You've heard the phrase, "You snooze, you lose." Perhaps this philosophy is the reason that at least 70 million Americans are sleep deprived with 60% chronically so. (Source: National Center on Sleep Disorders Research.)
There's increasing pressure in society to get less sleep because we have so many other demands on our time – from work to play, from family to friends. We don't leave work at work anymore – we have home offices, e-mail that we feel compelled to check every day and 24/7 availability through our cell phones. We think being able to work hard and play hard is a badge of honor.
Unfortunately, no one gets away with being sleep deprived. When we get less sleep than we need each night, we develop a "sleep debt." This debt is cumulative, meaning that one less hour of needed sleep at night adds us to a seven hour deficit by the end of the week.
As with any debt, a sleep debt needs to be paid back. If it isn't, consequences occur including sleepiness that:
- Reduces your ability to perform, think, concentrate, learn, and react
- Increases anxiety, irritability and depression
- Changes certain body functions
Worst of all, sleep deprivation can be dangerous. It causes accidents on the job, in the home, and, most serious of all, on the road.
Why does the human body need sleep? The truth is, no one really knows. There are two basic theories: (1) that sleep has a restorative function; and, (2) that sleep has an adaptive function helping us to consolidate and fix memories and advance learning. Many scientists believe that in a few years we'll understand not just why we sleep, but also what underlying biochemical mechanisms control the activity.
- Societal pressures to work more and at odd hours-evenings, weekends, the night shift, round-the-clock-have reduced Americans sleep time over the past century by about 20%. (Source: "The Promise of Sleep" by William Dement and Christopher Vaughan, 1999)
- At least 70 million Americans are sleep deprived with 60% chronically so. (Source: National Center on Sleep Disorders Research.)
- 45% of adults agree that they will sleep less in order to accomplish more. Shift workers (56%) are more likely to agree they will sleep less in order to get more work done compared to regular day workers (44%). (National Sleep Foundation 2000 Sleep in America Poll)
- One-half of the American work force (51%) reports that sleepiness on- the-job interferes with the amount of work they get done. (National Sleep Foundation 2000 Sleep in America Poll)
- Television and the Internet are prime contributors to Americans not getting enough sleep, causing 43% of adults to stay up later than they should. (National Sleep Foundation 2000 Sleep in America Poll)
- 100,000 auto accidents and 1,500 deaths occur each year because of fall-asleep crashes. (National Highway Traffic Safety Administration)
- Sleep-deprived people who are tested by using a driving simulator or by performing a hand-eye coordination task perform as badly as or worse than those who are intoxicated.
- Many people's depression can be attributed to the lack of a good night's sleep.
- A great majority of adults think their sleep related problems are not serious enough to seek the services of a sleep specialist and therefore go on through life suffering from these disorders
Ask Your Doctor
This list of questions is a good starting point for discussion with your doctor. However, it is not a comprehensive list.
- How should I expect to feel given my age and lifestyle?
- What alternatives will you consider in pursuing a diagnosis?
- Could any of my medicines be causing my problem or making it worse? If so, is it possible to change the medicines, their dosages, or the time of day that I take them?
- Are there things I can try to alleviate my symptoms while you pursue a diagnosis?
- Should I see a sleep specialist?
If your doctor prescribes a sleeping pill:
- How can I avoid becoming dependent on sleep medications?
- What other side effects can I expect from sleep medications?
- Could this be dangerous if I have a medical problem, like sleep apnea?
If you doctor refers you to a sleep specialist:
- What do you suspect?
- An underlying medical or psychiatric illness?
- Sleep apnea?
- What tests should I expect?
Key Point 1
Lack of good sleep causes problems. Sleep allows the body to repair and is critical to good health.
Sleep loss in America has reached epidemic proportions. Unfortunately, many of us are unaware of the negative impact sleep problems can have on our health and performance. It is a basic biological drive.
How much sleep do we need?
Our sleep needs change at different stages in our lives. While it varies from individual to individual, the following are the average amounts of sleep a person needs to allow them to function well during the day:
Average Number of
15 - 18
|Babies and toddlers|
12 - 14
11 - 12
|Elementary School-age children|
10 - 11
9 - 10
7 - 8
The amount of sleep you get is extremely important. But the type of sleep you get also determines how well-rested you'll be when you awake. If you're feeling drowsy during the day, you may not have gotten enough quality sleep. Healthy sleep is characterized by a specific sequence of stages or sleep cycle. If the sequence is interrupted the quality of our sleep suffers.
