Up all night: Capitalising on India’s big sleep gap

It was in early 2018, in the temperature-controlled Sleep Research Laboratory in the Life Sciences department of Delhi’s Jawaharlal Nehru University (JNU), that seven mice took us one step closer in the quest to unravel the mysteries of sleep. Shepherding them was Dr Sushil K Jha, a neurologist who’s devoted 20 years to mine whatever there is to know about sleep and memory consolidation.

In his experiment built on classical conditioning, Jha trained the mice to respond to a light that’d flash before a dispenser apportioned some juice. He then conditioned some to sleep after the ‘treat’, and restricted the others’ sleep. His findings? One: that sleep-deprived mice didn’t respond to the sequence of events and forfeited their chance to get juice. Two: proof that sleeping cements appetitive memory, or memory of food-related stimuli. Appetitive memory is what makes us pick a cola in a clear, chilled bottle over cola in an opaque plastic bottle. It’s what prevents animals from visiting an area rich with food if they’re conditioned by the stimulus of a threat (read: predator) there. Sleep dictates responses to stimuli and can be the difference between whether you have, or are had.

“In essence, sleep deprivation after the acquisition of a new memory leads to some impairment of that memory,” Dr Jha underlines.

Let’s zoom out and view things in perspective. In March 2017, activity tracker Fitbit announced its India-specific data for 2016. India was the second-worst sleeper (6.55 hours) after Japan (6.35 hours). As per the Sleep Cycle app, which updates country-wide findings every week, fewer than 20% Indians sleep for eight hours. Godrej Interio’s 2018 survey, which had 8,000 participants in metros, revealed that 93% reported sleep deprivation. Mattress startup Wakefit, which has an ongoing survey called the Great Indian Sleep Scorecard, released its findings across Bengaluru, Hyderabad, Delhi, and Mumbai in March 2019. Mumbai had the worst sleep, with 81% respondents reporting insomnia and 36% sleeping less than seven hours, followed by Delhi, Bengaluru, and Hyderabad.

It’s fair to raise a brow over sleep surveys by commercial stakeholders in the ‘sleep economy’. But India has no official or government-mandated sleep survey to date. We’re one of many countries on a bandwagon that equates the lack of sleep with success. Nowhere is this more apparent than in the US, where Silicon Valley is obsessed with attaching metrics to sleep, turning a necessity into a task to be perfected in the cult of productivity. Sleep, as they know it, is an inconvenience in the pursuit of optimum wakefulness, something to be hacked through. Consider Oura smart rings, electromagnetic field-blocking Faraday tents, mattresses with sensors, white noise machines, lights that simulate sunrise, mulberry silk eye masks, and Nightfood.

Yet, the US’ Centers for Disease Control and Prevention declared sleep deprivation a public health epidemic. No such concern in India, whose prime minister uses lack of sleep (3-4 hours) as some kind of calling card.

India’s sleep economy largely operates on the fulcrum of bedding and treating disorders like obstructive sleep apnea (OSA) and insomnia. These seem drab compared to flashy sleep tech developed elsewhere — unless you listen to those who harbour dreams of culturing a sleep ecosystem in the country.

But first, a crash course. Why do we need sleep?

Short answer: We don’t know.

Sleep science

“As far as we know, the only reason we need to sleep that is really, really solid is because we get sleepy.”

This, one of the most famous quotes in sleep science circles, is attributed to William Dement, who helped establish the Stanford Center for Sleep Sciences and Medicine.

To gauge where today’s sleeping patterns could take us tomorrow, we must first understand how, of all basic biological functions (eating, hydrating, excreting, sleeping, and mating), sleep is the least known, but the most compromised.

