Clinical Updates in Sleep Medicine

We’re Not Sleeping Enough!

Associate Director, Johns Hopkins Sleep Disorders Center; Assistant Professor of Psychiatry, Johns Hopkins University School of Medicine, Baltimore

First published in Psychiatry Weekly, Volume 5, Issue 5, on March 8, 2010.

“I’ll sleep when I die” is the attitude of millions of people who get to bed too late and get up too early, leaving insufficient time in between for adequate sleep. Getting sufficient sleep is important for the mental and physical health of all people—whether healthcare providers or patients. Unfortunately, both lifestyle choices and schedules for work and school challenge the natural biological drive to sleep ~8 hours most nights. The result is varying degrees of chronic sleep deprivation resulting in daytime sleepiness and cognitive impairment, dependence on caffeine, and an increased risk for assorted health problems.

The CDC recently released a report analyzing data from a large-scale 2008 survey of adults in the United States. Participants answered questions from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based random-digit-dialed telephone survey of noninstitutionalized people at least 18 years of age. The BRFSS survey for 2008 included the question, “During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?” The findings were remarkable: Only 30.7% of the respondents reported having no days of insufficient rest or sleep and 11.1% stated that they did not get enough rest or sleep on any of the previous 30 days. Interestingly, the prevalence of insufficient rest or sleep for all 30 days generally declined with age, suggesting that work schedules and other lifestyle choices among the younger age groups may be major contributing factors. The rate was the highest in the 25–34-year old group and lowest in those ≥65 years of age.

Who says we need 8 hours of sleep most nights? Although there is no absolute measurement of sleep need and there is some degree of individual variation, considerable evidence supports an average of ~8 hours as the optimum amount. Healthy sleepers typically will sleep slightly >8 hours when they are given an ample opportunity to sleep without any time constraints. Since many people are mildly sleep deprived, it is common for them to sleep well >8 hours when an unlimited opportunity occurs, which may happen during weekends and vacations.

Adequate sleep, like exercise and an appropriate diet, should enhance personal health. If more people slept an adequate amount there also would be major benefits for society. There is a huge economic burden associated with the widespread sleep debt. Fortunately, regulations regarding work schedules are in effect in some professions, including airline pilots, some commercial drivers, and medical trainees. However, the rules cannot regulate how much people sleep in their free time. It is a mistake to regard sleep as a waste of time. Rather, sleep should be seen as an investment in an improved waking life and better long-term health.

Disclosure: Dr. Neubauer is a consultant to sanofi-aventis and Takeda.