Why do we need sleep?
Why we sleep is still one of the world's great unanswered questions. Ongoing research is just beginning to shed some light on the subject and scientists are formulating some promising explanations. They hypothesize that sleep helps the body restore and rejuvenate in many different ways by:
- Replenishing the energy stores that we use up while awake
- Allowing us to process, consolidate and retain new memories and skills
- Contributing to the formation of new nerve cells in the brain and exercising important neuronal connections that might otherwise deteriorate due to lack of activity
- Increasing the amount of growth hormone that is secreted (vital for children but also important for rebuilding tissue in adults)
- Boosting the immune response
- Reducing damage caused by oxidative stress
- Promoting optimal performance of the part of the brain that controls emotions, decision-making and social interactions
Just as the theories behind why we sleep are still being researched so too are the consequences of sleep deprivation. We do know that when we are sleep deprived over long periods, our health suffers. It's difficult for scientists to separate the effects of lost sleep from those of stress or other factors, but several studies point to a multitude of potential problems.
Too little sleep can:
- Hinder our ability to perform daily activities, making even simple tasks difficult
- Increase stress and affect our mood
- Impair memory
- Increase the number of mistakes we make, including fatal ones like car accidents
- Increase hunger and affect the body's metabolism. The link between quality/restful sleep and weight loss is not yet clear. It makes sense, but it has not been proven in a substantial way.
- Contribute to diseases like high blood pressure, heart disease and diabetes
- Make it harder to fight off infections
- Cause symptoms that mimic some of the hallmarks of aging such as blood levels with higher amounts of cortisol
- Cause digestive problems such as constipation, diarrhea, excessive gas, abdominal pain, and heartburn
- Affect quality of life and level of satisfaction.
Bottom line – sleep needs to be a priority in your life, along with a healthy diet and regular exercise.
Key Point 2
Sleep disorders are very common and serious. There are many causes of sleep disorders. You can work with your team of doctors to diagnose your problem.
The National Commission on Sleep Disorders Research estimates that 40 million Americans suffer from chronic sleep disorders and another 20 to 30 million experience sleep problems intermittently. And since sleep disorders increase with aging, those suffering from chronic sleep disorders are expected to rise to 79 million and those suffering from intermittent problems to increase to 40 million by 2010, as the U.S. population ages. However, the vast majority of Americans with sleep disorders remain undiagnosed and under treated.
The National Institutes of Health define a sleep disorder as any difficulty related to sleeping, including:
- Difficulty falling or staying asleep
- Falling asleep at inappropriate times
- Excessive total sleep time
- Abnormal behaviors associated with sleep
- Sleep disorders can generally be grouped into categories such as:Lack of sleep (e.g., insomnia )
- Disturbed sleep (e.g., obstructive sleep apnea, periodic limb movements, and restless legs syndrome )
- Excessive sleep (e.g., narcolepsy and hypersomnia )
- Disturbed circadian rhythm(e.g. shift work sleep disorder and jet lag)
If you suspect that you may have a sleep disorder, discuss your symptoms with your primary care physician.
The first steps towards getting a diagnosis will commonly include:
- A thorough description of symptoms. Other family members play an important role here, since they can describe behaviors that the patient won't remember, such as snoring, limb movements, or sleepwalking.
- Both a medical history and a psychological history.
- A physical exam.
- A sleep questionnaire (Epworth Sleepiness Scale). The patient ranks whether certain situations make them sleepy and, if so, how sleepy.
- A sleep diary. Many doctors ask patients to keep a sleep diary for one or two weeks to record their sleep habits and daily routines.
- Tests to rule out other conditions. These may include blood tests for thyroid levels, iron, and glucose, kidney and liver function tests and an EKG.
If insomnia is diagnosed your doctor may refer you to a specialist for psychological tests. Insomnia is frequently associated with mood or affective disorders.
