Inadequate Sleep – the consequences beyond excessive daytime sleepiness

Sharon L. Merritt, RN, MSN, EdD
Lack of sufficient sleep (about 8 hours per night EVERY night) seems to be an epidemic among U.S. adults. In the 2002 national scientific poll conducted by the National Sleep Foundation (NSF), about one-quarter of the people responding said they weren’t getting the minimum amount of sleep needed to be alert the next day. About a third indicated that they were so sleepy during the day that it interfered with their activities at least a few days a month. Among healthy adults, people who had gone 19 hours without sleep tested substantially worse on performance and alertness tests than those with a blood alcohol level of .08, the definition of being legally drunk in most states.

Researchers at Stanford University found that people with mild or moderate sleep apnea, a fairly common breathing disorder during sleep, did as poor or worse on reaction time tasks than those who were legally too drunk to drive. These findings tend to disprove the myth that people can just “tough it out” during their usual daily activities when they don’t get enough sleep. In previous NSF polls, one-half to two-thirds of the respondents reported difficulties with concentration, solving problems, making decisions and listening to co-workers when attending work with inadequate sleep.

More recently, research indicates that feeling sleepy and performing at a lower level aren’t the only difficulties one faces when trying to function after having inadequate sleep. Since many biochemical and physiological processes occur during sleep, the consensus among sleep experts is that adequate sleep is necessary for health and wellness. Recently, connections were made between inadequate sleep and risky health conditions such as type II diabetes and hypertension. Dr. Van Cauter and her colleagues at the University of Chicago showed that young healthy males with a sleep debt of 3-4 hours per night over 1 week experienced a significant loss in their ability to process glucose and showed blood glucose levels associated with a pre-diabetic state. The good news is that, when these same subjects slept for 12 hours a night for 7 days to make up for their sleep debt, their blood glucose levels returned to normal. Furthermore, Dr.Van Cauter’s group found that men who slept less at a young age produced less growth (GH) hormone with increasing age. Since GH plays an important role in controlling the body’s balance between fat and muscle, less may increase ones propensity to become overweight and have a middle age paunch. Low levels of leptin, a hormone that regulates the metabolism of carbohydrates and promotes carbohydrate craving regardless of caloric intake, have been associated with inadequate sleep.

Supporting evidence is provided by 25% of the respondents in the 2002 NSF poll who reported that they ate more than usual following nights of inadequate sleep. Intuitively, we tend to associate being overweight with too much sleep. However, if people are overweight or having trouble losing weight, they may need to examine their sleep habits. Perhaps, the problem is that they aren’t getting enough sleep.

Besides our performance and health, how we feel is increasingly being associated with insufficient sleep. In addition to feeling grumpy, inadequate sleep is associated with feeling more stressed, angry and sad. The NSF suggests that many people may not be aware of the symptoms that can be associated with inadequate sleep. They list the following daytime consequences of inadequate sleep:

· Dozing while reading, watching TV, in meetings or sitting in traffic

· Slow thinking or reacting

· Difficulty listening to what has been said or following directions

· Difficulty remembering information

· Frequent mistakes or errors

· A narrowing of attention

· Poor judgment regarding complex situations

· Difficulty coming up with new approaches to a problem

· Depression or negative mood

· Impatience, angers easily

· Frequent blinking, difficulty with focusing or heavy eyelids

When experienced on a regular basis, these problems could be related to an individual’s sleep habits. Steps need to be taken to manage sleep/wake activities and these difficulties should be discussed with a health care provider.