Inside the buzzing business of sleep

Sleeplessness has created a new market for sleep products like hormone supplements, tracking and breathing devices, memory foam mattress and subscriber-only bed time stories.

New Delhi: It’s a Japanese folklore called The Moon Princess. A poor couple discovers a baby girl inside a bamboo stalk and takes her in as a divine blessing. They name her Kaguya-hime and raise the child as their own. Kaguya-hime grows up in the idyllic countryside, the word of her beauty travelling far and wide. But she spurns every suitor, including the emperor of Japan, and returns to where she came from—the moon.

The story, more than 1,200 years old, is listed on an app called Neend, literally meaning sleep. Following her own struggles with sleep post-covid, 32-year-old Surbhi Jain, an IIT Bombay graduate, started Neend in mid-2021. Its USP is bedtime stories told in a languid tone, peppered with simple instructions on how to prepare oneself for sleep: not just turning off the lights but how to breathe, relax each part of the body and let go of the day gone by.

Neend takes a leaf out of internationally hit podcasts such as ‘Sleep with me’ by Drew Ackerman who tells boring stories with a generous dose of humour, lulling his listeners to sleep.

“Our narrators have a calm and familiar tone which helps listeners relax. The voices are carefully curated, based on research on what frequencies are soothing to the ears," Jain said. The plots are unhurried, to ensure one does not get all excited.

Alongside app-based podcasts, which Jain claims has 30,000 daily listeners, Neend has also ventured into sleep solution products like melatonin gummies—a hormone which induces sleep in response to darkness—and herb-based relaxants. It also offers therapy and counselling services by connecting users to sleep experts. An annual subscription to the app costs ₹699.

“We think of ourselves not as a content or an e-commerce venture but a sleep and relaxation company," Jain said.

Neend, in a way, stands apart as a unique venture in an emerging market promising to deliver a restful night of sleep to customers. This market comprises new age mattress companies, makers of breathing devices and nutraceuticals, wearable sleep trackers such as smart watches and wrist bands, and medical practitioners urging their patients to get a sleep study done—to diagnose serious underlying conditions like sleep apnea.

Biological rhythms

But should one obsess over sleep? For Sagar Bishnoi, the answer is an unequivocal yes. Now 29, Bishnoi, a Delhi-based environment professional, struggled for years to get a good night’s sleep. The earliest memory, which he said is printed in his brain, dates to a morning when he was just 12. Unable to wake up on time, Bishnoi had reached school late. He was publicly admonished for frequently coming late for the school assembly. He felt humiliated.

Later, even as he graduated from college and took up a job, the distress over sleep never left him. “I would go to bed on time but not fall asleep. The deepest sleep came only towards morning. I would miss alarms and phone calls. I used to wake up tired and feel sleepy mid-day while at work," Bishnoi recalled.

The trauma of sleep deprivation led Bishnoi to box himself as a night owl. But thankfully, after a year of concerted effort, Bishnoi managed to fix his problem last year. The break came after he realized the importance of circadian rhythm—bodily functions which control temperatures, hormone secretion and the cycles of sleep and wakefulness.

These bodily rhythms are often impacted by external factors like exposure to light, ambient temperature and eating or drinking habits. Exposure to light blocks release of melatonin, a sleep-inducing hormone produced by the brain in response to darkness. Conversely, anxiety leads to elevated levels of cortisol, a stress hormone, which interferes with normal sleep. While cortisol levels rise and fall with the sun, melatonin levels move in the opposite direction, maintaining the body’s circadian rhythm.

Why is sleep important? During sleep, memories are consolidated—transferred from short term to long term storage sites—and the metabolic waste generated in the brain due to nerves firing through the day is cleared, explained Swami Subramaniam, neuroscientist, and author of the book

Mastering Sleep.

Sleeping less can severely impair daily activities as well as affect long-term health. For instance, a 2018 study of 10,000 individuals, published in the journal Sleep, found evidence of cognitive impairment among adults sleeping less than the recommended 7-8 hours in a day. The sleep deprived found it difficult to learn new things, concentrate, make decisions, or react to a situation.

The long-term health impact is more damaging. A growing body of evidence links sleep loss to chronic conditions like obesity, hypertension, type-2 diabetes, anxiety, dementia, depression, and Alzheimer’s disease.

Data on sleep deprivation in India is sparse and mostly comes from non-official sources. According to a LocalCircles survey released in March this year, more than half (55%) of respondents said they got less than six hours of ‘uninterrupted’ sleep in a day. A little over fifth said they were not even sleeping for four hours.

Interruptions lead to poor quality sleep by disrupting different stages of a sleep cycle. The cycles usually move from three non-rapid eye movement (non-REM) stages of light to deep sleep, to rapid eye movement (REM) sleep—when dreams happen. These cycles keep repeating through the night, allowing the brain and the body to recuperate.

Another survey, by Wakefit—a mattress and sleep solutions startup—released in 2023, showed a high incidence of self-reported insomnia: one in three respondents. Almost 90% of the respondents said they woke up once or twice during the night, with 60% saying they got up in the morning not feeling well-rested. Nearly 45% of respondents said social media browsing kept them awake at night. Worries about the future, finances and work were the second most important reason which kept people awake.

Melatonin to mattress

Due to the changing nature of work and bizarre sleep routines, insomnia is now a common complaint, said Akanksha Jha, pulmonologist and sleep disorder specialist at Kailash Hospital, Greater Noida.

According to Jha, many who struggle to sleep regularly pop melatonin supplements or sleeping pills. Melatonin products are now readily available on e-commerce websites or as over-the-counter drugs.

