Sleep Hygiene Basics: How to Avoid Sleep Debt and Its Consequences
You have probably long known that getting a good night’s sleep is an important
part of a healthy lifestyle. After all, who hasn’t heard that we should all sleep 8 hours
each night? You might even be aware that when you fail to get enough sleep you aren’t
“yourself” and begin to feel “run-down.” But did you know that getting inadequate sleep
can increase your appetite and cravings, especially for carbohydrates? Long-term your
risks for obesity, cardiovascular diseases (hypertension, stroke, heart attack, heart
failure), diabetes (and other disorders of glucose metabolism), mood disorders
(depression, anxiety) and cognitive decline (poor recall, slowed thought processing) can
increase directly as consequences of accumulating a sleep debt, or becoming
chronically sleep deprived.
New research suggests that a large number of people with sleep disorders
remain undiagnosed, but that with treatment people suffering from sleep deprivation and
sleep disorders can avoid all of the potential health problems just noted. So take a
closer look at sleep disorders and sleep habits now, and decide whether you (or a loved
one) should be further evaluated for a potential sleep disorder that might be
unnecessarily putting you at risk for multiple chronic diseases, advanced aging, and
How much sleep is required by the average person?
Teens: 9-10 hours per night
Adults: 7-8 ½ hours per night
Older Adults: 6 ½ - 7 ½ hours per night, plus a 1 hour nap each afternoon
Quality of sleep is just as important as quantity of hours slept. In most cases of sleep
deprivation it is the deep stages of sleep (stages 3 and 4) that have been sacrificed.
The functions of deep sleep include:
• Growth hormone essential for growth and development is produced only during
• Restorative functions such as tissue repair and growth occur. Muscles are
• Blood pressure is lowered, providing rest to the heart and circulatory system.
• Metabolic processes including glucose utilization and storage, and the ratio of
appetite-controlling hormones are adjusted in an attempt to preserve healthy
weight and normal cell and receptor functions.
• Important functions of the nervous system (nerves) including memory
consolidation (improves recall) take place only during this time. The brain is
fueled for the next day.
• Stress hormone production (cortisol, adrenaline) is decreased to restore balance
to the body.
• Hormones that fuel the immune system are produced, aiding the body in fighting
What are the daytime effects of sleep loss?
• Daytime somnolence (extreme sleepiness); frequent napping
• Increased risk of accidents; beware of driving
• May become difficult to family, maintain work and social obligations
• Likely not to maintain exercise regimen or other self-care routines
• Impaired psychomotor performance; longer periods of sleep loss lead to greater
impact on speed of performance
• Reduction in performance of reasoning tasks
• Impaired short term memory or recall
• Impaired decision making under conditions of uncertainty, worse with age
• Typically affects tasks that are long or monotonous with no feedback or
motivation (e.g.: driving leads to increased accidents and citations)
• Irritability, depression, anxiety, others
• Lack of motivation can interfere with performance of many activities such as
increasing absence from work, or failure to make or carry out plans with friends
or family leading to social isolation.
• Mood disorders can lead to poor health habits, missed appointments, lack of
routine care, and further sleep problems.
• Lack of stamina may lead to the abandonment of one’s exercise regimen; this
has been shown to worsen a depressed mood by altering the balance of “feel
good” hormones produced during exercise.
*There is strong evidence of the reversal of all of the effects of sleep loss
following recovery from sleep deprivation. Energy improves as fatigue fades. Memory
improves via restored brain neurons; recall and concentration improve. Mood gradually
returns to what is normal for you. Some of these factors will improve more quickly than
others, and each person’s experience will differ to some degree.
Types of sleep problems and their causes:
Insufficient Sleep Syndrome can result from:
• Decreased/inadequate sleep time
• Irregular sleep/wake patterns and poor sleep hygiene
• Substance abuse including overuse of caffeine, alcohol and nicotine
o Caffeine can affect sleep architecture up to 10-12 hours after consumption
leading to frequent arousals and fragmented sleep, reduced total sleep
time, and decreased sleep efficiency.
o Alcohol causes frequent arousals and is associated with sleep apnea.
• Shift work (e.g.: doctors, nurses, truck drivers, soldiers)
Treatments include: adequate sleep time and good sleep hygiene; hypnotic
medications are not encouraged.
Secondary causes of sleep debt (common examples)
• Pain from medical conditions (e.g.: headaches, arthritis aches, muscle cramps)
• COPD (Chronic Obstructive Pulmonary Disease) (breathing difficulty)
• Chest pain (fear vs. anxiety?)
• Post-stroke or MI (nervousness)
• Psychiatric disorders (anxiety, depression, “racing thoughts”)
Treatment involved working with your doctors to best manage your diseases and
the pain associated with them.
