SLEEP AND THE CITY: CIRCADIAN HEALTH VERSUS THE 24/7 CITY

BY ANGELA MAZZI & MEGAN MAZZOCCO

Sleep is the No. 1 predictor of physical and mental health outcomes. But when it comes to sleep in the 24/7 city, where does productivity end and the public health burden begin? Exploring the delicate balance between public health and productivity, dark skies and safety, and modern life and wildlife.

We are going to set the stage by talking about the exposome, a term coined in 2005 by Christopher Wild that describes everything we’re exposed to throughout our lifetimes, whether it’s chemicals, VOCs, climate extremities, light, or darkness. Anything that can be felt by the senses is the exposome, and they determine our health outcomes.

Only 15% of our health risk is determined by our DNA. The good news is that DNA is not a death sentence, but that means 85% of our health outcome is determined by the exposome, which shapes how our DNA is expressed in what we call the epigenome, which is like the operating software for the hardware. It’s either turning on favorable or unfavorable gene expressions. Based on that, you have your health outcomes.

When we look at the exposome, we look at external environmental factors like air and water quality, noise and light pollution, the microclimate, and global warming. But there’s also the personal side: How stable is our income? How safe is our neighborhood? Do we have a permanent housing solution, a robust social network, financial stability, and reliable transportation? Together, those things either provide you with a lot of resources and resilience or give you a very under-resourced life that leads to high stress, which creates biological responses in the body.

According to the World Health Organization, air pollution is the No. 1 source of toxicity. Noise pollution is No. 2, then light pollution: A 100 lux, only 100 candles worth of light, can disrupt your circadian health. It can stunt or halt the production of melatonin, which has been shown to put individuals at risk for breast and prostate cancers. Exposure to artificial light at night can still disrupt the health of the body in a very detrimental way.

We know that the brain has executive function and higher-level thought processing, but the amygdala at the base of our brain controls our sympathetic nervous system and the hypothalamus pituitary adrenal axis, which controls our circadian rhythms. Stress has a huge impact on our sleep quality. When we are stressed, our amygdala takes over. It can sense a threat in the environment and respond by activating the fight-or-flight response in nanoseconds. Before you’re even consciously aware, your body already has that physical response. That’s great if you are in a situation to fight off a physical threat; however, most of what stresses us in the urban environment is non-physical. Therefore, this stress response does not serve us because we don’t allow it to work through our system. Instead, it builds up to toxic levels, leading to higher levels of anxiety, depression, and PTSD, as well as inflammation, which can lead to heart disease, cancer, and obesity.

How can we eliminate those stress burdens through our physical environment? One of the antidotes to the exposome is sleep, which is the No. 1 predictor of physical and mental health outcomes. The WHO has declared that every industrialized country in the world has a sleep-deprivation epidemic. It’s not sustainable when 50% of your population is walking around sleep-deprived and anxious. The CDC has determined that 1 out of 3 adults is sleep-deprived. The U.S. Preventative Services has recommended that all physicians speak to patients 65 and under about screening them for anxiety. We say they should also talk to them about their sleep because during deep sleep, we experience a total nervous system reset.

If we want to calm that stress response, we must consider building up resources. We like to make the analogy to a video game, where you collect coins or some kind of bonus so that you have the resources to keep playing. Well, it’s the same for humans. To build resiliency, we must give people resources to cope.

Salutogenesis is a term that was coined by the medical anthropologist Aaron Antonovsky. He discovered that those who had the resources to cope did better. When we talk about salutogenesis, we discuss it as having five aspects.

• Sense of Coherence: Do I know where to go? Do I know what to do? Do I understand the city functions?

• Prospect and Refuge: Psychological safety, having vantage points, social choice, and spaces for introverts and extroverts.

• Biophilia: Biophilia is important because we’re part of nature and need nature to resonate with us to reset our nervous systems.

• Self-Efficacy: Do you feel empowered or afraid? Do you feel like you can’t make a difference or everything’s always going to stay the way it is?

• Relaxation Response: Having positive distractions, moving to work off energy, and having an appropriate level of complexity in our spaces so we can daydream or look at something and find something new each time.

When you think about a city and these five aspects of well-being, what comes to mind? For example, what is the scale of things? How much can we customize our environments to meet our needs? How much green space are we providing? Have we considered crime prevention through environmental design to feel like we have defensible, safe spaces? Have we looked at opportunities for gathering? Have we looked at wandering paths?

Artwork? All these things are important.

When we resource our citizens, we want to make it easy to get all those “coins” to build our health span, which refers to your healthy years of living, not life expectancy. Most people spend the last 20% of their lifespan with a chronic or debilitating condition. We want a health span, which is lifespan plus quality of life and vitality. Reducing stress and inflammation and getting regular sleep are inextricably linked, so much so that second- and third-shift work is known as a probable carcinogen, according to the WHO. Those cities that don’t sleep are health risks for diabetes, metabolic disease, pulmonary

Additional Sleep Resources

• The Sleep Revolution by Arianna Huffington –Appendix C

• National Transportation Noise Map

• Jet Lag Rooster

• Philips SmartSleep and WakeUp Therapy Lamp

• The Sleep System, 28 Days to Better Sleep disease, Alzheimer’s, and obesity. Your body holds onto fat and calories if you don’t sleep enough. We must encourage and make it easy for people to collect all these “coins,” especially the sleep coin.

• Well-Being by Design: Women’s Vitality Circle.

We want to think about how we can combine zoning and planning, ecological health, and physical health, whether it’s through ordinances or different ways to think about safety, gathering spaces, social zones, biodiversity, noise and light pollution, and opportunities for movement and play. How do we integrate sleep for brain health? For example, a green wall is a low-tech, high-tech solution because the foliage absorbs excess noise and acts as an acoustic buffer. The greenery is also a natural air purifier that gives biophilia and visual complexity to a vertical surface.

Studies show that only 10 minutes of active rest in nature will trigger the relaxation response and let you perform higher on cognitive tasks. Daily movement is another key ingredient to your sleep outcomes. And then also relationships, community, and connection: We know from studying Blue Zones that practicing well-being in a community is critical to health outcomes and health span.

Join the Conversation

Angela and Megan host the Clubhouse room “Architects as Healers: Buildings as Medicine” every Monday at 9 a.m. EST where they discuss issues around the culture of design, therapeutic landscapes, social justice, and more.

Principal, GBBN Architects

Cincinnati, Ohio

Angela Mazzi, FAIA, FACHA, EDAC, is an architect and firm partner at GBBN Architects known for her research and designs that promote well-being. She is a fellow and past president of the American College of Healthcare Architects, a fellow of the American Institute of Architects, and 2023 president of its Cincinnati Component. Her work earned her the HCD10 Top Architect Award in 2022. She is the founder of Architecting, a community consisting of a podcast, online learning, and weekly Clubhouse room “Architects as Healers: Buildings as Medicine.”

Sustainability Director, Spring Architecture Chicago, Illinois

Megan Mazzocco is an architecture and design journalist fascinated by the power of the built environment as a conduit to positive health outcomes. She began teaching in a corporate setting in 2018, and when she observed her positive impact, she started yogaXdesign to guide architects and designers to a path of ease through yoga. Her CEU, “A+D Toolkit for Daily Creative Renewal,” teaches micro practices to help design professionals sustain creativity-on-demand.