As per Future Markets Insights, the melatonin market in India is expected to cross $10 million by 2033. The small size of the market has not deterred established and relatively unknown brands to test the waters. A check on e-retail outlets throws up numerous options for melatonin sold as tablets, syrups and gummies, often punched with vitamins and natural ingredients like chamomile, lavender and other herbs. Earlier this year, Procter and Gamble launched a melatonin sleep gummy named Vicks ZzzQuil Natura, a product which it claims is non-addictive with no next day drowsiness.

The makeover of India’s organized sector mattress market—estimated at $240 million in 2023 by Statista—is no less interesting. Most mattress manufacturers, including established ones like Sheela Foam and Kurlon are now pitching themselves as sleep solutions companies, promising that their products will help customers ‘sleep like a pro.’ The startup ecosystem is also flush with mattress makers which include the likes of Wakefit and The Sleep Company.

“While working on the design, we realized that consumers were paying a steep price for mattresses which hamper blood flow and leave a mark on the skin," said Chaitanya Ramalingegowda, co-founder of Wakefit which began operations in 2016. The startup has seen its annual revenues surge 22% year-on-year to ₹825 crore in 2022-23.

“Our mattresses are designed to ensure that the spine is aligned correctly and one wakes up without pain. The products are tested for breathability, firmness, and humidity (control)," Ramalingegowda added.

The Bengaluru-based startup, which claims to have served two million customers, has a unique policy for its employees. They are entitled to a 30-minute nap every afternoon to ‘recentre and recharge’ themselves on recliners placed in an air-cooled and dark nap room.

In addition to medical supplements and mattresses, a growing number of consumers are now using sleep monitoring devices which include wearables like smartwatches and wrist bands. Data from Statista shows that shipments of smartwatches to India jumped to 31 million units in 2022, from just 12 million units the year before.

Popular smartwatch brands like Apple and Fitbit help consumers track duration and time spent in different sleep stages—like REM and deep sleep—as well as snoring patterns, which can alert users to serious medical conditions like obstructive sleep apnea (OSA).

In OSA, breathing can stop and resume repeatedly. In obese patients, fat deposits around the upper airway obstruct breathing. This not only makes it hard to reach the deep and restful stages of sleep—leading to daytime fatigue—but also increases the risks of a stroke or a heart attack due to a sudden drop in blood oxygen levels.

Costly sleep study

To check for sleep apnea, patients need to undergo a sleep study where sensors track the activity of multiple body systems, including heart, brain and the respiratory system, over the course of a night.

According to sleep specialists, sleep apnea is common but many patients hesitate to get a sleep study done since it is expensive, costing between ₹30,000 and ₹40,000. Some are also averse to using a continuous positive airway pressure (Cpap) machine which delivers continuous pressurized air into a mask that one must wear while sleeping.

The sleep apnea devices market in India was estimated at $121 million in 2021, as per an estimate by TechSci Research, and the segment is forecast to cross $200 million by 2027. The growth, the report said, will be driven by factors like an ageing population, increasing pollution levels leading to higher incidence of respiratory disorders, and rise in lifestyle diseases like hypertension and obesity.

The boom in medical services catering to sleep disorders is already visible. Today, most major cities in India have multiple sleep clinics where patients can get a sleep study done and take medical advice.

“Four out of 10 patients who come to us suffer from sleep apnea. The remaining cases consist of insomnia and circadian rhythm disturbances," said N. Ramakrishnan, founder of the Nithra Institute of Sleep Sciences, Chennai, which was set up in 2004.

Ramakrishnan, who is also director of critical care services at Apollo Hospitals, said that the number of patients visiting the sleep clinic has multiplied manifold in recent years, with rising awareness and growing sleeplessness.

He often gets patients who appear like overworked zombies, yet complain of declining productivity at work. Many admit to popping anti-anxiety medicines and cough syrups—without visiting a doctor—just to get a few hours of sleep.

“It is ironic that medical insurance does not cover sleep treatment and breathing devices (like Cpap) since the treatment does not require hospitalization. Only when sleep deprivation leads to bigger troubles like a heart attack or stroke, insurers step in," Ramakrishnan added.

Darkness is bliss

The cost of sleep deprivation goes beyond personal health. A 2017 study published in the RAND Health Quarterly warned about the high economic costs of insufficient sleep, estimated at $680 billion a year in five OECD countries—including, $400 billion for the US and $60 billion for Germany. Lost sleep impairs productivity and performance at work, coupled with higher absenteeism. OECD is short for Organisation for Economic Co-operation and Development.

According to Charles A. Czeisler, professor of sleep medicine at Harvard Medical School, the often-glorified corporate executive who logs 100-hour workweeks or lives out of a suitcase in multiple time zones is endangering themselves, putting their companies at risk.

The more we light up our lives, the less we seem to sleep, Czeisler wrote in a Nature piece published in 2013. “Sleep is essential to our physical and mental well-being, so it is vital that we learn more about the impact of light consumption and other ways our 24/7 society affects sleep, circadian rhythms and health," he added.

Lest one is drowned by the wave of sleep hacks on the internet, the US Centres for Disease Control and Prevention offers some useful tips for a good night’s sleep. Be consistent and follow a routine. Make sure, the bedroom is quiet, cool, dark. Stay away from all electronic devices including mobiles, laptops and television. Avoid large meals and caffeine before bedtime. And go, get some exercise during the day.

Sagar Bishnoi has been doing exactly that to fix his sleep. But when friends and family come visiting his bachelor’s pad in Delhi, they are often left wide-eyed. Dim lights or a candle placed at floor-level late evening, gentle wafts of cool breeze, a mild sandalwood fragrance hanging in the air.

“Kya mahol banake rakhha hai (what mood have you created, man)," they would say.

Bishnoi takes the jest lightly. He is not worried about his preoccupation with sleep taking a toll on his social life. “But once in a while I do break the rules when it’s worth it."

Source