How Sleep Affects Your Health

How Much Sleep Do We Need?

The pressure of a deadline, high caseload, concerns about clients, and working toward partnership can make for sleepless nights, but lack of sleep can slow down our thought process and make those sleepless nights less effective than we think.

Several studies have assessed performance after sleep deprivation through comparisons with different levels of alcohol intake. After 17–19 hours awake, human performance is equivalent to that of a blood alcohol concentration (BAC) level of 0.05 percent and after longer sleep deprivation, the level of performance reaches levels equivalent to a BAC of 0.1 percent. An alcohol level of 0.08 percent is the threshold for a DUI in most states.

In 2015, the American Academy of Sleep Medicine and the Sleep Research Society published a joint consensus recommending that adults should sleep seven to eight hours per night on a regular basis to promote optimal health.

Before the broad usage of the light bulb in early 1900, people used to sleep nine hours on average. Current surveys indicate that 35–40 percent of the adult US population report sleeping less than the usually recommended seven to eight hours on weekday nights and about 15 percent report sleeping fewer than six hours.

Sleep deprivation can be caused by sleep disorders, work schedules, and modern lifestyles. When we do not get enough sleep, or when we have poor quality sleep, we feel very tired throughout the day. Sleep deficiency can interfere with work, school, driving, and social functioning. You might have trouble learning, focusing, and reacting. Also, you might find it hard to judge other people’s emotions and reactions. Sleep deficiency also can make you feel frustrated, cranky, or worried in social situations. Sleep deprivation also appears to play a role in chronic health diseases, such as dementia, cardiovascular disease, obesity, and type 2 diabetes.

How to Get Appropriate Sleep

1. Avoid Stimulants
   Caffeine is a powerful and readily available stimulant and is found not only in coffee but also in teas, cocoa, chocolate bars, and carbonated drinks. Read the labels on products you might consume in the evening to make sure they are caffeine-free. It is recommended to avoid caffeine four to six hours before bedtime.
   
   Nicotine is also a stimulant drug, and smokers are recommended to refrain from tobacco products close to bedtime.
   
   Alcohol depresses central nervous system function. It may help people falling asleep at the beginning of the night, but as the ethanol is metabolized, it produces withdrawal symptoms and may cause lighter sleep and arousals. Therefore, it is recommended to avoid alcohol four hours before bedtime.
2. Create an Inviting Sleep Environment
   Noise level, lighting, temperature, and air quality in the bedroom should be inviting to sleep. The bedroom should be quiet, dark, with a temperature between 65–70°F, and fresh air to promote sleep. A comfortable mattress and pillows are also necessary.
   
   Avoid activities other than sleep and sex in the bedroom, which helps enhance the mental association between the bedroom and sleep. It is recommended to keep computers, TVs, and work materials outside the bedroom as well as pets that disrupt your sleep.
3. Establish a Routine
   Sixty minutes before bedtime, relaxing activities can start to ease the transition from wake to sleep time, such as light reading, TV, or relaxation exercises. Preparing a “To-Do List” for the next day to avoid thinking about those duties at bedtime can be helpful as well.
4. Go to Bed When You’re Tired
   If you are not able to sleep in the first 20 minutes, get out of bed, go to another room to do something relaxing, and go back to bed after feeling tired again.
5. Don’t Watch the Clock
   Set up your clock facing away from you. Looking at the clock when unable to sleep can exacerbate anxiety and make it harder to fall asleep.
6. Use Light to Your Advantage
   Light keeps our internal clock synchronized. Get exposed to light in the morning and through the day.
7. Keep a Regular Sleep Schedule
   A regular sleep schedule helps to ensure adequate training of the internal clock for a consistent time falling asleep and waking up. Keeping the awakening time consistent helps sleep the best. Even if the prior night’s bedtime was interrupted, it is best to wake up at the usual time. The extra sleep drive (the longer we are awake, the easier it is to fall asleep at bedtime) will help consolidate sleep the next night.
8. Avoid Naps or Nap Early
   If naps are needed, a short, 20-minute nap before 5:00 p.m. can be helpful. If you have problems falling asleep at the beginning of the night, avoid taking naps.
9. Appropriate Diet, Hydration, and Exercise Are Paramount
   Hunger can cause wakefulness. That is why a light snack a little before bedtime can aid sleep. On the other hand, going to bed too full can cause wakefulness. Adequate hydration is also important. Water keeps us from waking up due to thirst, but not so much so close to bedtime that a trip to the bathroom is needed during the night.
   
