Insufficient sleep epidemic

Insufficient sleep is a huge public health issue and is becoming an epidemic leading to negative health outcomes. This article tells you the possible negative health outcomes from insufficient sleep, how much sleep you should be getting, and general sleep hygiene tips.

Sleep is increasingly recognized as important to public health, with sleep insufficiency linked to motor vehicle crashes, industrial disasters and medical and other occupational errors. Unintentionally falling asleep, nodding off while driving, and having difficulty performing daily tasks because of sleepiness all may contribute to these hazardous outcomes. People experiencing sleep insufficiency also are more likely to suffer from chronic diseases such as hypertension, diabetes, depression and obesity, as well as from cancer, increased mortality and reduced quality of life and productivity. Sleep insufficiency may be caused by broad scale societal factors such as round-the-clock access to technology and work schedules, but sleep disorders such as insomnia or obstructive sleep apnea also play an important role. An estimated 50 to 70 million U.S. adults have sleep or wakefulness disorder. Notably, snoring is a major indicator of obstructive sleep apnea.

In recognition of the importance of sleep to the nation's health, Centers for Disease Control and Prevention surveillance of sleep-related behaviors has increased in recent years. Additionally, the Institute of Medicine encouraged collaboration between the CDC and the National Center on Sleep Disorders Research to support development and expansion of adequate surveillance of the U.S. population's sleep patterns and associated outcomes. Two new reports on the prevalence of unhealthy sleep behaviors and self-reported sleep-related difficulties among U.S. adults provide further evidence that insufficient sleep is an important public health concern.

Sleep-related unhealthy behaviors

The Behavioral Risk Factor Surveillance System survey included a core question regarding perceived insufficient rest or sleep in 2008 (included since 1995 on the Health Related Quality of Life module) and an optional module of four questions on sleep behavior in 2009. Data from the 2009 survey's Sleep module were used to assess the prevalence of unhealthy sleep behaviors by selected sociodemographic factors and geographic variations in 12 states. The analysis determined that among 74,571 adult respondents in 12 states, 35.3 percent reported fewer than seven hours of sleep during a typical 24-hour period, 48.0 percent reported snoring, 37.9 percent reported unintentionally falling asleep during the day at least once in the preceding month, and 4.7 percent reported nodding off or falling asleep while driving at least once in the preceding month. This is the first CDC surveillance report to include estimates of drowsy driving and unintentionally falling asleep during the day. The National Department of Transportation estimates drowsy driving to be responsible for 1,550 fatalities and 40,000 nonfatal injuries annually in the United States.

Self-reported sleep-related difficulties among adults

The National Health and Nutrition Examination Survey introduced the Sleep Disorders Questionnaire in 2005 for participants 16 years of age and older. This analysis was conducted using data from the last two survey cycles (2005 to 2006 and 2007 to 2008) to include 10,896 respondents aged older than or equal to 20 years. A short sleep duration was found to be more common among adults ages 20 to 39 years (37.0 percent) or 40 to 59 years (40.3 percent) than among adults aged older than or equal to 60 years (32.0 percent), and among non-Hispanic blacks (53.0 percent) compared to non-Hispanic whites (34.5 percent), Mexican-Americans (35.2 percent) or those of other race/ethnicity (41.7 percent). Adults who reported sleeping less than the recommended seven to nine hours per night were more likely to have difficulty performing many daily tasks.

How much sleep do we need? And how much sleep are we getting?

How much sleep we need varies among individuals but generally changes as we age. The National Institutes of Health suggests that school-age children need at least 10 hours of sleep daily, teens need nine to 10 hours, and adults need seven to eight hours. According to data from the National Health Interview Survey, nearly 30 percent of adults reported an average of less than or equal to six hours of sleep per day from 2005 to 2007. In 2009, only 31 percent of high school students reported getting at least eight hours of sleep on an average school night.

Sleep hygiene tips

The promotion of good sleep habits and regular sleep is known as sleep hygiene. The following sleep hygiene tips can be used to improve sleep:

* Go to bed at the same time each night and rise at the same time each morning.

* Avoid large meals before bedtime.

* Avoid caffeine and alcohol close to bedtime.

* Avoid nicotine.

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Negative effects of sleep deprivation

This article discusses how important sleep is for people, and how detrimental sleep deprivation can be.

There's a tendency to see sleep as a giant time suck - some unfortunate biological need to be kept at bay until someone's finished their English paper or beaten a tricky level on Candy Crush Saga.

Robert Wittig sees it differently.

"The only time you cannot possibly waste is when you're sleeping," said Wittig, medical director at the Aspirus Keweenaw Sleep Disorder Center in Laurium.

Perceiving those work, school or social demands as more important than a restful night is the leading cause of sleep deprivation, Wittig said.