If your doctor suspects that you have a sleep disorder, he or she may refer you to a sleep disorder clinic. A sleep specialist will review your symptoms and may suggest that you undergo a sleep study. Tests include:
- Polysomnography (PSG). This test measures brain waves, eye movements, cardiac rhythms and other physical functions during sleep. It usually requires an overnight stay at a sleep clinic for observation though portable equipment is available for home recording of a limited number of factors.
- Overnight oximetry. This test is used for patients with suspected obstructive sleep apnea to determine the oxygen level in the bloodstream during apnea episodes.
- Multiple sleep latency test (MSLT). This test measures the speed with which a patient falls asleep during a series of planned naps during the day and also measures the amount of REM sleep that occurs.
- Repeated test of sustained wakefulness (RTSW). This test measures how long it takes for a patient to fall asleep by challenging his or her ability to stay awake. This is also known as the "MWT" or maintenance of wakefulness test.
Key Point 3
With proper diagnosis, treatment for sleep disorders can be effectively targeted.
A Gallup poll from the late 1990s revealed that:
- 69 percent of Americans with sleep problems never mentioned the problem to their physicians
- 26 percent mentioned it, in passing, while visiting their doctor for another problem
- Only 5 percent directly sought help
Instead, four out of ten medicate themselves to get to sleep with alcohol, non-prescription sleep aids (usually containing antihistamines), aspirin and supplements like melatonin and valerian. And they self-medicate to stay awake, with caffeine and other over-the-counter stimulants.
The problem is, alcohol can produce abnormal sleep patterns that cause you to wake too early. Antihistamines can make you feel tired and groggy the next day. Caffeine and other stimulants may give you the illusion that you're performing well, but with prolonged use, they may actually decrease performance.
Effective treatment for sleep disorders depends on the cause. (See Key Point 2 for information on diagnosis of sleep disorders.)
If you're tuned into the media, prescription sleeping pills seem to be the Holy Grail for sleep problems. It's almost impossible to watch television without seeing advertising for several brands, each promising an effective solution with minimal side effects. As a result, about 42 million sleeping pill prescriptions were filled last year, according to the research company IMS Health, up nearly 60 percent since 2000.
However, sleeping pills treat the symptom, not the cause. And, they're not as effective as you might hope.
- Most have a half life of six hours, meaning that the amount of the drug in your bloodstream drops by 50% well before you reach your optimum hours of sleep.
- They're meant for short term use. People with chronic conditions cannot be put on sleeping pills for life.
- They may mask an underlying condition, leaving it undiagnosed and untreated.
The large majority of sleep problems can be effectively treated. The following are a sampling of some common sleep disorders and common treatments.
Insomnia may be secondary to psychological or medical disorders, medication side effects, or substance use. In that case, treatment would focus on those issues. Otherwise, treatment to improve sleep habits can make a dramatic difference. To establish good sleep habits you can:
- Keep a regular schedule, even on weekends
- Make sure your bedroom environment is conducive to sleep (quiet, comfortable temperature, etc)
- Decrease stress and stimulation at bedtime
- Perform relaxing bedtime rituals, such as progressive relaxation
- Exercise daily but not just before sleep
- Avoid caffeine, alcohol and cigarettes, especially just before sleep
- Cut down on coffee, alcohol and other stimulants all day
- Also, and perhaps most important, use the bed for sleep and sex alone, and not for any other activities. When awake, stay out of bed.In some cases, a sleep psychologist can help people alter behaviors and attitudes that are counter-productive achieving restful and sufficient sleep for healthy living.
Obstructive Sleep Apnea
There are many different kinds of sleep apnea. Obstructive sleep apnea is the most common.
Treatment alternatives include:
- Weight loss
- Avoiding sleeping on the back
- Dental appliances
- Continuous Positive Airway Pressure (CPAP)
Patients with sleep apnea should not take sleeping pills because they can prevent the person from waking up enough to start breathing again.
Periodic Limb Movement Disorder
Medication can reduce movements or help the person sleep through the movements.
Restless Leg Syndrome
Treatments may include:
- Hot baths, ice packs, leg message and regular exercise
- In certain cases Vitamin E, supplemental calcium, iron and magnesium
Narcolepsy can't be cured but symptoms can be managed with:
- Changes in behavior
- Scheduling short naps during the day
Conduct an off-site search for Sleep Disorders information from MedlinePlus. These up-to-date search results are based on search terms specific to Second Opinion Key Points.