Arguably, the best return on investment is adequate, quality sleep and a work-life balance that allows time for restful reflection — yes, a nap. In a culture that highly values educational, athletic and professional productivity, rest can be seen as a sign of weakness, where the ability to get by with minimal sleep is cause for bragging rights. Many of us seem to have no choice. We work two jobs just to pay the bills and care for the ohana. A national study has shown that nearly half of Native Hawaiians and Pacific Islanders do not get enough sleep.

Quality sleep is not a waste of time. The average adult requires seven solid hours of slumber. Sleep is a vital form of nourishment that supports creativity, memory and mental clarity, a healthy mood and satisfying relationships. Sleep also improves physical stamina, reduces stress, lowers blood pressure, minimizes the risk of diabetes and heart disease, and helps the body fight infection.

The age of “surveillance capitalism,” as written about by Shoshana Zuboff, captures the raw material of human experience and secretly uses it to drive behavior for commercial sales. It has us glued to our screens late at night to binge on social media, streaming and gaming. We then struggle with insomnia when the bright light from our screens tricks the pineal gland into suppressing melatonin and to think its daytime even when it’s dark. Media content is packed with enhanced violence and sexual content that worsens insomnia with elevated nighttime levels of activating neurotransmitters such as dopamine and norepinephrine. We reach for sleep medications, alcohol and cannabis so that we can get some shut-eye, but the resultant sleep architecture tends to be of poor quality.

Sleep apnea is the other intruder on much-needed rest and was the topic of the previous Wealth of Health article. Apnea is defined by long pauses in breathing, multiple times each hour, that cause oxygen levels to drop and adrenaline and cortisol levels to rise. It can result in nighttime waking but often goes unnoticed except by a bed partner who will complain of snoring. Causes include excess body weight, poor anatomy or mechanics in the throat, allergies, alcohol, medicines for sleep or pain and sometimes traumatic brain injury. The end result is nonrestorative sleep and a tendency toward weight gain, high blood pressure, diabetes and heart disease.

Key questions to assess whether you get adequate rest:

>> Do you generally experience vitality in the morning?

>> Do you need a kick start to get going and stimulants to keep up during the day?

>> How many hours do you actually sleep, and how many do you feel you need?

>> Do you have a hard time falling asleep without a sleep aid?

>> Are you troubled by nighttime or early morning waking?

>> Does your bed partner complain that you snore?

Whether lack of quality sleep is the result of overwork due to the price of paradise, social media and digital entertainment, bonafide sleep apnea, or drugs and alcohol, lack of rest comes at a huge cost to our joy and well-being, and our physical and intellectual performance. It also enhances the risk of heart disease, weight gain, diabetes, stroke and depression.

Youth helps. In our 20s and 30s we might have the vitality to push through, but as the years pass, the cumulative impact of poor sleep hygiene begins to take its toll. Many of us see a simple doable change that will make the difference. More often, we might end up in a hole of fatigue, depressed mood, reduced stamina and a fading memory and it’s hard to know how to climb out.

If you don’t experience vitality throughout the day and restful sleep at night, make some of the obvious impactful choices: Reduce caffeine late in the day, moderate alcohol use, commit to a routine of physical activity and end digital screen time an hour or two before bed. If problems persist, see your health provider for an annual exam. An overactive or underactive thyroid, for example, is a common cause of poor rest and easily treated.

If insomnia or fatigue persist, it may be time to do a deeper dive. The threshold for insurance to pay for a sleep study is simply observed snoring and nonrestorative sleep, and there are many ways to approach resolution of sleep apnea. Often a collaborative team of providers may be optimal, including a sleep trained medical provider, a naturopathic physician, acupuncture, occupational therapy focused on life management skills and a team of psychologists skilled in behavioral therapy to optimize quality sleep.

This year, resolve to rest. It is a game-changer.

Ira Zunin is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Serv­ices Inc. His column appears the first Saturday of every month. Please submit your questions to info@manakaiomalama.com.