Sleep Deprivation: An Unmet Public Health Problem

Sleep deprivation refers to the condition in which a person is not getting enough or enough quality sleep. People can suffer from sleep deprivation during a short time or over an extended time, with negative health impacts growing the longer the length of sleep deprivation. Insomnia differs from the term sleep deprivation in that insomnia specifically refers to a condition in which people cannot sleep when they are actively trying to rest. Sleep deprivation is any period in which a person is not achieving adequate sleep². 

Sleep deprivation occurs in clinically outlined stages. When people have gone at least 24 hours without sleeping, they enter stage 1. During this stage, people’s symptoms manifest similarly to those seen when under the influence of alcohol. This means that once stage 1 has been achieved, it is unsafe for the afflicted person to drive. In stage 2, these symptoms amplify. This stage is characterized by a lack of ability to focus or think clearly² as well as microsleeps, occurrences in which a person falls asleep for a few seconds and that, thus, can be dangerous if a person is engaging in an activity such as operating machinery³. In stages 3 and 4, these symptoms continue to intensify, with afflicted people often experiencing severe hallucinations and an inability to communicate with those around them².

Sleep deprivation is diagnosed by a licensed clinician after they collect information about symptoms, health history, and routines. Further testing, however, is often suggested to assess for the presence of contributing or resulting conditions related to sleep deprivation. Therefore, it is common for healthcare providers to suggest testing such as an electroencephalogram (EEG), actigraphy, sleep apnea testing, multiple sleep latency test (MSLT), and the maintenance of wakefulness test (MWT)².

Recommended sleep durations, the benchmarks for determining if one is getting the proper amount of sleep or is experiencing sleep deprivation, vary based on age. The CDC outlines the following sleep duration recommendations⁴:

While these recommendations are helpful, particularly from a population-level perspective, the adequate amount of sleep a person needs is unique to them as it is impacted by genetic and environmental factors, amongst other things. Thus, individualized care plans are necessary when diagnosing and treating sleep deprivation⁵.

There are many lifestyle factors, medical conditions, and environmental issues that can cause or contribute to sleep deprivation. Some life circumstances that can result in sleep deprivation include engaging in shift work (especially if the shifts are overnight), high stress levels, and attempting to sleep in new environments (like hotels when traveling). Consumption of alcohol or stimulants like caffeine later in the day can result in sleep deprivation as well. Medical conditions that can cause sleep deprivation include degenerative neurological disorders such as Parkinson’s disease, traumatic brain injuries, sleep apnea, short-term illnesses such as the flu, insomnia, and chronic pain². 

Poor sleep hygiene is an additional factor that can cause sleep deprivation. Stimulants and inconsistent sleep schedules (often impacted by shift work), as mentioned previously, contribute to one’s sleep hygiene as this concept includes any elements of the sleep-related environment or behaviors. In the modern, technological era, sleep hygiene patterns amongst the population have been particularly damaged, exacerbating concerns of an epidemic related to sleep deprivation⁶. Smartphone use around bedtime has been found to contribute negatively to sleep quality⁷. Hours of screentime of any kind have been found to also cause sleep deprivation by disrupting melatonin cycles⁸. In today’s culture, many adults also work from home. If work enters too heavily into the home and bedroom, it can also impact one’s sleep hygiene by creating a less sleep-focused environment and stress surrounding a constant ability to work rather than destressing in the home⁹.

There are consequences associated with both short-term and long-term sleep deprivation. Short-term sleep deprivation can impair judgment, ability to learn, retain information, communication skills, and mood regulation. It can also increase one’s risk of accident/injury, as highlighted in the stages of sleep deprivation outlined previously¹⁰. Studies have shown that those reporting six or fewer hours of sleep per night have an increased risk of crashing a motor vehicle compared to those getting more than 6 hours of sleep per night, especially later in the day and the early morning¹¹. 

Long-term sleep deprivation is associated with an increased risk of chronic illness. These illnesses include cardiovascular disease, osteoporosis, diabetes, kidney disease, and dementia¹². Long-term sleep deprivation can also result in an increased risk of infectious diseases and diminished ability to recover from infections, as a lack of sleep negatively impacts the proper functioning of the immune system¹³. Additionally, lacking sleep or poor sleep quality increases the risk of mental health disorders. Sleep deprivation can exacerbate symptoms of depression, anxiety, and suicidality. Aside from psychiatric disorders, a lack of sleep contributes overall to worsened mental health as people experience a diminished ability to regulate emotions and successfully cope with stress¹⁴.

Strategies to address sleep deprivation on an individual level are well-documented and published. Creating and maintaining a sleep schedule is an important way to improve one’s sleep. This entails allocating adequate hours for sleep, establishing a relaxing nightly routine, and waking up at the same time every day. Ensuring an ideal sleeping environment is also critical to optimal sleep hygiene. A cool, dark, and quiet environment helps many people achieve quality sleep. Another method for alleviating sleep deprivation is being mindful of what you eat and drink. Reducing consumption of stimulants such as caffeine, nicotine, and alcohol can be very helpful, as well as avoiding heavy meals too close to bedtime.  Limiting daytime naps, employing stress management tactics, and including physical activity in one’s daily routine are also all mechanisms for decreasing sleep deprivation on an individual level¹⁵.

Addressing sleep deprivation at a population level can involve implementing many different programs. Employers can help their employees by respecting the importance of adequate sleep through cultural elements (like disincentivizing working after hours) and providing access to amenities like gyms and napping booths. There have also been technological advancements, such as consumer wearables, that have increased in popularity in recent years and helped many people learn more about their sleep patterns¹⁶. Sleep quality assessments are also an important tool for clinicians to utilize to catch poor sleep habits early and prevent increased risks of morbidities in the long term amongst patients¹⁷. 

Implementing educational initiatives can also help address issues of sleep deprivation early, hopefully preventing future health afflictions. Studies have shown that teachers can effectively implement sleep education into existing curricula and, thus, assist their students with improving their sleep habits¹⁸.  

Addressing sleep deprivation is critical for improving public health.

There are recommendations surrounding how much sleep a person needs based on age, but, ultimately, one’s necessary amount of sleep is determined individually. The symptoms of sleep deprivation increase as the duration without sleep or quality sleep elongates. Many Americans struggle with getting enough sleep and achieving high sleep quality, increasing their risks of infectious and chronic diseases, both physical and mental. These issues can be addressed at an individual level with behavioral and environmental changes and at a population level utilizing clinical, educational, technological, and employer initiatives. 

Find ways to improve your sleep hygiene today, and work to promote the implementation of programs that can improve the health of the public by decreasing the prevalence of sleep deprivation.