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Author: Ron Cridland, MD
Insufficient sleep is one of the most common causes of fatigue and daytime sleepiness. It is also one of the most commonly overlooked sleep disorders by both patients and doctors alike. On the surface you might think it would be the easiest to treat. However, entrenched lifestyles and over commitment can often make it difficult to find the time to get the sleep that we need.
On average, a person needs 7 – 9 hours of sleep per night to be rested. A National Sleep Foundation pole showed that 33% of the population slept less than 6.5 hours per night, 20% found sleepiness interfered with their work a few days per week, 51% reported feeling drowsy while driving in the previous year and 17% reported actually falling asleep at the wheel. Insufficient sleep is an epidemic in our society.
In the workplace the same poll showed 27% of workers feeling sleepy at work, and 19% reported making errors at work due to sleepiness. The cost of sleepiness in the workplace from lost productivity, errors or reduced work quality costs businesses and consumers millions of dollars every year.
Consequences of insufficient sleep include inattention and cognitive impairment that significantly increases the risk of motor vehicle accidents. For example, 22 hours of continual wakefulness can result in an impairment equivalent to that of being legally drunk with a 0.08 blood alcohol level. Four hours of sleep for 2 weeks can be equivalent to no sleep for 3 days. Sleepiness and alcohol are two of the main causes of single vehicle accidents during the nighttime hours. Sleepiness is also one of the most common contributing factors to daytime accidents as well.
Insufficient sleep not only contributes to accidents, mistakes and reduced productivity, it also has health consequences as well. The stress of pushing yourself to function when you are tired immediately increases your blood pressure and heart rate. Chronic sleep restriction increases your risk of developing hypertension and heart disease. Insufficient sleep slows your metabolism and increases insulin resistance contributing to obesity and type II diabetes. Sleep restriction aggravates inflammation in the body increasing the tendency to painful illnesses like arthritis and fibromyalgia. The associated fatigue makes it harder to cope with stress, significantly increasing the risk of depression and anxiety disorders. It is also thought that insufficient sleep undermines the immune system contributing to infectious disease and cancer.
Diagnosis
The diagnosis of Insufficient Sleep Syndrome is made if there is excessive sleepiness associated with less than 8 hours of sleep per night secondary to sleep restriction that is not caused by insomnia and there is no other sleep disorder to account for the sleepiness. The condition has to have been going on for a few months. In addition, increased sleep results in resolution of the symptoms of sleepiness and fatigue.
I am often asked, “How much sleep do I need"? Here is a two-fold test that you can use to determine if you are getting enough sleep. First, do you wake up in the morning spontaneously feeling refreshed, as opposed to an insomniac who may wake up spontaneously but is not refreshed? The second point has to do with our natural lull in alertness that occurs in the mid afternoon due to our biological clock. Most of us are too busy and living on adrenalin to notice it. However the second part of the test is if you can sit down and relax for 20 minutes in the afternoon and not feel sleepy, then you have likely had enough sleep.
Management
Obviously, management requires getting enough sleep. When insufficient sleep has been going on long enough to become chronic, it often involves lifestyle changes or personal commitments that make getting enough sleep more difficult than it sounds.
Often times, getting enough sleep is postponed until you get caught up on all the priorities on your agenda. The problem is that when you are sleep deprived you are also less efficient at getting things done and make more mistakes. Sometimes, you are not able to catch up on your priorities because of this inefficiency. Sometimes, it is necessary to focus on getting enough sleep first and then catching up on other things later once you are feeling rested and functioning at normal efficiency.
When over commitment is a factor, then it is important to give sleep greater priority. There are a lot important things in our life although few things are as important as our health and wellbeing. Sometimes we need to ask ourselves, "how important is it for me to feel well"? If feeling well is important enough, then you can use that to discipline yourself to create a successful strategy to consistently achieve it.
When insufficient sleep has been going on a long time, some people have trouble sleeping longer even when they create the opportunity to do so. This is because of habit or conditioning and means they have a component of Psychophysiological Insomnia. They need to “train” themselves to sleep longer. You can train yourself to sleep longer by following the recommendations in the section on Sleep Hygiene or following the Online Insomnia Management Program. The most important factors are to take enough time to wind down before bed to allow the adrenalin to wear off, use relaxation to help fall asleep, and set the alarm. Once you are waking up with the alarm to anchor your sleep, then you can gradually delay the alarm or go to bed earlier 30 minutes at a time until you are getting enough sleep to feel rested.
