The Japanese Government’s “Good Sleep” Challenge: Sleep Guidelines for Health Promotion 2014

Abstract

Sleep is one of the most important components of lifestyles that are associated with risk of non-communicable diseases (NCDs). For example, it is well known that both short and long durations of sleep are associated with increased risk of cardiovascular disease.1 Some studies have shown that irregular sleep rhythms (eg, those resulting from shift work) is associated with increased risk of cardiovascular disease2 and cancer.3 Poor quality of sleep due to apnea and nocturnal intermittent hypoxia is also recognized as a risk factor for cardiovascular disease.4,5 Therefore, it is crucial to have “good sleep” for the prevention and control of NCDs; however, we have few guidelines for sleep, unlike other lifestyles, such as diet and physical activity. In fact, there is no description related to sleep in the global action plan for the prevention and control of NCDs for 2013–2020.6 At the end of March 2014, the Japanese Heath Service Bureau published “Sleep Guidelines for Health Promotion 2014”7 after thorough discussion by an expert committee for the revision of previous guidelines. First, the expert committee concluded that evidence exists, especially from epidemiological studies with large sample sizes of free-living populations over the last decade, that allows us to understand the effect of sleep on risk of NCDs and focusing on “good sleep” for health. The new guideline has 12 messages on how to improve sleep for health, such as how sleep can reduce risk of NCDs as well as accidents. Although previous guidelines used the phrase “comfortable sleep”, the expert committee concluded that “comfortable sleep” was too subjective an expression and decided not to use this phrase in the new guideline. The present guidelines have messages for three generations (ie, the young, middle-aged, and elderly). For the young generation, such as schoolchildren, the guidelines recommend not staying up late, as this may result in a short duration of sleep.8 The use of smartphones is also likely to delay the time of falling asleep and reduce sleep duration. We warned young persons and their parents, as well as health professionals, of these and other current major causes for inadequate sleep duration. For the working middle-aged generation, the guidelines recommend that workers sleep as long as they can, because persons in the working generation are likely to receive inadequate sleep and justify it as being for work.9 To help workers improve their sleep, we also mention several tips for falling asleep and sleeping deeply. Persons in the elderly generation were encouraged not to make an effort to extend sleep duration if they cannot sleep. Some elderly people get enough sleep but are obsessed with the idea that they could not sleep well, which leads to difficulty falling asleep.10 This message encourages them to have “good sleep” by reducing their obsession. The Japanese Health Service Bureau published the new guideline to be used by health professionals in community workplaces and clinics, but it will also be made available to all residents through the government’s health promotion measures as well as commercial tools. We also requested that all users review their own sleep and use the guidance to improve specific individual sleep issues, because the adequate range of duration and suitable methods vary widely between individuals and generations. The Government of Japan has started a new challenge for health promotion through “good sleep” for the prevention and control of NCDs. In this challenge, we encourage all residents to assess and improve their sleep though “Sleep Guidelines for Health Promotion 2014”.