A good night's sleep has been redefined downward over the past century as advances in technology and luminosity have extended shopping and recreation to a 24/7 distraction. The average person got nine hours of sleep a night in 1900; now, it's under seven.

"You can see that as a great improvement in human efficiency, or you can see it as a looming disaster," Wittig said. "Personally, as a child of the 60s, I think it might explain the loss of creativity in popular music."

But there's more to fear from drowsiness than Karmin. About two-thirds of single-vehicle accidents on the road are due to falling asleep, Wittig said.

"It probably wasn't a problem when people had horses, because you could fall asleep and the horse would still get you there," he said. "You're going down a highway in a car that's supposed to be comfortable, and a car that's supposed to be quiet and luxurious, you're more likely to fall asleep."

People operating on fewer hours of sleep will also have less initiative and be less efficient, he said.

When people come into the clinic, the first thing Wittig does is take the patient's case history. This can include what drugs they're taking, how often they have substances like alcohol or caffeine and their usual sleep environment.

Wittig once treated a woman from Detroit with terrible insomnia. She was admitted to the sleep center, where she had an uneventful, restful night. They were puzzled until she remarked on how warm it was. As it turns out, her house had no heat.

"That's why you literally have to spend an hour asking these questions, because something simple and obvious can end up being the problem," Wittig said.

About two-thirds of the people who come to the center wind up going through a sleep study. The three main measurements used are electromyography (muscle response), electroencephalography (electrical activity in the brain) and eye movement.

"With those three things, you can tell if a person's awake, asleep, what stage of sleep they're in," Wittig said.

Other tools can include an electrocardiogram, strain gauges on the chest, electrodes to measure restless legs and an oximeter to measure the oxygen saturation of hemoglobin in the blood.

But about a third of patients don't need a sleep study to find the remedy, said Wittig. He cautioned against overtreating patients when simpler solutions exist, using the example of a man who only snores when he drinks.

"As a male, half snore by the age of 50," he said. "It doesn't mean we all need sleep studies."

Some remedies are surgical.sSleep apnea, which causes snoring can be caused by obesity, or by large tonsils or a jaw defect; surgery can be used to open up the throat. Another route is continuous positive airway pressure, in which a machine blows air into a tube connecting to a mask that goes over the nose and mouth.

"Literally, that can be an overnight miracle for someone who got into a problem over years and didn't realize," Wittig said. "Overnight, they're a new person, and they think you're wonderful."

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People with Sleep Apnea More Likely to Fall Asleep at the Wheel

New study results show that those with sleep apnea are more likely to report nodding off while driving and/or fail a driving simulator test.

People with sleep apnea are more likely to fail a driving simulator test and report nodding whilst driving, according to new research.

The study was presented April 12, 2013 at the Sleep and Breathing Conference in Berlin, organized by the European Respiratory Society and the European Sleep Research Society.

Sleep apnea has previously been linked with an increased chance of being involved road traffic accidents. A research team from the University Hospital in Leeds, UK, carried out two separate studies looking at the effect sleep apnea has on driving during a simulator test, carried out at the University of Leeds.

In the first study, 133 patients with untreated sleep apnea and 89 people without the condition took part in the test. All participants completed a 90 km motorway driving simulation and were tested on a number of key criteria, including: ability to complete the distance, time spent in the middle lane, an unprovoked crash or a veer event crash.

The results showed that patients with untreated sleep apnea were more likely to fail the test. 24% of the sleep apnea patients failed the test, compared to 12% of the people without the condition. Many patients with sleep apnea were unable to complete the test, had more unprovoked crashes and could not adhere to the clear driving instructions given at the beginning of the simulator test.

In the second study, 118 patients with untreated sleep apnea and 69 people without the condition completed a questionnaire about their driving behavior and undertook the 90 km driving test on the simulator.

35% of patients with sleep apnea admitted to nodding at the wheel and subsequently 38% of this group failed the test. This compared to 11% of people without the condition admitting to nodding and none of this group failing the test.

Chief investigator, Dr. Mark Elliott, commented: "Driving simulators can be a good way of checking the effects that a condition like sleep apnea can have on driving ability. Our research suggests that people with the condition are more likely to fail the test.

"In the first study, although some people in the control group also failed the test, there were several key differences in the reasons for failure. For example 13 patients were unable to complete the test because they fell asleep, veered completely off the motorway and 5 patients because they spent more than 5% of the study outside the lane that they had been instructed to remain in. No controls failed for either of these reasons. Further investigation is needed to examine the reasons for failure of the simulator test."

Dan Smyth, Sleep apnea Europe, said: "The dangers of untreated sleep apnea and driving are highlighted in both studies. These studies give weight to the need for provision of sufficient resources for early diagnosis and treatment of sleep apnea, where effective treatment ensures a return to acceptable risk levels for road users."

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