September 24, 2020

Manly Quarantine

Healthy is Life

Why We Buy In to the Big Business of Sleep

In a small room without windows, I am instructed to breathe in sync with a...

In a small room without windows, I am instructed to breathe in sync with a colorful bar on a screen in front of me. Six counts in. Six counts out. Electrodes tie me to a machine whirring on the table. My hands and feet are bare, wiped clean and placed atop silver boards. My finger is pinched by an oximeter, my left arm squeezed by a blood-pressure cuff. Across from me, a woman with a high ponytail, scrublike attire and soft eyes smiles encouragingly. She is not a doctor, and this is not a lab. The air smells like lavender and another fruity scent I later learn is cassis. My chair is made of woven reeds, topped with a thick cushion and a pillow for lumbar support. The windowless room feels more cozy than claustrophobic; this is not torture but a luxury. I am, in fact, in a five-star resort with a 2,000-sq-m spa and an indoor heated pool. This process, I have been promised, will help me sleep better.

For years, I had been waking up exhausted. My primary care doctor ran my blood work three separate times to try to suss out an underlying problem, and each time it came back fine. I had no problem falling asleep, or even really staying asleep. The problem was that no matter how many hours of sleep I got, I had to haul myself out of bed in the morning, grumpy and lethargic.

So, in December, before COVID-19 ravaged the world and made travel unsafe, I journeyed to a beautiful valley in Portugal’s Port wine region to take part in the €220-per-night Six Senses Sleep Retreat to try to learn to sleep better. Six Senses has long made wellness and sustainability two of its main pillars of business. They have yoga retreats and infrared spas. They’re aiming to be plastic-free by 2022—all plastic, not just single-use. But for the past two years, the luxury resort brand has bet big on sleep. In 2017, they launched a sleep program with a sleep coach, sleep monitoring, a wellness screening, bedtime tea service and a goody bag of sleep-health supplies. The idea was that, with three nights of analysis and behavioral adjustments, I might finally train my body to get a good night’s sleep. It’s a vacation with a purpose, and it’s one with big appeal: Six Senses offers the program at 10 of its resorts and is requiring all new resorts (including New York City in 2021) to include the program.

Luxury hotels have been pushing health as a selling point for travel since well before events made the two oxymoronic. The global wellness-tourism market was valued at $683.3 billion in 2018 by Grand View Research, and according to the Global Wellness Institute’s 2018 report, 830 million wellness trips were taken by travelers in 2017. That was up nearly 17% from 2015. In 2018, American Airlines partnered with the meditation app Calm to help their passengers sleep. Headspace has partnerships with seven different airlines to do the same thing, all over the past few years. A survey from the National Institutes of Health shows that the number of U.S. adults who reported meditating while traveling tripled from 2012 through 2017. And all this travel wellness has one common goal: to get people to sleep better, because we know that—generally—people aren’t sleeping well.

In 2016, the Centers for Disease Control (CDC) published findings claiming that one-third of adults are not getting enough sleep and that sleep deprivation is costing the country some $400 billion each year in productivity. It is also important to note that many studies have found a large disparity in sleep quality based on race, ethnicity and socio-economic status. In comparisons of white and Black populations, studies have found that white women have the best sleep duration and Black men the worst. Those disparities do not go away when studies adjust for socio-economic level. The Sleep Foundation writes that a factor may be higher levels of stress because of discrimination in daily life.

Although consumers have opened their wallets in pursuit of better sleep since the debut of memory foam in 1966, the past five years have been a boom for the sleep-wellness industry. The global sleeping-products market brought in $69.5 billion in revenue in 2017, and, according to the most recent report published in May 2018 by P&S Market Research, the industry is on track to hit $101.9 billion in 2023. The consulting group McKinsey put out a seven-page guide to investing in sleep health in 2017. And anyone who has tried to buy a mattress online recently has noticed just how many new mattress brands there are: Casper, Tuft & Needle, Purple, Leesa, Allswell, SleepChoices, Bear. The U.S. mattress industry has doubled in value since 2015, from $8 billion to $16 billion.

In my desperate quest for good sleep, I’ve bought into all of this. When I sat down to calculate it all, I was stunned to find that over the past three years, I have spent more than $1,000 on sleep. I bought a Fitbit, a Sonos speaker with a built-in alarm, a new pillow, a new mattress, a fluffier comforter, a weighted blanket, cold eye masks, a humidifier, pajamas made of bamboo, pajamas made of 100% cotton, pajamas made of satin and an alarm clock that mimics a sunrise. The sleep retreat, I hoped, would do something all the other purchases had not.

