Another dangerous debt

Experts say lack of sleep can cause problems beyond crankiness

Experts say lack of sleep can cause problems beyond crankiness

February 02, 2004|by ANDREA ROWLAND

Don't skimp on sleep - the body needs rest to function at its best.

"Sleep is undervalued in the 24/7 society we live in. We don't value sleep as we should," said Dr. Carl Hunt, director of the National Institutes of Health's National Center on Sleep Disorders Research. "Sleep does indeed matter. There's no substitute for getting a good night's sleep on a regular basis."

Although scientists still have much to learn about the functions of sleep, it is clear that the body needs plenty of rest - at least nine hours nightly for children and adolescents and about eight hours per night for adults - to maintain health, safety and performance, said Susan Sagusti, technical writer and editor for the NIH's Office of Prevention, Education and Control at the National Heart, Lung and Blood Institute.

The "sleep debt" that occurs when individuals get less sleep than needed each night can be dangerous.


Lack of sleep and poor quality of sleep can affect mood and impair performance, Sagusti said. Sleep problems such as chronic insomnia - the most common sleep disorder - and sleep apnea also have been shown to contribute to decreased cognitive functioning, reduced productivity, poor job or school performance, and diminished ability to control impulses and emotions, she said.

A study on the effects of sleep deprivation found that subjects who slept four to six hours a night for 14 consecutive nights showed such deficits in cognitive performance as reduced ability to pay attention and react to a stimulus, to think quickly and not make mistakes, and to multitask - equivalent to going without sleep for as many as three days in a row. The subjects, however, reported feeling only slightly sleepy and were unaware of how impaired they were, according to findings published in the March 2003 issue of SLEEP journal.

"The results provide a clearer picture of possible dangers to people who typically are awake longer on a regular basis, including members of the military, medical and surgical residents and shift workers," principal investigator David Dinges said. "Reduced cognitive abilities can occur even with a moderate reduction in sleep."

In addition, sleep problems have been linked to such safety hazards as motor vehicle crashes and medical errors, Sagusti said. About 100,000 traffic accidents and 1,500 traffic fatalities per year are sleep related, according to the NIH.

Chronic sleeplessness also might increase the risk of common viral illnesses, cardiovascular disorders and depression, the agency states.

Fifteen to 30 percent of older adults in the United States, and 15 to 20 percent of young- and middle-aged adults, suffer from chronic insomnia - the inability to sleep at least three nights per week for more than one month, Hunt said.

An estimated 70 million people in the United States suffer from sleep problems, and nearly 60 percent of them have a chronic disorder, according to NIH statistics. About 30 million U.S. adults have frequent or chronic insomnia, about 12 million adults suffer from sleep apnea, and an estimated 250,000 adults have narcolepsy.

Sleep disorders, sleep deprivation and excessive daytime sleepiness add about $16 billion annually to the national health care bill, according to the NIH.

"It's a major public health problem," Hunt said.

Females, elderly people and individuals battling depression are more likely to experience chronic insomnia, he said. It's unclear why women are more prone to sleeplessness, but scientists suspect a hormonal link, Hunt said. Stress, anxiety, underlying physical or mental disorders, some prescription drugs, and the misuse of caffeine and alcohol can exacerbate the problem. Alcohol might bring upon sleep faster, but it disrupts the quality of sleep, Hunt said.

Treatment for chronic insomnia consists of diagnosing and treating underlying medical or psychological problems, identifying behaviors that may worsen insomnia, and stopping or reducing them, according to the NIH.

Sleeping pills and behavioral therapy can be effective strategies for treating primary insomnia - sleeplessness that is not attributable to a medical, psychiatric or environmental cause, Hunt said.

"The good news is there are some new medications," he said.

Most older prescription drugs for sleeplessness wore off slowly, causing a "morning hangover," and were addictive, Hunt said. Newer medications such as Ambien boast quick onset, shorter duration and no evidence of addiction, he said.

The U.S. Food and Drug Administration now approves only short-term use of such newer generation sleeping pills, but emerging data suggests that these drugs could be recommended for long-term use, Hunt said.

"People with chronic insomnia need long-term therapy," he said.

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