What is Sleep Insufficiency?
Insufficient sleep, also known as sleep deprivation, happens when a person doesn’t get the amount of sleep needed to stay awake during the day. According to the American Academy of Sleep Medicine (AASM) and the Sleep Research Society, children between 6 and 12 years need at least 9 hours of sleep, adolescents need 8 hours, and adults should get a minimum of 7 hours.
If you’re getting less sleep than what’s recommended for your age, you’re experiencing insufficient sleep. This piece will talk about the causes, how common it is, what signs to look out for, how to diagnose it, and what kind of impact it can have on your life.
What Causes Sleep Insufficiency?
Not getting enough sleep can be due to not having enough time to sleep, or not getting good quality sleep. This might mean not having many hours in bed, or not getting the deep, restful sleep stages that our bodies need. When we don’t get enough sleep, it can make us feel tired during the day, affect our daily tasks, and even impact our overall happiness and health. It can also raise the risk of accidents, high blood pressure and heart-related health issues.
The current official definition of not getting enough sleep, as set out by the International Classification of Sleep Disorders (ICSD-3), requires this pattern of poor sleep to have been happening for at least three months.
Risk Factors and Frequency for Sleep Insufficiency
Lack of sufficient sleep is a common problem in the U.S., with around a third of adults getting less than 7 hours of sleep each night. Various age groups and races experience different levels of sleep deprivation. Also, there isn’t a significant difference in sleep patterns between men and women.
- About one-third of adults regularly sleep less than 7 hours each night.
- Short sleep duration affects 37% of people aged 20-39, 40.3% of people aged 40-59, and 32% of people aged 60 or more.
- 53% of non-Hispanic blacks, 34.5% of non-Hispanic whites, and 35.2% of Mexican Americans also have short sleep durations regularly.
- Similar sleep patterns are observed amongst other ethnic groups at 41.7%.
- There’s no significant difference between men and women, with 39.8% of men and 35.8% of women reporting short sleep durations.
Other research shows that the number of adults sleeping six or fewer hours a night has gone up by 31% between 1985 and 2012. People in different job fields have varying levels of sleep deprivation too. For example, in the realm of transportation and warehouse jobs, those involved in the production, installation, maintenance, and repair experience the highest levels of short sleep duration. In manufacturing jobs, those involved in installation, maintenance, and repair also have the highest levels of short sleep duration.
Signs and Symptoms of Sleep Insufficiency
Insufficient sleep is a condition that can lead to a range of symptoms. This usually includes feelings of sleep deprivation, being overly tired during the day, and having problems functioning properly. Some people might also experience episodes of sleep paralysis or see things that aren’t really there as they are falling asleep, known as hypnogogic hallucinations.
In addition, psychological symptoms such as mood changes, irritability, lack of concentration, and decrease in motivation can be encountered. Those with insufficient sleep often don’t get enough time in bed due to lack of sleep opportunities. Unlike insomnia, individuals suffering from insufficient sleep do not have troubles getting to sleep or staying asleep. Interruptions like an alarm clock or a sleeping partner might disrupt their sleep, but generally, they can sleep well given no disturbances, which can then alleviate their daytime symptoms.
It’s necessary to note that some people might not recognize the difference between how much sleep they’re getting and how much they really need. A detailed history is crucial to help medical professionals come up with a preliminary diagnosis and also to rule out other causes of disturbed sleep or excessive daytime sleepiness.
A physical examination of someone dealing with insufficient sleep usually won’t reveal anything abnormal. However, a comprehensive clinical assessment is key to check for signs of other sleep disorders.
Testing for Sleep Insufficiency
The International Classification of Sleep Disorders, also known as ICSD-3, sets specific criteria to diagnose Insufficient Sleep Syndrome. These criteria are as follow:
1. The patient experiences excessive sleepiness during the day, and they may even fall asleep. In children under puberty, symptoms might show through changes in behavior related to sleepiness.
2. There should be evidence that the patient is not getting enough sleep. This can come from the patient’s daily routine, sleep diaries, or tests like actigraphy which records physical activity and can help estimate sleep patterns. Usually, the amount of sleep is less than what’s typical for their age.
