The Significance of Sleep Deprivation & Strategies for a More Restful Night

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:

• Aim to cut off fluids 2 hours before bedtime to decrease the need to get up to use the bathroom during the night. Try to obtain most of your fluid goals in the first two-thirds of your day. Drink 16oz of water soon after waking to hydrate your body, help to flush out toxins, and to help reduce breakfast portion sizes.
• Avoid caffeine intake after lunch time, as caffeine may stay in your system for up to 12 hours. Drink water, herbal tea, or decaffeinated coffee instead.
• Avoid napping during the day. If you feel a strong desire to nap after meals, you may need to take a closer look at your digestion and the types and amounts of food that are causing you to feel this way. Consider partnering with a healthcare practitioner for food sensitivity testing or a guided elimination diet.

General Principals:

• Keep the temperature in your bedroom between 55-74 degrees, with cooler temperatures preferred. Anything outside of this range can affect your sleep. Utilize fans, air conditioners, or electric blankets as needed. Some individuals find the white noise from a fan to likewise produce a soothing background noise.
• Stay on the same sleep schedule 7 days per week. Aim to go to bed and wake up at the same time every day to help program your biological clock. The deepest and most regenerative sleep occurs between 10 p.m.-2 a.m. Aim for a 10 p.m. or 11 p.m. bedtime.
• Log at least 7 to 9 hours of sleep each night.

• Use your bedroom for sleep and intimacy only. Do not watch television, eat, or read in bed. If there is a television in your bedroom, move it to another room.

Before Bed:

• Avoid nicotine 45 minutes before bed (or better yet, avoid it altogether!) as nicotine, like caffeine, is a stimulant.
• Avoid screens (computer, phone, or television) or other bright lights for 1-2 hours before bedtime. These concentrated sources of light can mimic sunlight and trick our brains, thereby impairing the secretion of the hormone melatonin (which helps to regulate sleep-wake cycles).
• Carve out time before bed for your evening wind-down routine, and also schedule adequate time in the morning to ready yourself for the day so you are not rushed. If you are aiming to be asleep by 10 p.m., start your evening routine by 9 p.m. (or try timing your various activities to calculate an alternative length of time).
• Avoid large meals/snacks close to bedtime. Eating a large dinner interrupts one’s ability to fall asleep because it forces the body to contend between two different processes – preparing for sleep and restoration vs. handling undigested food in the stomach.

Relaxation Techniques:

• Try gratitude or accomplishment journaling, especially if you are prone to feeling anxious and restless before bed. Write down 3-5 things you are grateful for and/or 3-5 things you accomplished that day. Aim to write something different each day. This helps turn the mind away from the worrisome, ruminating thoughts that many people experience before bedtime which leads to restless sleep.
• Avoid vigorous exercise prior to bed as it may increase alertness. Instead, engage in stretching and gentle yoga positions to help relax and soothe sore, tired muscles.
• Try various meditation practices such as a guided meditation from a CD or phone app, or an adult coloring book
• Employ relaxing deep-breathing exercises, such as the 4-7-8 breathing technique. Place the tip of your tongue on the roof of your mouth, just behind the front teeth. Exhale completely through your mouth, making a whoosh sound. Close your mouth and inhale quietly through your nose to the count of four. Hold your breath for a count of seven, then exhale completely through your mouth, to a count of eight. Continue the cycle. This is also a helpful relaxation technique during the day.
• Progressive muscle relaxation is another technique that may be especially helpful for those experiencing anxiety or insomnia. It involves tensing and relaxation different muscle groups in a head-to-toe (or toe-to-head) fashion.

When to Seek Help:

• If needed after these other techniques have been attempted, talk to your healthcare provider about natural sleep aids such as melatonin, valerian, chamomile. Avoid long-term use of aids such as Motrin PM or Tylenol PM.
• If you suspect you may have sleep apnea, consider completing the Epworth Sleepiness Scale (an 8-step questionnaire measuring daytime sleepiness).
• If you would like to test for food sensitivities or for advice on an elimination diet
• If you suspect hormonal imbalances may be playing a role
• If you could use guidance and support for desired behavioral changes

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.

References

AAA Foundation for Traffic Safety. (2005). FAQs: Drowsy driving. Retrieved from: http://www.

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Akerstedt, T., Fredlund, P., Gillberg, M., Jansson, B. (2002). A prospective study of fatal occupational

accidents–relationship to sleeping difficulties and occupational factors. Journal of Sleep Research. 11(1):69–71.

Centers for Disease Control and Prevention, Division of Adult and Community Health. (2011). Sleep and

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Centers for Disease Control and Prevention, Division of Population Health. (2014). Drowsy driving:

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Hasler, G., Buysse, D.J., Klaghofer, R., Gamma, A., Ajdacic, V., Eich, D., Rossler, W., Angst, J. (2004). The

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U.S. Department of Health and Human Services (2011a). Healthy people 2020. Retrieved from

http://www.healthypeople.gov/2020/default.aspx.

U.S. Department of Health and Human Services. (2011b). Sleep Health. Retrieved from:

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx? topicId=38#five

Van Dongen ,H.P., Maislin, G., Mullington, J.M., & Dinges, D.F. (2003). The cumulative cost of additional

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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