Common primary sleep disorders include:
• Insomnia: the inability to fall asleep or remain asleep
• Restless legs syndrome (RLS): unpleasant feelings in the legs like creepy, crawly
or tingly feelings at night with an urge to move upon lying down to sleep
• Narcolepsy: a neurological disorder caused by the brain's inability to regulate
normal sleep-wake cycles. Daytime features include excessive daytime
sleepiness (EDS), cataplexy (sudden muscle weakness, especially in the legs
but also the face and neck, that is brought on by strong emotion, especially
laughing), and sudden sleep attacks. Nighttime features include insomnia,
dream-like hallucinations, and sleep paralysis.
• OSAS (Obstructive Sleep Apnea Syndrome)
Treatments include: biofeedback, meditation and other relaxation methods,
cognitive behavioral therapy, good sleep hygiene, medications as warranted
Obstructive Sleep Apnea:
By far the most common sleep disorder is Obstructive Sleep Apnea (OSA). OSA
is a sleep disorder characterized by pauses, known as apneas, in breathing during
sleep due to upper airway collapse or shallow breathing. These episodes occur
repeatedly throughout sleep leading to disturbance of normal sleep patterns (known as
sleep architechture) that are important for health. Snoring is the most obvious sign of
sleep apnea, although not all people who snore have sleep apnea. There are several
ways that a physician may identify patients at risk for OSA, but a true diagnosis requires
a polysomnogram which entails an overnight study in a controlled sleep laboratory.
The consequences of untreated OSA are known collectively as Obstructive Sleep
Apnea Syndrome (OSAS). Considerable data supports OSAS as an independent risk
factor for cardiovascular diseases (CVD), including hypertension, stroke, heart failure
and cardiac sudden death, as well as the Metabolic Syndrome (Syndrome X). In
addition, it is now theorized that OSAS is independently associated with glucose
intolerance, type 2 diabetes, and possibly insulin resistance.
Treatment options for OSA may include one or more of the following:
• Weight control
• Continuous positive airway pressure (CPAP)/BIPAP Therapy *Gold standard
• Surgical interventions
• Dental/oral appliances
• Positional therapy
*The good news: Data indicates that compliance with CPAP therapy may provide
a protective effect against OSAS and appears to improve the diseases associated with
it, as well as prevent death from CVD. Similarly, surgical weight loss methods have
been shown to be very successful in treating OSA and its associated conditions.
A Final Word about Sleep Restriction:
Sleep Restriction in general appears to increase appetite and food cravings by
altering levels of unique hormones in the body. Chronic Sleep Deprivation results from
long-term inadequate sleep quantity and/or quality ultimately leading to weight gain,
insulin resistance or glucose intolerance, and increased fatigue. This begins a forward-
moving cycle of increased hunger coupled with decreased physical activity that is
almost certain to result in weight gain. This cycle has been shown to cause the
metabolic syndrome, cardiovascular diseases and diabetes in previously healthy
The impact of sleep deprivation appears to affect so many systems that many
experts are predicting that sleep hygiene will be added to diet, exercise and smoking as
a major modifiable risk factor for a number of chronic diseases in the foreseeable future.
Sleep hygiene for optimum health; How to Avoid Sleep Debt and Its Consequences:
• Keep regular bed- and wake times, even on the weekends
• Try not to nap during the day. If you must nap, limit naps to brief periods. (10-15
• Ensure bedroom conditions are conducive to sleep (dark, quiet, comfortable
temperature, comfortable pillow and mattress; use earplugs or eyeshades if
• Restrict caffeine to before 10:00 a.m.; give it up altogether ideally.
• Do not smoke during the evening hours (if you must smoke at all).
• Limit alcohol to light consumption (it can fragment sleep architecture leading to
• Limit food and beverage intake for three hours prior to bedtime.
• Regular exercise is a must, but finish at least four to six hours prior to bedtime.
An exception is for those with anxiety, in which case light exercise before
bedtime may help them to relax.
• Get at least 30 minutes’ exposure to sunlight in the morning hours, and avoid
bright lights in the evenings. This includes avoiding computer and TV screens in
the hours prior to bedtime. (Bright lights suppress melatonin production.)
• Do not bring business or homework into the bedroom; no TV either. Recreational
reading is OK. Keep the bedroom a place for quiet and rest.
• Practice stress management techniques as necessary or appropriate.
• Keep a bedside diary to record problems, plans etc. so they don’t remain in your
mind preventing sleep. Avoid reading or watching news about troubling events
just before bed.
• A warm bath one to two hours prior to bedtime may help promote sleep. A warm
glass of milk helps for many people as well.