I don’t sleep well on the plane. After four hours of fitful slumber interrupted by turbulence, dinner service and my seat neighbor bumping into me on the red-eye from New York City to Lisbon, I groggily deplane and replane for the short flight to Porto, down another espresso and drive the one and a half hours to the Douro Valley. By the time I arrive at the hotel, the sun is beginning to set and my bed looks very inviting. It is only 5 p.m.

I’m led to my room by a woman named Vera who introduces my supplies: an eye mask, bamboo pajamas, earplugs, lavender spray for my bed and a worry journal where I can write down anything bothering me before I sleep. I flop down on the €2,500 mattress and hope that whatever I learn here will be easily transferable to the $200 mattress I bought off Amazon and my sad cotton-blend sheets. By the bed is a small box made by ResMed, which will track my movements while I sleep and present me with colorful graphs of data each morning.

I follow the given instructions: eat dinner leisurely, have only one glass of wine, take a bath in the deep tub, drink chamomile tea, put on the new pajamas, write in the journal and go to bed around 10 p.m. When I wake up, the ResMed app shows a series of colorful bars—my “sleep architecture” progression through deep, REM and light sleep—and a score of 97. “I had nothing to say about that sleep,” shrugs Javier Suarez, the director of the spa and wellness programs at Douro Valley, at my first consultation. He studied physiotherapy at the University of California, San Francisco (UCSF), and he knows this is abnormally good. “What we [often] see here is the first night, [guests] sleep bad because they come jet-lagged or they’re anxious,” he says. I’d slept a hard, uninterrupted eight hours. I feel proud of the prep I did before I came, adjusting my bedtime to try to prevent jet lag.

There are many scientific reasons to desire good sleep. Poor sleep quality is associated with a whole host of unhealthy side effects. Getting bad sleep puts people at a higher risk for diabetes, cardiovascular disease, Alzheimer’s, impaired memory, problem-solving issues, fatigue, anxiety, mood disturbances and poor performance at work. There’s a market, then, to help people sleep better, not just because it makes money, but also because it is generally good for people. “There’s no wellness without good sleep. Forget about it,” Suarez tells me. “If you don’t make sleep your priority, then you will not be healthy.”

The Global Wellness Institute attributes the growing wellness industry to four things: an aging population, increased global rates of chronic disease and stress, the negative health impacts of environmental degradation and the frequent failures of modern Western medicine. In the case of insomniacs, the ever popular sleep drugs Ambien, Lunesta, Sonata and others received black-box warnings from the FDA—the agency’s most serious caution—in May 2019. Those turned off by the foreboding -packaging may turn to more holistic sleep-wellness methods. Sleep scientists have also been working to better publicize their research on the benefits of sleep hygiene. In 2013, the CDC and the American Academy of Sleep Medicine launched the National Healthy Sleep Awareness Project, which aimed to raise public knowledge of sleep disorders and the ways sleep affects health.

Obsession is the inevitable peak of any trend. While I’m at the resort, Suarez recommends several other ways I can optimize my health, including Wellness FX, a company that will run a full blood panel, and Viome, a company you can mail your poop to in order to learn about your gut -micro-biome. We have the ability now to analyze absolutely -everything about ourselves sans doctor oversight: our blood pressure, our pH, our urine, our poop, our genes. Sleep is just part of the cultural movement toward health obsession. A 2017 study done by Rebecca Robbins at New York University found that a full 28.2% of people in the U.S. track their sleep—with an app, a wearable sleep tracker, or both—and Robbins, now a postdoctoral fellow at the Brigham and Women’s Hospital and Harvard Medical School, says she thinks that number has likely increased since the study.

All this data is what runs the sleep-wellness industry. Every major sleep-wellness company tracking sleep is collecting data—cumulative data. Eight Sleep, for example, says it has 40 million hours of sleep traffic logged. Alexandra Zatarain, a co-founder and vice president of brand and marketing for the company, says the medical establishment has “never had access to people’s actual sleep [outside of] clinical settings.” Six Senses, on the other hand, has complete data about how people sleep when they’re on vacation, thanks to their sleep programs. Companies theoretically use all this data to make their products better for the consumer, but they also use it for targeted marketing (perhaps to sell you a new pillow or blanket) or sell it outright. Some sleep-wellness companies more benevolently share their data with academic institutions to learn more about what it could mean. Eight Sleep is working on studies with Mount Sinai, UCSF and Stanford. Matt Mundt, who founded a company called Hatch Sleep, which makes a blanket cocoon sleep pod for adults, says he plans to announce a partnership with a major medical system to bring the product into clinical trials.