“Here’s what we can confirm. It governs memory, emotional fluctuations, metabolic rate and hormonal balance, immunity, and protein synthesis,” says Dr Jha. “It’s only during sleep that growth hormone — essential for cell repair and reproduction and by extension, bone and muscle health — is secreted.” Growth hormone is why children need more sleep than adults. Infants can sleep up to 17 hours daily because their brain’s mushrooming synaptic connections, bombarded with information after they come into the world, need rest to make sense of it all.

Adults aren’t immune to sleep’s domino effect on every bodily function either; not for nothing is sleep deprivation a popular torture method. “In the head of the interrogated prisoner… he has one sole desire: to sleep. Anyone who has experienced this desire knows that not even hunger and thirst are comparable with it,” wrote former Israeli prime minister Menachem Begin, on being a political prisoner of the KGB (Russia’s spy agency) in Soviet Russia.

Sleep’s cyclical nature is something to behold. It’s at night that the brain truly comes into its own after retreating from the sensory overload of the day. It decides which memories to keep and which ones to junk in stages one and two. It then kicks deep sleep (stages three and four) into gear, prodding cells to secrete growth hormone. Deep sleep is also when the brain literally cleans house.

“Neurons in the brain, densely packed during daytime, expand at night. This is so that accumulated metabolites (cellular metabolic waste) can be flushed out,” Dr Jha explains. “The spaces between these neurons then become like roads after dark. It’s like going on a long drive at night versus driving in the day.”

Flights of fantasy: Dreams manifest during REM sleep, which typically surfaces in the early morning hours

Our body cools and breathing slows during deep sleep before we wake briefly, only to be taken through REM sleep. This is when we dream. This is when our eyelids flutter, moods are regulated, protein synthesis reaches its peak, and bodies reach their lowest temperature. This is when our breathing becomes shallow. This is when the brain is free to play.

Non-REM and REM sleep together form ‘sleep architecture’, so called because it resembles city skylines on a hypnogram. Think a sleep graph, measured on polysomnography machines. “Each stage lasts a certain duration and is repeated a number of times at night,” says Dr HN Mallick, president of the Indian Society of Sleep Research (ISSR). “Inadequate or poor quality sleep affects this architecture. Which we’re seeing a lot more of.”

Material designs

OSA or sleep apnea is the most visible sleep disorder. Yet, there’s just 1% market penetration for diagnostic and therapy equipment in India, where an estimated 50 million people have the condition. Again, no official figures are available for OSA.

Now, consider that research on understanding sleep, rather than sleep disorders, is even more nascent. Philips India, an arm of global conglomerate Royal Philips, alone has 500-plus sleep labs to develop iterations of its Respironics line of devices like continuous positive airway pressure (CPAP) machines. These are some in a host of offerings to help patients with breathing problems sleep better. Compare this to just five labs (in JNU and All India Institute of Medical Sciences in Delhi, National Institute of Mental Health and Neurosciences in Bengaluru, Sree Chitra Tirunal Institute for Medical Sciences and Technology in Thiruvananthapuram, and Lucknow’s King George’s Medical University) fully involved in researching the mental and physiological repercussions of sleep deprivation.

“India’s sleep labs are focused on clinical solutions for disorders because that’s where the money is,” says Dr Mallick.

When data on sleep evolution is virtually nonexistent, it’s easy to make hay while the sleep economy shines. Nowhere is this more evident than in the mattress market.

In 2014, entrepreneur Philip Krim launched Casper, a direct-to-consumer mattress-in-a-box that attracted investors like Leonardo DiCaprio and a rash of other celebrities. The company did something genius; it never claimed to better sleep but instead, made mattress-buying mighty convenient. Casper’s “obsessively engineered” minimalist aesthetic — created by Japanese designer Gen Suzuki — a low price point, and 100-day trial period (a) turned it into a $1.1 billion company, and (b) inspired clones in both the US and India.

