Q&A with Tony J. Cunningham, PhD: When the World Stays Up with You

When a City Stays Up Together

In Boston, you don’t even need to have watched or cared. The mood on the street tells you everything you need to know about last night’s playoff game. You’ll feel the win or the loss on the T, in the line at the coffee shop, in the air. For better or worse, the whole town slept differently last night.

We tend to treat a late night as a personal peccadillo — poor discipline, bad habits, too much screen time. But what if it’s something else entirely? What if collective sleep loss is as predictable and measurable as a shift in public mood?

Tony J. Cunningham, PhD, director of the Center for Sleep and Cognition at Beth Israel Deaconess Medical Center (BIDMC), thinks it is. In an opinion piece in the journal Clocks & Sleep, Cunningham and colleagues propose the concept of “public sleep” — systematic, population-level changes in sleep timing, duration, and quality that emerge when communities share a major event, whether a presidential election, a natural disaster, a pandemic, or a late-night game seven. We spoke with Cunningham about why naming this phenomenon matters, what questions the research still needs to answer, and what any of us can do the next time the world keeps us up.

Questions & Answers with Dr. Cunningham

What exactly is “public sleep,” and is this a new field?

Cunningham: I would describe it more as a new call to action. At a high level, we noticed a trend across a lot of different fields that showed big, systematic changes in sleep on the population level following major public events. These systematic changes can have impacts on all aspects of the public’s behavior, from politics and the economy to their social lives, at home and at work. We wanted to give it a name to encourage more research in the area. There’s a lot of previous research on sleep at the population level, but there is still a lot more that we need to figure out about what Public Sleep is and what it isn’t.

Similar concepts like Public Mood and Public Memory – which show how our emotions and memories can be affected by being part of a major social event — have been around for much longer. But as globalization continues and we become more interconnected and have the internet at our fingertips at all times, I think we’re beginning to see how the 24/7 access to information can have major consequences on our sleep. Public Sleep is something that I see being important for researchers, clinicians, corporations, and people to be aware of, especially as “once in a generation” events keep happening on a distressingly frequent basis.

You open the paper with the 2018 World Series. Was that drawn from your own experience?

Cunningham: I’m actually a displaced Cubs fan, but when I was moving to Boston in 2018 I had a very similar experience. They were in the playoffs, and I stopped at a hotel for the night and they went to, I think, 13 innings. I was exhausted after 10-12 hours of driving, and I still stayed up for another hour just to hear them lose. So I’ve definitely been on the receiving end of that one — the kind of collective sleep loss the paper is really about.

The research so far seems strong on predictable events — elections, Daylight Saving Time. What’s still missing?

Cunningham: A lot of the research right now is focused on planned events. An election is coming, Daylight Saving Time is coming, there’s a World Series going on, and so you start collecting data up to that event. What is missing, or is much harder to capture, are the unexpected events, which in a lot of cases are probably more impactful on sleep. Usually those would be things like natural disasters or maybe a terrorist attack. There’s probably a baseline level of stress and trauma and then sleep disruption goes on top of that. The best way to address that gap in the research is basically just ongoing data collection — getting a community of people and tracking their sleep, to see what happens when shocks happen. That’s a very expensive way of trying to begin to answer that question, because you really just can’t predict the unpredictable.

What are the other big open questions?

Cunningham: How big of a community does it need to be to produce measurable public sleep disruption? How severe does an event need to be? How long do the sleep effects last? What are the actual economic, behavioral, cognitive, and emotional outcomes, and how long do they reverberate? I imagine your reaction to staying up until 3 am watching your team win the World Series is much different than the reaction of suddenly being attacked by a neighboring nation or being impacted by a hurricane — and the sleep loss that follows would look very different too. Those are the types of things I’d be really interested in beginning to understand. It’s a big question — there’s a lot to explore here. But I do think the more we become interconnected, the more important understanding public sleep becomes.

You intentionally wrote this as an opinion piece rather than a formal systematic review. Why?

Cunningham: I don’t think public sleep as a construct is ready to be fully defined yet. We need more data and to give some people the language they can use to attack this problem. That’s why I’m really hoping this paper is just kick-starting the conversation — just getting it out there, giving people a term, something they can put in grants, something they can put in theses, something they can cite as motivating their work. That was my goal with this.

What does this mean for the average person — not a policymaker, not a corporate executive, just someone trying to get through their week?

Cunningham: First of all, I think knowing that public events affect your sleep is very validating. Having an awareness going into a planned stressful event — or even a fun event, because again, these things can be fun — just having an awareness of, oh, I’m going to lose sleep tonight: How can I mitigate the effects of that? Does this require a nap earlier in the day, or a planned nap the next day? Prophylactic napping can help people manage sleep loss from these events.

And then also acknowledging that when you’re going through something like this, you can expect that maybe your emotions and your cognitive performance might not be at their best. It might be best to try to stick to situations where that’s okay, and just having some mindfulness that maybe you need to take a step back if something frustrating happens. There are events that are worth staying up for, frankly — it is worth watching your team in the World Series or Super Bowl. But if you do stay up late, understand how that sleep loss affects you, and then: Are you doing other things that could make the sleep loss even worse, like scrolling? It’s really trying to meet people where they’re at.

We've talked about public sleep across so many settings. How does it play out when people are on the job?

Cunningham: Safety is another really important component of the public sleep conversation. A well-rested employee is more productive, makes fewer mistakes, causes fewer accidents and gets injured less often.

Sleep is the great multiplier. It doesn’t really matter what we’re talking about — whether it’s a diet, exercising more regularly, or just not being as cloudy or fatigued. It optimizes your performance. It optimizes your ability to do whatever you need to get done. And it makes you so much more efficient — it’s not just about getting the job done and getting it done well, it’s getting that job done and being able to move on to the next one. Whatever your goals are, sleep helps you be the best you.

About Beth Israel Deaconess Medical Center

Beth Israel Deaconess Medical Center is a leading academic medical center, where extraordinary care is supported by high-quality education and research. BIDMC is a teaching affiliate of Harvard Medical School, and consistently ranks as a national leader among independent hospitals in National Institutes of Health funding. BIDMC is the official hospital of the Boston Red Sox.

Beth Israel Deaconess Medical Center is a part of Beth Israel Lahey Health, a healthcare system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,700 physicians and 39,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.