The topic of sleep deprivation has gained recognition as a leading health-related concern, featured as one of the new focus areas in Healthy People 2020 (HP2020) - a national 10-year blueprint aimed at improving the health and general well-being of the American Population (U.S. Department of Health and Human Services, 2011a). The Centers for Disease Control and Prevention (2011) purports that at least 25% of the U.S. population does not get an adequate amount of sleep on a consistent basis. Adequate sleep for adults 17 years and older is defined as 7-9 hours of uninterrupted sleep; however, a large proportion of individuals tally 6 hours or less per night. This is a significant and largely under-recognized health issue which may require a multi-dimensional approach to modify previous behaviors.
Numerous factors may contribute to sleep loss. This includes, but is not limited to: insomnia and other disorders affecting sleep (i.e., anxiety, restless leg syndrome, chronic pain), sleep-disordered breathing (such as obstructive sleep apnea), increased demands on time (multiple jobs, expectations at work, school, family, social life), side-effects of caffeine and other simulants or medications to help maintain alertness during the day, and beliefs related to sleep in popular culture (that sleep is a luxury and not a necessity, sleep is a “passive” activity, sleep loss and fatigue are unavoidable in order to accommodate other demands on time)(Centers for Disease Control and Prevention, 2011).
Why is this such a serious problem demanding immediate attention and intervention? There is a direct causal relationship between sleep deprivation and adverse outcomes related to health, safety, and job performance. Lack of adequate sleep can have a multitude of immediate and long-term health consequences adversely impacting the sleep-deprived individual, as well as other persons they interact with and perhaps care for. Persons getting an insufficient amount of sleep can sometimes sense a decline in the functioning of their immune system, but they may not make the connection to their increased risk for chronic health issues such as hypertension, cardiovascular complications (including heart attack, arrhythmias, and stroke), diabetes and obesity (due to the impact on endocrine and metabolic function), depression, anxiety, decreased life expectancy, and all-cause mortality. Sleep is essential to normal biological function, and death from all causes is lowest among persons logging 7-8 hours of sleep per night, and highest among those sleeping less than 7. Hundreds of billions of dollars per year are spent on direct medical costs associated with healthcare visits, hospital services, and prescription and over-the-counter medications. Compared with healthy individuals, those suffering from sleep loss, sleep disorders, or both are less productive, have an increased health care utilization, and an increased likelihood of accidents (Centers for Disease Control and Prevention, 2011; U.S. Department of Health and Human Services, 2011b; Institute of Medicine, 2006).
For individuals looking to attain a healthy body weight, making sure to log 7-8 hours of quality sleep each night is as important as a good fitness routine and a healthy diet. One study examined levels of two appetite-related hormones and discovered that sleep insufficiency reliably increased the participants’ appetites. Inadequate sleep was associated with lower levels of leptin (a hormone produced by adipose (fat) tissue which suppresses appetite, and higher levels of ghrelin (a peptide that stimulates appetite) (Taheri et al., 2004). This suggests that there is a hormonally-mediated increase in appetite which may help explain why sleep loss and obesity often go hand-in-hand: when an individual sleeps less than 7 hours per night, there is a definite inverse dose-response relationship. A prospective 13-year cohort study consisting of almost 500 adults found that by age 27, individuals with a sleep duration of less than 6 hours per night were 7.5 times more likely to have a higher body mass index (BMI) after controlling for confounding factors such as family history, amounts of physical activity, and other demographic factors (Hasler et al., 2004).
Sleep deprivation may also adversely affect mental alertness. This can lead to decreased performance at school and at work, leading to poor grades and decreased productivity. There is likewise an increased likelihood for a work-related injury to oneself or to those under the care of sleep-deprived individuals. This may be especially concerning for health-care workers who work long hours and/or night shifts as studies have shown a positive correlation between sleep deprivation and an increased incidence of medical errors (U.S. Department of Health and Human Services, 2011b). Likewise, in a large 20-year prospective study in Sweden comprised of almost 50,000 subjects, those reporting inadequate sleep were nearly twice as likely to die in a work-related accident (Akerstedt, Fredlund, Gillberg, & Jansson, (2002). Employees who are working overtime in an attempt to be more productive may be doing themselves and their employers a disservice as their health and ability to concentrate suffer in the long-run, leading to less productive work days as well as more sick days utilized due to acute and chronic illnesses. It is commonly believed that a chronic “sleep debt” can be easily repaid by sleeping in a couple of extra hours during the weekend, but such is not the case. An individual may feel more refreshed in the morning after obtaining a good night’s sleep, but the effect on attention and concentration may take months to repair.
Drowsy driving due to sleep loss is another serious side effect which has been paralleled to driving while intoxicated. According to the AAA Foundation for Traffic Safety (2005), “studies have found people's cognitive-psychomotor abilities to be as impaired after 24 hours without sleep as with a BAC of 0.10%, which is higher than the legal limit for DWI conviction in all US states.” Motor vehicle accidents from sleepy driving, which are more difficult to measure than drunk driving, are thought to cause over 100,000 collisions and 6,000 fatalities each year, which is believed to be a conservative estimate. Law enforcement officials in several states are attempting to move forward with legislation that would hold sleep-deprived drivers responsible for injury or death accountable for criminal negligence (Centers for Disease Control and Prevention, 2014; National Sleep Foundation, 2015).
While the multitude of negative consequences as a result of sleep deprivation may seem obvious, it remains a struggle to find the motivation to modify our behaviors. So, what are some strategies an individual might employ to tackle this issue and form healthy habits around sleep hygiene? Try implementing one or more of the following techniques to help ensure adequate rest for yourself, your loved ones, and/or the individuals under your care:
During the Day:
When to Seek Help:
Take some time to examine your personal habits and beliefs surrounding sleep. Encourage your partner, friends, and family to do the same, but lead by example to foster an environment where sleep is revered as the vital behavior it truly is.
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National Sleep Foundation. (2015). Facts about drowsy driving. Retrieved from: http://drowsydriving.
Taheri, S., Lin, L., Austin, D., Young, T., Mignot, E. (2004) Short sleep duration is associated with reduced
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For more information on suggestions for better sleep and to receive personalized health coaching, we invite you to schedule a one-on-one consultation with Ivy in your pursuit of optimal health & wellness. - Ivy Carson, Nurse Practitioner & Integrative Health Coach