India has six ‘sleep startups’, all focused on bedding. Think spring and foam isn’t technology enough? Bourgeois mattress-makers want you to believe otherwise. If India had a modern history timeline of the mattress, it’d read like this: bare-bone khatiyas (cots), lumpy cotton gaddas (mattresses), coir mattresses, spring Kurl-Ons and Duroflexes, and PU foam and latex bedding. Branded variants make up 34% of India’s $1.7-billion mattress market. This number is expected to rise in contexts where people don’t think twice about renting mattresses, or paying more for proclaimed patented technology to keep bedding cool.

Think spring and foam isn’t technology enough? Bourgeois mattress-makers want you to believe otherwise

But this isn’t just about mattresses. It’s about how startup founders consider bedding to be one spoke in the sleep wheels they want to build. Bengaluru-based Wakefit, which sells an average of 10,000-12,000 mattresses (priced from Rs 7,100-9,500 or $103-138) monthly, suspects functional bedding is the way to go. Which is why co-founder Chaitanya Ramalingegowda has plans for maternity, nursing, and baby pillows.

“We also wanted to tie up with Xiaomi to gift Mi Band trackers with our mattresses and get sleep data from customers who opted in. But they (Xiaomi representatives) weren’t receptive,” he shares. “That’s the intent, though. To go deep into India’s sleep patterns.”

Ramalingegowda, in whose startup Sequoia Capital invested Rs 65 crore ($9.4 million), could be onto something. India’s wearables market may be growing, adding to the likelihood of more people using trackers to monitor sleep. But there are doubts about sleep logging. One, movement sensors in current fitness trackers sometimes peg tossing or turning as wakefulness — an inaccurate reading of sleep. Two, heart rate and breathing sensors alone aren’t enough to monitor brain waves in each sleep stage to provide accurate readings. Three, sleep scientists have a term for the sleep tracking obsession: orthosomnia. Treating sleep like a project, they say, could worsen rather than improve your quality of shut eye.

“We already deal with information overkill in our waking lives. We don’t just need metrics. What we need are actionable solutions”

Dr HN Mallick, president, ISSR

Shashank Palli, founder of pillow company Cuddl, admits India’s sleep startup founders can’t use wearables data to claim improvements in sleep, regardless of beta testers who report sleeping better. So if ‘smart bedding’ or bedding sensors won’t yet make business sense in India, what will? Features. Casper, remember?

Cuddl has three stock keeping units (SKUs) of shredded foam pillows. Over the next three years, Palli plans to have 40 SKUs spanning materials beyond latex and memory foam so he can cover a large market base. He knows no one goes shopping for a branded pillow. He wants to change that.

“I want to be the Apple of pillows in India,” Palli chimes. “People didn’t know they needed 1,000 songs in a pocket until iPod came along. And they lapped it up. But with respect to positioning, we want to be the Android of pillows.” Cuddl currently has four pillows ranging from Rs 1500-2500 ($22-36), all sold online. Palli plans to introduce options that go for Rs 700 ($10).

What’s in the offing? Multiple iterations with aromatherapy and waterproofing; kids’ pillows that go from one inch to six inches and “grow with the child”; hybrid pillows with a mix of fibre and foam; better bolsters and cushions; pillows for different body types, like for people with wide shoulders. “Because they typically have problems sleeping on their side,” he claims.

Niche and custom sleeping solutions are the way in the near future for Alphonse Reddy too. Reddy heads Sunday, another Bengaluru startup that hinges its unique selling proposition (USP) on Belgian latex and European-certified mattresses. But he’s thinking software, not hardware. He’s also refreshingly candid about his own problems with sleep — a rarity for a mattress founder.

“If I don’t sleep well myself, I’m just a foam seller,” Reddy jokes. So while working on Sunday, he’s also involved in research and development (R&D) for “an operating system that will turn sleep data into solutions.” Think mattress recommendations based on whether you prefer sleeping on your back or your sides. Information on how exactly your patterns differ from typical sleep architecture, and whether hitting the gym, cryotherapy, or working less will help you sleep better.

