Thinking Out Loud | Don't Let Your "Sleep Freedom" in Youth Become a "Health Debt" in Middle Age and Beyond

Ask AI · Why do young people staying up late partying pose health risks?

About 20 years ago, I said that adults should sleep 6 to 8 hours a night. Later I found that modern people’s sleep duration is getting shorter and shorter.

Many young people don’t sleep when it’s time to sleep, instead they go out to make friends, sing, watch videos, play games… They have the conditions and the time to sleep, and they could fall asleep if they wanted to, but they just don’t want to! In medical terms, this behavior of young people who choose not to sleep when they should is called “sleep deprivation.”

Because they are young, their ability to regulate sleep is very strong. Even with short-term sleep loss or irregular sleep patterns, they can still maintain high energy levels.

But as they age, their sleep regulation ability gradually declines. Although the decline is slow, they can feel this change, and health problems become more frequent. Clinical studies show that most middle-aged and elderly people with sleep problems have a history of poor self-control and irregular routines in their youth.

So I want to remind everyone: even if you’re very young now and your regulatory ability is strong for the moment, maintaining a normal daily rhythm is still the foundation for future health.

Anxiety is the primary emotional factor affecting sleep

In over 40 years of clinical work, I have treated patients with various sleep issues.

The primary emotional factor affecting sleep is anxiety. It manifests as overthinking and worry. Many patients who come to me with sleep disorders have a tendency toward anxiety. These patients often carry thick medical records from multiple hospitals, with repeated tests and similar examinations, and X-rays in thick stacks. When they put all their files on your desk, you immediately know they are anxious. They first get checked at Xiehe Hospital, and if no issues are found, they go to Tongren Hospital, then to Chaoyang Hospital. This pattern of seeking multiple opinions is a sign of anxiety.

Even more extreme was a time I was giving a lecture abroad with over a hundred attendees. Midway through, I received a call on my mobile. The caller’s name sounded familiar—perhaps a former patient, but I couldn’t remember who he was. He said something that shocked me: “Dr. Guo, I want to say goodbye today. I don’t want to live anymore. I haven’t been able to sleep recently, and it’s too painful.”

The problem was simple: poor sleep led to mental breakdown and severe depression. Many people start with initial difficulty falling asleep, then develop anxiety, and eventually severe depression. If this progression isn’t caught early and the anxiety and depression aren’t treated, the harm can be as serious as cancer or other severe diseases.

With timely adjustment and treatment, this patient’s mood improved significantly, and his sleep also got better. However, he still needed to continue medication to consolidate the effects. Sleep disorders pose huge risks to both physical and mental health.

Sleep assessment should be required for driver’s licenses

In 2018, statistics in the U.S. showed that up to 38% of all traffic accidents were caused by sleep disorders. Among severe accidents involving fatalities, 87% were related to sleep issues. That means most serious traffic accidents are linked to sleep problems. In our country, this sleep disorder is often called fatigue driving, which essentially includes sleep disorders.

In the U.S. and Canada, there is a law requiring sleep doctors like me to assess patients not only for sleep diseases but also for alertness and judgment related to traffic safety. If a patient’s condition is poor and poses a potential danger when driving, I am responsible for informing relevant authorities to suspend their driver’s license temporarily. If I fail to do so and an accident occurs, I could be held legally liable. Currently, our country has no such law or regulation.

One day, I was seeing a patient when two police officers brought in someone. After explanation, I learned he caused a serious traffic accident. I recalled he was my patient—someone with severe snoring and sleep apnea. After the accident, he told the police, “Dr. Guo warned me I shouldn’t drive for now. I ignored it and didn’t seek treatment. I was driving while sleeping, which caused the serious accident. I regret it.” They came to verify whether he had a sleep disorder and its relation to the accident. I checked his original medical records and issued a diagnosis certificate. So, sleep disorders and frequent driving issues are not just personal problems—they are social and major issues.

In foreign countries, besides the usual driving tests (theory, skills, road test), there is also a sleep assessment. If someone has a sleep disorder, like chronic insomnia, impairing judgment and alertness, they cannot be issued a driver’s license. Our country’s driver’s license system still needs improvement in this area. I believe this is a potential risk.

The dialectic of sleep aids: 0 and 1

Insomnia can be categorized into several types: difficulty falling asleep, easy to fall asleep but waking repeatedly, and early awakening. Sometimes these occur independently; other times, two or all three happen together.

Sleep disorders can be caused by irregular lifestyles or emotional instability. To solve these issues, we should address their root causes rather than immediately resorting to medication.

Many doctors, for convenience, prescribe medication expecting quick results. While this may solve short-term problems, it doesn’t address the root cause and the condition often recurs. I recommend considering non-drug therapies first.

As mentioned earlier, anxiety is the primary emotional factor affecting sleep, and it cannot be resolved with sleeping pills alone. You need to consider what causes the anxiety. Medically, relaxation techniques can help alleviate it.

Editor’s note: Relaxation therapy is a treatment training aimed at helping individuals reduce tension and anxiety from physiological and psychological levels. It can be used as an adjunct to treat anxiety, depression, pain, and stress.