The sleep-wellness industry is made up of three categories of products: treatments (prescription sleep aids, homeopathic remedies, and doctor interventions like surgeries or sleep-apnea-treatment devices), routine disrupters (sleep trackers, meditation apps, dietary changes and sleep programs) and nesting (mattresses, pillows, curtains, humidifiers). Treatments are mainly performed and monetized by the medical industry and the hospitality industry (like this sleep retreat). Most of the buzzy sleep-wellness companies like Eight Sleep, Oura, Casper and OMI are creating products that fit into the routine disrupter and nesting categories. Eight Sleep, for example, sells a mattress that regulates its own temperature (nesting) and tracks your sleep to provide personalized coaching (treatment). The brand has raised $70 million over the past three years, with $40 million of that raised in November. Zatarain says the company plays to the public desire to self-analyze and self-optimize. “We want people to be asking themselves, ‘Am I sleep-fit, or not?’” she says.

Courtesy Six Senses Douro ValleyAn outdoor resting spot at the Six Senses Douro Valley in Portugal

After my first night of delicious, wonderful 97-score sleep, I’m feeling a little cocky. I—I’ve convinced myself already—am sleep-fit. Suarez is not so sure. “I bet you tonight you’re going to do worse,” he says on day two. “You’ll get an 87 or something.” The data, he says, does not care about my confidence.

I spend much of my second day at the retreat thinking about my sleep score. The keys to good sleep, I’m told, are simple: exercise; eating well; not drinking too much; a dark, quiet space; creating a wind-down routine; no screens two hours before bed; and a comfortable bed. The greatest enemy of sleep is stress. The main value of the sleep score—and sleep tracking in general—is not to affect your sleep, but to tell you when you need to change your waking habits.

“The biggest win [of sleep tracking] is in the behavior change,” says Els van der Helm, the co-founder and CEO of Shleep, which designs customized sleep programs. Through her company, van der Helm works to convince companies that employees’ sleep should be prioritized not only because it is good for them, but also because it will make the company more profitable. (Shleep itself raised $1.4 million in venture capital in August 2019.) At her presentations, van der Helm sees the same behavior again and again. As she describes easy things employees can do to improve their sleep, she suggests a wake-up light alarm. Immediately, everyone grabs their phones and orders one online. “That’s great, but can they be as passionate about exercise, or creating a wind-down routine?” she says. “The issue is that people love throwing money at the problem and just buy something and think they’re good. ”

The problems with our sleep—for those who are otherwise healthy—are often problems we can fix ourselves. “You don’t need any of that stuff,” Suarez tells me when I run through the list of products I’ve tried. “People say, ‘How can I sleep better?’ And my answer is, ‘How can you have a better life?’”

Making sleep improvement all about what we can purchase to help us also creates an untrue narrative around what that data means. In her study on sleep-tracking habits, Robbins also found a disparity in who tracks their sleep: the higher a person’s income, the more likely they were to track their sleep. “A very concerning aspect of the conversation around sleep is the message that sleep is a luxury,” Robbins says. “We need to remove the notion that sleep is a luxury and replace it with the truth, which is that sleep is something we all deserve and that unifies us.”

So on my second day at the sleep retreat—yes, a massive luxury—I do everything right. I think about my sleep score and forgo a second glass of wine, even though I’m on vacation. I think about my sleep score and go to yoga. My body and I deserve it.

That night, I feel terrible getting into bed. I’m stressed about the amount of work I have to do, and I keep thinking about how that stress will disrupt my sleep. Suarez is either a sleep witch who intentionally cursed me, or someone who knows what he’s talking about. My money is on the latter. I close my eyes and open them again only a few hours later, thinking about my sleep score. Eventually, I get back to sleep and wake in the morning to a markedly worse 85.

Suarez had warned me that some Type A people slept worse on their second night simply because they knew they were being tracked, but when Vera reviews my Night 2 results, she says she can tell what the problem was. The ResMed shows two scores for each night’s sleep, both calculated based on your movement in bed: one for your mental sleep and one for your physical. On the second night, my mental sleep was fine. It was my body sleep that was a disaster. I needed, Suarez says, to wear myself out.