   Exercise is also important for general health and sleep. Exercising 20–30 minutes daily is recommended, but strenuous exercise before bedtime can wake up the nervous system and can lead to problems falling asleep. Adequate exercise three hours before bedtime is recommended.

How Can We Recover from Sleep Deprivation?

Life and responsibilities may sometimes prevent us from getting sufficient sleep. If we go through sleepless nights, for whatever reason, the following steps are recommended for faster recovery:

• Rehydration
• Light breakfast
• Minimize the use of caffeine
• Ensure that external distractions that can produce awakenings (smartphone alerts, telephone calls, doorbells, pagers) are managed
• White noise machines or low decibel music can help block out potential sounds versus earplugs and eyeshades
• Exercise early; heavy exercise can contribute to difficulty sleeping plus increase risk of injury

When Do You Need a Sleep Medicine Evaluation?

If despite getting the right number of hours of sleep and following the right sleep hygiene, you are still feeling sleepy throughout the day, it is important to be evaluated by your primary care physician or by a sleep physician to make sure no sleep disorders are present that affect your sleep. Below are the more common pathologies.

• Insomnia. About 30–40 percent of adults have some degree of disturbed sleep during the year. About 10–13 percent meet diagnostic criteria for insomnia in which the presenting features include difficulty sleeping at night and impaired functioning during the day. Insomnia is more frequent in females and the elderly, and it is also associated with other medical problems, especially mood disorders such as anxiety and depression. Adults with insomnia can have difficulty falling asleep or staying asleep, or a combination of both. Insomnia can produce daytime fatigue, excessive daytime sleepiness, difficulty concentrating, clumsiness, poor quality of life, or serious accidents. Treatment includes cognitive-behavioral therapy or a series of techniques to help relaxation, initiation of sleep, and elimination of inadequate behaviors that perpetuate insomnia.
• Obstructive sleep apnea. This disorder is characterized by a partial or complete collapse of the upper airway, causing fluctuation in oxygen levels and sleep fragmentation. Patients usually present with a history of snoring, breathing pauses, and excessive sleepiness throughout the day. A diagnosis can be made via a sleep study, and the treatment is lifelong and usually requires a medical, surgical, or behavioral approach. The most common therapy is the CPAP machine and weight loss.
• Restless legs syndrome. This disorder can occur in 5–10 percent of the general population, and it can be associated with difficulty initiating sleep. Patients usually complain of an irresistible urge to move the legs during prolonged periods of lying down, usually in the evening. It is twice as common for women to have this disorder. Eighty percent of the time, it is associated with leg movements through the night and while sleeping, which is called periodic limb movement disorder.
• Narcolepsy. Patients with this disorder are afflicted with intermittent, uncontrollable episodes of sleep during the day. They suffer from excessive daytime sleepiness, sleep attacks, sleep paralysis, the inability to move for several minutes when awakening, and hallucinations.
• Parasomnias. These disorders are not usually associated with excessive sleepiness. This includes REM (rapid eye movement)-behavior disorder (acting dreams in the second half of the sleep period), as well as patients with non-REM parasomnias such as sleepwalking, sleep-related eating disorder, and sleep terrors.

If you experience any of the symptoms described here, you should consult a doctor to get appropriate treatment and improve your ability to get restful sleep. The alertness and sense of well-being that comes from a good night’s sleep make us understand how important this function is for our health. Our bodies need sleep to rejuvenate, and our brains need sleep to prepare for the next day. Following the above recommendations can hopefully provide you with a better, healthier, and happier life.

Sleep well.