3. The patient’s sleep patterns must demonstrate these signs for at least three months, on most days.
4. Sleep reduction in patients is often due to external factors like an alarm clock or another person. Generally, these people can sleep longer if not disturbed.
5. When patients have more sleep than usual, their symptoms improve.
This condition shouldn’t be explainable by other untreated sleep disorders, effects from medication or drugs, or other physical or mental health issues.
The American Academy of Sleep Medicine suggests using actigraphy, a method to measure rest and activity cycles, to evaluate total sleep time in adults who might have Insufficient Sleep Syndrome. Compared to patient-reported sleep logs, actigraphy provides objective data that could better assess sleep quality.
Treatment Options for Sleep Insufficiency
If you aren’t getting enough sleep, the solution often involves adjusting your overall sleeping pattern. This typically involves a combination of lifestyle changes and different strategies designed to improve both the quality and amount of sleep one gets. These strategies can be useful for anyone who feels they’re not sleeping well, even if they don’t have a diagnosed sleep disorder.
One common set of strategies is known as sleep hygiene education. This involves things like avoiding caffeinated or alcoholic drinks and nicotine before bedtime, keeping a regular sleep schedule, and avoiding daytime napping. The reason these things are recommended is that sleep functions on a sort of internal clock, and keeping to a regular routine can help synchronize that clock. Daytime naps, particularly longer ones, can disrupt this internal rhythm, making it harder to sleep at night.
Caffeine, found in things like coffee and energy drinks, can stimulate certain areas in your brain and make it harder for you to sleep if you consume it up to six hours before bedtime. Nicotine can have a similar effect, as it also activates certain areas in your brain to promote wakefulness.
Drinking alcohol before you sleep might initially make you feel sleepy, but it actually disturbs your sleep overall. It fragments it into lighter stages and results in frequent arousals, making you feel less rested the next day. Hence, experts always advise against having alcohol close to bedtime.
Regular exercise is another beneficial lifestyle change. Exercise has been found to help people sleep for longer periods and enter more restful phases of sleep. Relaxation and mindfulness exercises, like meditation, are also very helpful in improving sleep quality. These kinds of changes can substantially improve sleep quality for anyone, and particularly those who aren’t getting enough sleep.
What else can Sleep Insufficiency be?
If someone is not getting enough sleep, it’s important to rule out other conditions that might be causing this issue or resulting in daytime tiredness. Conditions that doctors look at include:
- Sleep-related breathing disorders, such as sleep apnea, central sleep apnea syndromes, and sleep-related hypoventilation disorders
- Central disorders of hypersomnolence such as narcolepsy, idiopathic hypersomnia, or hypersomnia due to a medical condition, medication or substance use, or psychiatric disorder
- Chronic insomnia disorder
- Disruptions in the body’s circadian rhythm sleep disorders
- Affective disorder
- Periodic limb movement disorder
Insufficient sleep can also cause abnormal results on a mean sleep latency test (MSLT), which measures how quickly a person falls asleep and the number of times they enter the rapid eye movement (REM) phase of sleep. Therefore, it’s very important for doctors to do a thorough examination and assessments, including keeping up-to-date sleep diaries and conducting polysomnographies (sleep studies), to make the right diagnosis.
What to expect with Sleep Insufficiency
Regular lack of sleep has been linked to various health problems such as high blood pressure, heart disease, and strokes. Not getting enough sleep can also disrupt your metabolism (the process your body uses to convert food into energy), alter genes and hormones involved in metabolism, and even increase your risk of obesity. Lack of sleep in young people is also linked with impulsive behavior, signs of depression, and poor performance in school.
Feeling sleepy during the day due to lack of sleep can make you more likely to have a car accident. Although losing sleep can cause both physical and mental health problems, it’s something that can be changed and corrected.
In a study, the effects of catching up on sleep after being sleep deprived for several nights were evaluated. It found that measures of inflammation in the body, stress hormone levels, feelings of sleepiness, and fatigue all went back to normal levels after people caught up on their sleep. However, scores on tests of daytime alertness dropped a lot after being sleep deprived and did not improve much even after catching up on sleep.
