Might that trigger an earlier bedtime for them?

Employers and managers seeking to influence their workers to enhance their productivity by sleeping more, could take a page from the work of psychologist Betsy Paluck at Princeton University. Betsy’s work suggests that influencing the norms of influential individuals can influence the behaviors of others.  What if I sent an automatic reply to all the emails I received after 9 p.m., lamenting the fact that my colleague was sacrificing his/her health to send me a message?

2. Put Self-Tracked Data to Work

We have a mantra here at RWJF: You can’t improve what you can’t measure.

With this in mind, we’re working with CalIT2 to explore how researchers might analyze the data that people track through their personal health devices like FitBit and Nike+ FuelBands®, as well as the data they enter manually, to gain insight into public health. So much data is being compiled every day, and we’re excited about what it could reveal and how it could be used for broader social good.

These devices are getting much better at tracking sleep, not to mention factors like diet and exercise that may influence our sleep. Increasingly, we all have the potential to be citizen scientists—able to assess with relative ease what having sweets after 8 p.m. does to us, for example, or how much water keeps us hydrated without causing a trip to the bathroom in the middle of the night. Do we sleep better when we exercise? Is it better for us to exercise in the morning or the evening?

Using these devices and setting goals can help people compete with themselves...and their loved ones. Personally, I track my sleep on my FuelBand and get a sense of satisfaction when I see my average rise.

3. Apply Behavioral Economics

Finally, we’ve also been exploring the field of Behavioral Economics. Unlike traditional economics, in which I was trained, behavioral economists don’t assume that informed individuals make rational decisions. In a nutshell, behavioral economists assume that we will make the easy choice; therefore, behavioral economic interventions seek to make it easier for us to make the right decision–and harder to make the wrong decision.

A behavioral economist might tackle the micro behavior of reading on backlit devices by making it difficult to read on an iPad within an hour of bedtime. This could be done with a default setting timed fade on devices and lights—someone could have the option of reversing the fade, but if we make it taxing enough, say by throwing in a few different passwords requiring capital letters and numbers, maybe they wouldn’t go to the trouble... and could sleep better as a result.

In addition, by letting our devices make the decision to stop reading or working, we eliminate a decision we have to make each day. From what we’ve learned from Sheena Iyengar, Barry Schwartz, Sendhil Mullainathan and others who have studied the stress of choice, eliminating the need to make a conscious decision to go to bed earlier than we want to could have a ripple effect on our well being.

(Taking liberties to extrapolate on what I learned this week from Dr. Bazil about the cognitive processing that goes on while we’re dreaming, it’s possible that this increased mental bandwidth could help us solidify more memories each night.)

These are just a few methods researchers are finding effective in influencing people’s behavior when it comes to health. There are certainly others, such as social scientist BJ Fogg’s idea about creating tiny habits (hear an interview with BJ in the last episode of our Pioneering Ideas Podcast–incidentally, Sheena and Barry will be featured in the next episode, coming soon). I also wrote recently about the idea of applying the idea of microtargeting to health and health care.

What other ideas do you have, or have you read about, for influencing people’s health behavior? How can we apply these ideas to helping Americans catch some zzz’s?

Think about it tonight while you’re dreaming!