Waking Up to the Realities of Sleep Problems

When a few years ago Cornell University professor James B. Maas, PhD-a sleep expert-was to deliver the keynote address at the American College of Rheumatology/Association of Rheumatology Health Professionals Annual Scientific Meeting-to a rheumatology audience-I wondered why.

Then, when I heard him speak on the many ills of sleep deprivation, I found out.

Most Americans are moderately to severely sleep-deprived, Dr Maas explained, with close to three-fourths failing to meet the recommended 8 hours per night. Three-fourths experience a sleep-related problem at least 3 days per week, and one-third of adults had fallen asleep at work in the previous month.

A dynamic speaker reminiscent of legendary Cornell astronomy professor Carl Sagan, Dr Maas went on to connect sleep deprivation with rheumatology and other clinical disciplines: Sleep-deprived patients are more likely to be unhealthy and live shorter lives and are at greater risk for hypertension, depression, diabetes mellitus, periodontal disease, obesity, cancer, and other disorders.

All of this, of course, is in addition to the many patient complaints caused by or associated with sleep disorders. Collectively, sleep problems are more than a concern, they now constitute an epidemic. Consider the following 10 facts and figures:

1. The CDC in fact has labeled insufficient sleep a “public health epidemic.” About 70 million Americans have a sleep problem, and 60% of them have a chronic sleep illness, such as obstructive sleep apnea or insomnia.

2. Among 74,571 adult respondents to the Behavioral Risk Factor Surveillance System survey, 35.3% reported getting fewer than 7 hours of sleep during a typical 24-hour period, 37.9% reported unintentionally falling asleep during the day at least once in the preceding month, and 4.7% reported nodding off or falling asleep while driving.

3.Chronic complaints of insomnia are present in 20% to 35% of the population, and sleep apnea and restless legs syndrome are present in about 2% to 4%. The latter are even more prevalent (10% to 40%) in those with neuromuscular disease, stroke, obesity, renal failure, hypertension, and heart disease.

4. The risk of obstructive sleep apnea is increased nearly 7-fold in pregnant women who have gestational diabetes mellitus.

5. Mother-rated early childhood sleep problems predicted self-rated eating problems in adolescents in a recent study. Sex, birth weight, and a number of early childhood internal and environmental factors were controlled. Unexpectedly, early childhood eating problems were not associated with later eating problems.

6. Poor sleep quality can accelerate signs of skin aging and weaken the skin’s ability to repair itself at night.

7. Sleep deprivation affects facial features, and these features function as cues of sleep loss to other persons. Facial appearance can affect judgments of trustworthiness, aggressiveness, and competence and other attributes.

8.Sleep influences next-day exercise rather than exercise influencing sleep. In one study, the relationship between total sleep time (TST) and next-day exercise was stronger for those with shorter TST at baseline. The results suggest that improving sleep may encourage exercise participation.

9.Sleep-deprived teenagers make poorer dietary choices than their well-rested peers. In a recent study, the teens who reported sleeping fewer than 7 hours per night (18%) were 25% more likely to consume fast food 2 or more times per week and 20% less likely to eat healthful foods, such as fruits and vegetables.

10.Prescription sleep aids use is on the rise. Key findings from the National Health and Nutrition Examination Survey, 2005–2010:

• About 4% of US adults aged 20 years and older used prescription sleep aids in the past month.

• The percentage of adults using a prescription sleep aid increased with age and education.

• Prescription sleep aid use was highest among adults who sleep less than 5 hours (6.0%) and those who sleep 9 or more hours (5.3%).

• The use of sleep aids was reported by 1 in 6 adults who had a sleep disorder diagnosis and 1 in 8 adults who had trouble sleeping.

The American Academy of Sleep Medicine has issued an appropriate wake-up call:  Achieve optimal health through better sleep and improved evaluation and management of sleep disorders.