Future studies looking at the long-term effects of consistently getting enough sleep on things like heart disease and obesity will give us more information about what can happen if sleep deprivation isn’t treated.
Possible Complications When Diagnosed with Sleep Insufficiency
Not getting enough sleep can affect both your body and mind, influencing your daytime activities and leading to other health problems. Research from the Sleep Heart Health Study showed that getting less than 6 hours of sleep was linked to an increased risk of heart disease. Specifically, people getting little sleep were found to be 29% more likely to develop heart disease.
Based on further studies, both getting too little and too much sleep increase the risk of death from all causes, heart disease, coronary heart disease, and strokes. The safest duration was around 7 hours of sleep. For every hour of sleep less than 7, the risk of death from any cause increased by 6%.
Interrupted sleep and sleep restriction have been linked to risks such as obesity and changes in hormones that regulate hunger and blood sugar levels. This suggests a connection between how long and how well children and teenagers sleep and signs of type II diabetes.
Not sleeping enough influences how much we eat. Eating more is a body’s response to being awake longer and needing more energy, and catching up on sleep leads to eating less. These patterns might help explain how not getting enough sleep affects our metabolism.
Lack of sleep also affects academic performance. It can increase impulsive behavior and is linked to mood disorders like depression. Children who do not get enough sleep were observed to have poorer functions related to planning and emotional regulation.
Significant lack of sleep over a long period can affect reaction times and increase moments of inattention. Sleep restriction can also lead to periods of microsleep, which increase when sleep is reduced to 4 hours per night for a week. Some higher mental functions remain affected even when alertness is improved with measures to counter the effects of sleep deprivation. This suggests that not sleeping enough affects specific mental systems alongside a general decline in cognitive ability.
People who don’t get enough sleep are more likely to behave impulsively and may therefore be at a higher risk of suicide. Improving sleep quality can greatly affect mental health, symptoms of depression, and anxiety.
In fact, for people who work night shifts, feeling sleepy due to lack of sleep is a risk factor for car accidents. A research showed that compared to those who sleep 7 hours a night, people who sleep 5 hours or less are 3.6–3.8 times more likely to report drowsy driving, and those who sleep 6 hours or less are 1.9–2.0 times more likely.
During daylight savings time transitions twice a year, the average sleep duration reduces by slightly over an hour with a 10% reduction in sleep efficiency. Studies showed that the risk of heart attacks, heart disease for older males and females, and road traffic accidents increases during the spring daylight saving transition. The American Academy of Sleep Medicine supports year-round standard time because of these findings.
Medical trainees often work extended hours, and research suggests that eliminating shifts longer than 16 hours can improve patient safety and their quality of life. Those who work overnight shifts usually chronically do not get enough sleep and are significantly less alert after being on call overnight.
Studies have also found a connection between reduced speed and accuracy in simulated surgical performance and taking night calls. These suggest that not getting enough sleep due to extended work hours can impact alertness during the day. Comparing a 16-hour work limit to flexible duty hours with extended work hours found no significant difference in patient mortality.
More recent studies also confirm that resident physicians who work shifts between 24 to 28 hours slept significantly less compared to a work schedule that limited continuous shift hours to 16 hours. After adjusting for workload, the residents working shorter shifts were significantly less likely to make attentional errors and serious medical mistakes compared to those working longer shifts.
Preventing Sleep Insufficiency
Doctors should talk to their patients about lifestyle habits that may be leading to them not getting enough sleep. This might include things like daily rhythms of activity and rest (circadian rhythm) and the natural need to rest that builds up over time (homeostatic build-up). Understanding these can help patients recognize why it’s so important to get good, quality sleep for enough time each night. Doctors might consider giving patients leaflets or other resources with tips for improving sleep habits, either on paper or digitally. This advice could help patients manage, or even prevent, not getting enough sleep.
Not getting enough sleep is especially common among school-age children. Talking to children, and their families, about this from an early age might help them form good sleep habits that will last into the future.