The second influencing factor is sleep rhythm. Long-term irregular sleep can lead to sleep disorders. Using medication to regulate this, such as taking pills at 10 pm if you want to sleep then, or at 2 am if you sleep late, can cause circadian disruption or worsen it. The simplest and most effective method is to maintain a normal biological rhythm by regular routines.

Some ask if it’s okay to sleep late and wake late. In fact, sleeping late and waking late are not equivalent to sleeping and waking according to a normal rhythm. Nighttime sleep aligns with our biological clock, providing the highest sleep efficiency. Also, during the night, there are fewer disturbances like eating or water intake, allowing for restful sleep. If you sleep late and wake late, others may already be working or eating, causing external disruptions and circadian misalignment, reducing sleep quality. To adjust sleep, we often use light therapy with specialized medical lighting devices, which is a non-drug treatment.

Another non-drug method for treating sleep disorders is Cognitive Behavioral Therapy for Insomnia (CBT-I). It involves changing incorrect beliefs about sleep and bad sleep habits to improve sleep quality.

For example, many believe that lying in bed forcing themselves to sleep until they do is helpful. But this increases frustration and weakens confidence in sleep. This is a misconception. When you can’t sleep in bed, you shouldn’t stay in bed; instead, do other activities until you feel sleepy again. This is called sleep restriction therapy. Through such training, some sleep disorders can be improved. If sleep occupies more than 85% of your time in bed, it’s reasonable. If less than 80%, you should reduce your time in bed.

Another method, though simple but time-consuming, involves adjusting your wake-up time. For patients who can’t sleep at night or get up late, I advise setting a fixed wake-up time, like 6:30 or 7 am, regardless of bedtime. You must get up at that time, even if you have to wake yourself. Because of sleep deprivation, you will feel drowsy and sluggish during the day. Don’t sleep during the day; instead, stay awake until night. You will then feel more sleepy at night, making it easier to fall asleep. This process takes one or two months or more, gradually shifting your sleep schedule forward until you can sleep and wake at the desired times. It requires patient cooperation; otherwise, the effect diminishes.

All these non-drug methods for sleep adjustment are scientifically supported and effective. There are also traditional Chinese medicine approaches, such as acupoint massage and acupuncture. Their effectiveness varies from person to person, and clinical evidence is limited. Some patients are happy to try Chinese medicine, but it may not work for everyone.

Of course, non-drug therapies alone do not solve anxiety and depression. Patients with these conditions should receive appropriate medication treatment. Combining medication with CBT-I can improve sleep. But if after two or three months, or if the patient is uncooperative, sleep still doesn’t improve, then medication should be considered.

Regarding sleeping pills, some act quickly but have short duration, others act slowly but last longer. For difficulty falling asleep, short-acting drugs are used; for trouble maintaining sleep, medium or long-acting drugs are appropriate. The choice depends on the patient’s age and health. Medication must be individualized and used under medical supervision. China’s regulation of sleeping pills is very strict. Some patients are eager to use medication, while others avoid it due to perceived side effects.

For sleep disorder patients, avoiding medication can cause more harm than the side effects of the drugs themselves. If we compare the side effects of sleeping pills as “1,” and the benefit of good sleep as “100,” then the side effects are negligible compared to the benefit. When sleep is severely impaired, the benefit outweighs the risk, and medication is justified.

Under medical guidance, the side effects of drugs are limited and controllable. Currently, most market options are third-generation sleeping pills, with second-generation drugs as adjuncts, and their safety has greatly improved.

Editor’s note: Second-generation sleeping pills are benzodiazepine sedative-hypnotics; third-generation are non-benzodiazepine sedative-hypnotics.

One patient with insomnia told me, “Dr. Guo, I suffer so much from not sleeping!” I asked, “How long have you had this problem?” “20 years.” I said, “Have you taken medication before?” “Yes.” “What kind?” “An Ding, 30 pills before bed; another sleeping pill, 10 pills; and others, 5 pills.” I was shocked and joked, “Wow, you’re still alive! Since that’s the case, I’m not here to prescribe more medicine. I need to help you reduce your previous medications—you can’t keep taking so many.” He said, “No, Dr. Guo, if you reduce my medication, I won’t sleep.” In such cases, doctors must comfort patients and guide them gradually to reduce medication, replace it with other drugs, and finally cut down to just a few pills, ensuring good sleep. This process is long and challenging.

Another patient came to me and I asked, “Have you taken sleeping pills?” “Dr. Guo, I’ve taken many kinds.” “Can you tell me their names?” “I don’t remember, I’ve forgotten.” “You take unknown drugs? What if there are problems?” “I was so sleep-deprived that my memory worsened. I remember many drug names back then, but now I can’t recall any. What should I do?” He couldn’t provide any previous treatment info, so I had to rely on experience to develop a suitable treatment plan.

Some people have misconceptions about seeking medical help and medication use. For example, some patients demand many drugs but never take them, or they don’t understand proper dosages. Smart patients should use doctors’ expertise to treat their illnesses. Doctors and patients are allies fighting together against sleep disorders. So, during treatment, patients should seriously consider medical advice and trust science.

“The Blessing of Good Sleep”

Author: Wang Meng and Guo Xiheng

Changjiang Literature and Art Publishing House, 2025

Editor: Chen Qing

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