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Making Sleep a Priority

With the increasing demands and pressures of daily life, it’s not unusual for people to sacrifice a good night’s sleep to spend more time working or with loved ones. However, insufficient sleep can have serious consequences. It can lead to an increased risk of high blood pressure, diabetes, heart attack, stroke, and death. It also may be responsible for impaired judgement and slowed reaction time, including new evidence that sleep deprivation increases the risk of motor vehicle crashes.

“Healthy sleep is just as important as a healthy diet and regular exercise” says Daniel J. Gottlieb, MD, MPH, of the Division of Sleep and Circadian DisordersDepartments of Medicine and Neurology at Brigham and Women’s Hospital (BWH) and the Medical Service at the VA Boston Healthcare System.

Sleep deprivation can lead to cognitive impairments and the feeling of excessive sleepiness. Two of the most common reasons for insufficient sleep duration are sleep apnea and sleep deprivation.

You don’t have to spend a night in a sleep lab to be diagnosed with sleep apnea.

Sleep apnea

Sleep apnea is a condition in which the airway briefly collapses during sleep, causing breathing to stop or decrease. During these episodes, which may occur many times in a night, the patient becomes briefly awakened from sleep, though they may not be consciously aware that it has happened. Among US adults, one-third of men and one in six women have sleep apnea.

Sleep apnea is typically first noticed by a bed partner, who will either notice brief restlessness during sleep, or more commonly complain about loud snoring. Snoring is a common sign of sleep apnea, and the louder the snoring the more likely the individual is to have sleep apnea. Other symptoms include waking up from sleep feeling unrefreshed or more tired than when they went to sleep, awakening with a dry mouth or sore throat, and frequent awakenings at night.

Dr. Gottlieb notes that testing for sleep apnea has become much easier to do than it was a decade ago. He advises anyone who suspects sleep apnea to make an appointment with their primary care physician to discuss this concern. Sleep apnea can be diagnosed using a small portable device that monitors breathing and blood oxygen levels and can be worn overnight at home.

“You don’t have to spend a night in a sleep lab to be diagnosed with sleep apnea,” says Dr. Gottlieb.

Once someone is diagnosed with sleep apnea, many treatment options are available to significantly improve sleep quality. These include:

  • A pressurized mask worn over the nose and mouth, which helps keep the airway stay open during sleep due to pressure applied through the mask.
  • An oral appliance that can hold the jaw forward during sleep to help prevent the airway from closing.
  • Minor surgical procedures to prevent the airway from collapsing.
  • Weight loss and decreasing alcohol consumption can also help to improve or eliminate sleep apnea.

Insufficient sleep duration

If someone doesn’t show signs of sleep apnea, and yet still suspects that they are sleep deprived, they may not be getting a sufficient duration of sleep.

“Most adults need seven-to-eight hours of sleep at a time to feel fully rested. It’s important for people to make it a priority to get sleep for seven or more hours,” says Dr. Gottlieb.

The main treatment for insufficient sleep is changing behavior in the hours shortly before bedtime. These include avoiding stimulating behavior, such as drinking too much caffeine or exercising vigorously, and avoiding stressful situations before bedtime such as paying bills or working.

Insufficient sleep is defined as six or fewer hours of continuous sleep. One-third of adults in the US report regularly sleeping six hours or fewer. In addition to excessive sleepiness, insufficient sleep can cause poor concentration and emotional instability. An individual is diagnosed with insufficient sleep based on events and circumstances relating to their health, as there are currently no specific tests. 

The main treatment for insufficient sleep is changing behavior in the hours shortly before bedtime. These include avoiding stimulating behavior, such as drinking too much caffeine or exercising vigorously, and avoiding stressful situations before bedtime such as paying bills or working.

Importantly, individuals may not be able to assess whether they are cognitively impaired as a result of chronic sleep deprivation. A recent study by Dr. Gottlieb and his colleagues found that sleep deficiency due to either sleep apnea or insufficient sleep duration increases the risk of motor vehicle crash. The study found that those who are sleep deprived had an increase in motor vehicle crash risk regardless of an individual’s self-reported sleepiness level.

“It can be important to listen to the impressions of spouses, family, friends, and coworkers as we may not always be best positioned to perceive our own level of sleepiness,” advises Dr. Gottlieb.

- Allie H.