The workarounds

There are those who see opportunity in offering actionable sleep solutions. Then there are those who see opportunity in a world that’ll have little choice but to operate on frugal and disjointed sleep. One of them is Masthan Adam, Dubai-based CEO of Aviserv Airport Services.

In January 2018, Aviserv established India’s first transit lounge in an airport arrival area, in Terminal 2 of Mumbai’s Chhatrapati Shivaji Maharaj International Airport. In a departure from lounges that are almost always equipped with WiFi and/or TV screens — Aviserv’s compact and more private egg-shaped, reclining GoSleep pods, located in the exclusive Aviserv Lounge, have just a charging point. The message is clear: you’re here to sleep, not keep yourself busy.

Pod ‘combo plans’, which range from Rs 1,875-5,985 ($27-87) depending on how long you want to sleep, come with a la carte add-ons such as wifi, cloak room services, and steam press.

“Whenever I arrive at the airport and exit customs in early morning hours, I see passengers either sleeping on gang chairs or on the floor during transits or layovers. This is a huge untapped opportunity in India,” says Adam, who introduced the Aviserv Lounge in the departure zone of Bengaluru’s Kempegowda International Airport in November 2018. He now wants to set up pods in ‘dead’ or unused spaces within other Indian airports by the third and last quarters of 2019 – he didn’t specify which ones.

Transit napping

Rest zones are common in European and Southeast Asian airports. The airports in Singapore, Seoul, Tokyo, Finland, and Estonia are regulars in online surveys on the best and worst airports to sleep in (yes, that’s a thing). Delhi’s Indira Gandhi International Airport has pods by Sams Snooze At My Space. But the ‘pods’ are more rooms, complete with WiFi, TV, mini bar, and work desks.

But airports aren’t the only gears to be oiled for India’s budding sleep economy. Ever been an attendant at a hospital? Chances are you’ve either slept on a chair, an uncomfortable Rexine sofa, or not at all. Another opportunity for Aviserv and Adam, who’s considering sleeping pods for hospital attendants, equipped with tech to alert nursing staff, much like the alert system near a patient’s bed in case of emergencies. He’s also thinking pods at railway stations, which he thinks is more doable than not due to ‘far cheaper rentals than airports.’

And what if there was a way to enhance sleep quality while sleeping for fewer hours? A way to truly hack slumber: spend less time drifting off, and more time in the deep sleep stages? For that, there are the Dreem and Philips’ SmartSleep DreamSleep headbands, which use cranial sensors and white noise to enhance delta wave range and frequency during deep sleep. Philips’ DreamMapper app, which, in India, is coupled with its breathing therapy devices, has some element of gamification in the US version when paired with the DreamSleep headband. It uses scores and points to incentivise sleep. Turn sleep into a game, and people are more likely to play it.

“Whether India will have the affordability range ($400) for the DreamSleep remains to be seen, but we won’t rule it out. We want to govern the entire portfolio of sleep,” says Harish R, Head of Sleep & Respiratory Care, Philips India. “Currently, what makes sense in India is affordable devices for sleep disorder management. More so equal monthly installments (EMI) for such specialised equipment — something you don’t often see here.”

Meanwhile, in Bengaluru’s Koramangala, fintech startup Razorpay is planning to add another nap room for its employees. Its current nap room, with two bunks (four beds) has takers among its workforce, interns, and even outstation interviewees who want to catch some Zs before being questioned in conference rooms. Anuradha Bharat, the company’s head of people operations, cites nap rooms and lounge areas a must for companies that sometimes demand long hours from employees. Not all jobs offer the option — nay, the luxury — of switching off. So it’s only fair to offer spaces for sleep, and some empathy.

“Good sleep makes one more productive. Nap rooms aren’t a distraction, but a sensible solution. Employees no longer have to pretend to be sick if they want to nap or catch up on sleep.”

Ah, optimum wakefulness. A laminated card that will never fold.

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