“I don’t sleep well and I’m exhausted” were her main complaints that day in the office. I then asked her, “What does an average 24-hour day look like for you?” She proceeded to describe her work as a janitor from 6 PM until 12:30 AM, sleeping from 1 AM until 6 AM, getting up to take her children to school, and then going to a second part-time job from 7 AM until 12 PM. After returning home from her second job, she does home errands and cooks, then picks up her children from school. She feeds them dinner before heading to her main job. After getting a peek into a typical day of my patient’s life, and looking at her sleep study, it was clear that she had more than one sleep problem. Yes, she snored and had a crowded airway and indeed was found to have mild obstructive sleep apnea. Yes, she was under constant stress and sometimes had trouble falling asleep. But her biggest sleep disorder was the one that was eclipsing them all—insufficient sleep.
We now know that nutrition, exercise, and sleep are the three key components, or pillars, to living a healthy life and reducing the risk of poor performance and disease. 15 years ago the consequences of chronic insufficient sleep were not well-established, whereas today physicians and the general public are much more attuned to the potential consequences of sleep deprivation. In the latest issue of SLEEP (Watson, NF et al., Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. SLEEP 2015; 38(6):843–844), experts in Sleep Medicine published their consensus statement on the desired sleep duration for adults ages 18-60. After reviewing 5314 scientific articles on the association between sleep duration and health, they came to the following conclusions:
- “Sleeping less than 7 hours per night on a regular basis is associated with adverse health outcomes, including weight gain and obesity, diabetes, hypertension, heart disease and stroke, depression, and increased risk of death. Sleeping less than 7 hours per night is also associated with impaired immune function, increased pain, impaired performance, increased errors, and greater risk of accidents.
- Sleeping more than 9 hours per night on a regular basis may be appropriate for young adults, individuals recovering from sleep debt, and individuals with illnesses. For others, it is uncertain whether sleeping more than 9 hours per night is associated with health risk.
- People concerned they are sleeping too little or too much should consult their healthcare provider.”
Although wanting eight hours of sleep at night is a laudable goal, eight hours is not what everyone needs, and even 7 hours, as recommended above, may be hard to attain due to employment, home responsibilities, and other factors beyond our control. One of the treatment challenges of improving sleep duration is that by putting pressure on ourselves to sleep enough, we may inadvertently trigger anxiety about sleep and therefore push sleep further away. In an achievement-oriented world, we easily fall into the trap of treating sleep as another “achievement,” rather than as something we let happen. We humans have the unique ability to push sleep away. In the case of my patient described above, we’ve taken a pragmatic approach to her sleep problem–our biggest accomplishment so far has been working together to carve out a precious hour in her day….to take a nap.
–Melissa Lim, MD
Redwood City, CA