MPs and peers of the All-Party Parliamentary Group (APPG) for Sleep have urged immediate action to tackle what they are calling a sleep crisis in the north-west of England, marked by concerning levels of sleep disorders and inadequate sleep among the region's residents. Experts told the APPG that the crisis is made worse because the north of England is hit particularly hard but most sleep clinics are in the south.

Insufficient sleep has been scientifically linked to a multitude of detrimental effects, including increased risk of early death, decreased productivity, higher healthcare expenses, and a high likelihood of accidents. In the United Kingdom alone, sleep disorders are estimated to place an annual economic burden of £40 billion through lost productivity and healthcare costs. That is equal to £1 in every £50 of national income.

The north-west of England is particularly hard hit. While the NHS recommends a minimum of seven hours sleep per night, recent survey data from SIMBA in April 2023 highlighted the north-west of England as the most sleep-deprived area in the country, with over 74% of individuals receiving less than seven hours of sleep per night. Merseyside in particular was highlighted as the worst area for sleep deprivation in the whole of the UK.

"Lack of sleep affects our daily lives, our work and our relationships. Insufficient sleep increases mortality risk by up to 13 per cent and has close associations with poor mental health, especially depression,"

said Jim Shannon MP, Chair of the APPG on Sleep.

The negative impact of poor sleep is often increased in the most deprived areas and research undertaken by the Mental Health Foundation in 2023 found that concerns about finances had a negative effect on a person's ability to engage in some activities and showed that 30% of adults in these circumstances in the UK have poorer quality sleep.

Experts suggest that a majority of the people in the north-west of England suffering from sleep-related disorders are not getting the treatment they need. Dr. Sonya Craig, a sleep and respiratory physician working at University Hospital Aintree, Liverpool, estimated that when last reviewed in 2015 (using the British Lung Foundation toolkit) only a third of the patients suffering from sleep apnoea are using continuous positive airway pressure (CPAP) machines, which would help them sleep better.

"Sleep apnoea today is like hypertension in the 1950s. There are so many patients out there. In our practice, we should have diagnosed 22,000 people, according to a British Lung Foundation model, but fewer than 8,000 are on CPAP,"

said Dr. Craig.

"Clinics are down in the south while all the sleep problems are up in the north, So we have had to outsource some of the workload to reduce waiting times using our software".

said Dr. Craig

Sleep disturbances are especially prevalent among women experiencing menopause and perimenopause, impacting their daily activities and work performance. According to a UK survey, 60% of UK women are affected by insomnia at some point in the menopause transition.

Dr. Clare Spencer, a GP and co-founder of My Menopause Centre, said women struggling with unpleasant menopause symptoms such as brain fog, anxiety and hot flushes may find it difficult to maintain good sleep hygiene and keep up good habits.

"Many women I speak to drink alcohol to get them off to sleep. In addition to the negative health consequences of this, consuming alcohol before bedtime can mean that your sleep is lighter, hot flushes are worse and so you may be more likely to wake in the night,"

said Dr. Spencer.

The National Institute for Health and Care Excellence (NICE) recommends prioritising Cognitive Behavioural Therapy for Insomnia (CBTi) as the primary treatment, but the availability and access to CBTi across the country remain inconsistent.

A major concern highlighted by experts is that healthcare professionals are trained to look at sleep problems as a symptom of other health issues and not as an issue by itself. This leads to good sleep not being given the priority it deserves, which reflects in patients struggling to access CBTi therapies across the country.

Lisa Artis, CEO of The Sleep Charity, said

"Patients come to us frustrated at times due to a lack of clinical engagement with their sleep issues. If patients present themselves to their GPs with low mood and sleep issues, we find that the GPs tend to treat the low mood and leave out the sleep issues."

Patients who feel they don't have their sleep issues adequately addressed by their doctors may end up choosing to self-medicate with over the counter remedies. However, the consequences of insomnia and its mistreatment, such as the use of inappropriate medications, can lead to an increased risk of falls among older individuals. Falls can result in severe injuries, decreased independence, and increased reliance on healthcare services. Long-term use of medicines designed for occasional, short-term use can be very dangerous.

New technologies and digital innovations are being trialled by healthcare professionals to reduce the waiting times of patients who wish to diagnose and treat their sleep issues. Among these is an ‘intelligent clinical decision support system software' that could help non-specialists diagnose sleep apnoea, chronic insomnia and other sleep disorders and direct patients towards the care they need.

"In Liverpool, we have utilised such an approach to transform our sleep pathway resulting in reduced waiting times for patients, identifying high risk patient groups proactively in real time and ensuring that resources are directed to where it is most required,"

said Dr. Biswajit Chakrabarti, a consultant respiratory physician.

The importance of a good night's sleep cannot be overstated. In 2022, YouGov asked people in the north-west which health discovery they most wanted in the year ahead. A new pill for joint pain and a safe way of improving sleep were at the top of the list. This is clearly an issue that is important to the people of the region.

In another 2022 YouGov poll, 88% of responders in the north-west considered sleep quality very or somewhat important. People in the north-west also said that poor quality sleep had a higher impact on productivity than anxiety, back pain, depression or headaches.

Recognising the gravity of the situation, the All-Party Parliamentary Group for Sleep organised an event on the 5th of December that brought together MPs, clinicians, employers, trade unions and individuals affected by sleep issues. The MPs and peers were in Westminster while several experts gathered at the University of Manchester. Its primary objective was to unite stakeholders and generate momentum for change.

The APPG for Sleep has outlined a comprehensive five-point action plan for the north-west of England, which includes

1. Better and easier diagnosis of sleep disorders and insomnia

2. Improved access to Cognitive Behavioural Therapy for Insomnia (CBTi) for first-line insomnia treatment and universal access to all appropriate treatments

3. End current inappropriate medical interventions which cause harm to patients

4. Providing clinicians with improved access to a wider range of sleep treatment and management options as they become available

5. Enhancing public information on sleep disorders, prevention, and treatment options

The Sleep Crisis in the north-west of England requires immediate attention and collaborative efforts from all stakeholders. The APPG for Sleep urges citizens in the north-west of England and the NHS to be more mindful of the impact of sleep disorders on individuals and families and to join forces in improving sleep conditions throughout the region.