On the third day, I sign up for a cardio class in the gym after a nice long walk. By the time I begin my wind-down routine in the evening, I’m already sore. In the morning, I wake up feeling refreshed. I can’t remember the last time I felt this way first thing in the morning. I roll over and check my score: 94. Success. The charts show that I had not only slept well, but I also got plenty of deep sleep. “I’m not giving you a perfect solution for sleep,” Suarez says before I leave the resort, “I’m just showing you what happens when you do things right.”

When I return from the sleep program, I feel better physically than I have in a long time. I find myself making decisions based not on my health, but on how they will affect my sleep quality. I don’t have coffee late even though it’s a struggle to stay awake back on the East Coast. I do my wind-down routine and spray my lavender spray and sleep hard through the night. The biggest change, though, is how often I think about my sleep, which is constantly. I join a gym, something I had been meaning to do for a year, simply because I know it will help me sleep. And it does work—for a while.

My perfect sleep routine begins to devolve even before the pandemic hits. At home, I fall asleep with the TV on watching Monday Night Football. I don’t have time to exercise every day. Unsurprisingly, I’m much, much more stressed than I had been at the luxury hotel with every amenity in the world and no job to do. I need motivation—inspiration—so I turn to Instagram, and I find @followthenap.

Alex Shannon is a “sleep influencer” who spends most of his time running the account, crafting cozy-looking images of heavenly sleepscapes. He started the account a year and a half ago and says he has noticed a substantial growth in the focus on sleep health in the time since. The boom in products has been good for him too. Every new supplement or sunrise alarm clock or mattress is another potential sponsorship. He’s one of only a few influencers focused solely on sleep, but plenty of general wellness influencers also dabble in sleep, and the content is there. More than 26.8 million posts on Instagram have been tagged #sleep and almost 4 million have been tagged #nap. Even now, when he’s not traveling because of COVID-19 concerns—he was often sent to expensive sleep retreats gratis, in exchange for posts—Shannon has pivoted his sleep content to his own home. And he says he’s had a lot of interest from foreign travel boards making plans for when the travel restrictions are lifted. “I feel like as recently as a few years ago, making rest and relaxation a priority was seen as selfish somehow,” Shannon says, “but with the rise of ‘self-care,’ it’s become much more acceptable to slow down and take care of ourselves.”

Part of that impulse to slow down has been engineered by sleep companies themselves. If wellness can look good on Instagram, it can make money. Just take the boom in Casper sales. Casper was hardly the first mattress startup to market, and it wasn’t even the first to roll its mattresses. But in 2014, the company encouraged customers to post videos unboxing their Casper mattresses and watching them unfurl. The influx of mesmerizing videos, all featuring Casper’s logo, helped the company become the leading brand in mattress startups. James Newell, a vice president at an investment firm that backed Casper, said in an interview with Freakonomics that Casper “would tell you they’re not a mattress company, they’re a digital-first brand around sleep.” It helps that Casper is estimated to have an $80 million marketing budget.

“Our brand ambassadors”—a common synonym for influencers paid to promote a product—“are providing their honest feedback and review of our products, providing potential customers with another perspective outside of our own,” says Julianne Kiider, the affiliate and influencer manager for Tuft & Needle. “The way we sleep is such a personal thing, so these diverse perspectives help guide followers to the right product for their own sleeping habits.” Several major mattress brands declined to share data about how much of their advertiser budgets are spent on influencers, if mattresses are given to influencers for free, and how well influencer marketing really works. But a scroll through major wellness-influencer accounts shows plenty of cozy bed photos with discount codes in the captions. Shannon says in this scenario, the influencer’s payment is often a kickback of the percentage of mattresses sold with their discount code. For him, it’s paying off.

“We all dream of being a little more relaxed, a little less stressed and not feeling guilty about indulging ourselves,” he says. That dream—of sleeping through the night and being more relaxed and waking up refreshed and ready for the day—is exactly what has made sleep wellness such a lucrative industry.

In March, four months after my visit to the sleep retreat, COVID-19 began to spread in the U.S., and the dream felt further away than ever. Several of my friends got sick, and I stopped sleeping. Then the Black Lives Matter protests began, and I continued to sleep fitfully, worried for my friends and fellow citizens. This time, though, I knew what mistakes I was making. I knew that stress was keeping me awake, bolstered by scrolling through my phone for news updates until 11 p.m. and not exercising and having another glass of wine. I knew all that, but I was too stressed to stop. One night, in a sleepless haze, I swiped away from the news and found myself browsing my old online shopping haunts. I added a new lavender spray and a set of pajamas to my cart, and clicked Buy Now.

McKinney is a features writer and co-owner at Defector Media

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