Sleep as a Key Public Health Priority in the Prevention of Non-Communicable Diseases

Sleep is increasingly recognised as a fundamental pillar of health, on the same level with nutrition and physical activity. At the same time, sleep is closely intertwined with stress regulation and broader physiological recovery processes. Adequate and regular sleep supports metabolic, cardiovascular, cognitive, and mental health, while insufficient or disrupted sleep is associated with an increased risk of several non-communicable diseases (NCDs). For this reason, sleep should not be treated as a secondary lifestyle factor but rather as a core component of prevention strategies aimed at reducing the burden of NCDs. Integrating sleep into public health agendas can therefore strengthen prevention policies and contribute to a more comprehensive approach to population health.

Sleep disturbances and disruptions of the circadian rhythm are not merely risk factors for the development of certain diseases. Difficulties manifested as insomnia may also represent symptoms of underlying physical conditions as well as stress-related disorders such as anxiety, depression, and burnout. Chronic sleep deprivation and a disrupted circadian rhythm have been associated with an increased risk of hypertension and diabetes, a higher likelihood of unhealthy food intake and the subsequent development of obesity, and a greater risk of non-alcoholic fatty liver disease. In addition, insufficient or irregular sleep has been linked to a higher risk of various mental health conditions, including bipolar disorder, psychosis, post-traumatic stress disorder, depression, and anxiety, as well as an increased risk of burnout. Poor sleep is also associated with a lower subjective pain threshold, reduced ability to cope with stress, impaired immune function, and diminished cognitive performance, including poorer memory, concentration, and emotional regulation. Furthermore, evidence suggests that chronic sleep disruption may be associated with an increased risk of certain types of cancer.

Sleep is influenced by a range of factors commonly referred to as biopsychosocial determinants. These include individual biological factors, psychological factors, as well as social circumstances and the environment in which we live.

Biological determinants include genetic influences, hormonal changes (such as melatonin, cortisol, growth hormone, oestrogen, and progesterone), and overall health status, including the presence of acute or chronic illnesses. Psychological determinants include chronic stress, persistent rumination, and traumatic experiences. Personality traits may also play a role, such as perfectionism or a tendency toward anxiety. However, the picture would not be complete without acknowledging social determinants that may influence the timing, duration, and quality of sleep. These arise from our primary life roles (family responsibilities and relationships), the work environment (night or shift work, demanding organisational cultures, etc.), socioeconomic status, and the physical environment (for example light pollution, noise, and housing conditions).

Our need for sleep is fulfilled within broader social systems, and these systems in turn influence our sleep-related behaviors through feedback mechanisms, shaping the quantity, quality, and rhythm of our sleep. In modern society, numerous factors influence how effectively individuals meet their daily need for sufficient and high-quality sleep. The prevailing social context—characterised by a culture of constant activity, increasing productivity demands, financial pressures, and long working hours—often dictates the pace of daily life. Within such a framework, continuous availability and productivity are frequently valued above rest, and sleep may sometimes be perceived as a loss of time. For this reason, it is important to recognise both the essential role of sleep and the many factors that can disrupt our natural sleep rhythms.

Effectively addressing sleep-related problems requires a comprehensive approach at both the systemic and individual levels. The influences on sleep are biopsychosocial, but so are their consequences. Insufficient sleep affects not only physical health but also psychosocial functioning, shaping how individuals function within their families, workplaces, and wider society.

The content is translated from:

Nacionalni program duševnega zdravja – MIRA. Spanje – temelj našega zdravja in dobrega počutja. Slovenija, 26. Februar 2026 Available at:

https://www.zadusevnozdravje.si/aktualno/novice/2026/02/spanje-temelj-nasega-zdravja-in-dobrega-pocutja/ 

The majority of the content was first published in an article:

Makivić, Irena. Spanje v času družbenih sprememb. Psihološki inkubator. [Tiskana izd.]. sep. 2025, letn. 12, št. 17, str. 9-13. ISSN 2232–6553.

Within the Joint Action Prevent Non-Communicable Diseases framework, on the subtask 9.2.4 where Slovenia is leading and Iceland as a co-leading partner, we are conducting a situational analysis on the state of sleep strategies and guidelines. We developed a comprehensive instrument aimed at providing a holistic overview of the situation in all participating countries on the state of sleep strategies, availability of sleep and circadian data and on the consideration of sleep as a pillar of health in agendas and policies of participating countries. The sub-task also includes a review of cross-sectoral cooperation and the identification of relevant sectors, and a review of all stakeholders and rightsholders. Stakeholders are recognized as key institutions and their representatives who hold responsibility for sleep-related issues within their respective domains across different sectors and institutions. In contrast, rights holders are individuals or groups for whom final actions or interventions in the field of sleep are designed. These identified groups were already included in our research tool and comprise different demographic populations, vulnerable groups, and the general population.

Based on the two foundations: the World Sleep Society perspective and the perspective of Health promotion and prevention, we developed a detailed draft of the research tool comprising 25 questions. The research instrument is based on a structured questionnaire designed to collect comparable data across countries. The majority of the questions were designed as closed-ended, with only a few formulated as open-ended questions. To our knowledge, no comprehensive and standardised public health mapping tool currently exists. This tool is going to systematically capture sleep-related policies, public health measures, healthcare services, the availability of data on sleep and circadian rhythms and research capacities across countries. The tool is sufficiently comprehensive while remaining practical, allowing it to capture all relevant domains and to be applicable across different settings and for various purposes. Once appropriately disseminated, the tool may also be used by countries that are not formally participating in the project. Furthermore, it is suitable for repeated or periodic use to assess the situation or map developments in the field of sleep at the national level, enabling the evaluation of potential progress and supporting the planning of future policies, measures, and activities related to sleep based on the findings.

Public health professionals, along with other stakeholders, are challenged to translate the science behind sleep into policy and interventions that are implementable, effective, accessible, and sustainable. This initiative aims not only to identify good practices, but also to create a potential framework for their transferability and scalability across countries. The results of the analysis will contribute to the development of recommendations for integrating sleep into national public health strategies and for strengthening a cross-sectoral approach to the promotion of healthy sleep.

Sleep is increasingly recognised as a fundamental pillar of health and an important public health priority due to its strong associations with cardiometabolic, mental, and overall health outcomes. Despite the growing body of scientific evidence on the importance of sleep, many countries still lack comprehensive strategies or coordinated public health approaches in this field. The findings of this study will therefore contribute to the development of evidence-based recommendations to strengthen sleep-related policies and measures at both national and international levels.

This article was co-written by:

• Irena Makivić, Brigita Zupančič Tisovec, Marjeta Peperko, Nastja Salmič Tisovec, National Institute of Public Health, Slovenia, and;
• Sigrún Þóra Sveinsdóttir, The Directorate of Health, Iceland.