Chronic sleep deprivation is a significant public health concern that creates costs for both the individual and society. Some salient examples of costs to the individual from sleep deprivation include increased risk of chronic disease [1-5] and automotive accidents [6-8], and decreased cognitive performance [5,7,9,10-13] and emotional wellbeing [7,14,15]. The cost to society from sleep deprivation primarily manifests as economic burden due to increased healthcare costs and reduced work productivity [3,15,17,18]. Many of these individual and social costs of sleep deprivation go unrecognized by the general population in the US [8,16].
Americans have been progressively sleeping less over the course of the past 100+ years [19,20], and over 10% of Americans currently suffer from insomnia [17,21,22], which is a sleep disorder characterized by having chronic difficulty falling asleep and/or staying asleep [23]. However, insomnia is not the sole cause of sleep deprivation, as there are plenty of individuals who have no problem falling asleep and staying asleep, but who still experience sleep deprivation due to poor lifestyle management, uncontrollable environmental factors, and/or an abundance of responsibilities.
Historically, sleep researchers would only study the effects of 1 to 2 nights of total sleep deprivation (i.e. no sleep whatsoever) with very little focus on the effects of chronic partial sleep deprivation [24,25] (i.e. getting 6 or fewer hours of sleep per night, for several consecutive nights [7,26]). However, many contemporary sleep researchers have shifted focus onto the effects of chronic partial sleep deprivation, as it is much more common for individuals to sleep poorly for extended periods of time than it is for them to “pull all-nighters” [24]. This article series will address the effects of both total and partial sleep deprivation.
Unfortunately, Americans are largely uninformed about the negative consequences of sleep deprivation [3,8,16], especially compared to other public health concerns such as obesity, heart disease, and type II diabetes. To bring things into perspective, fatal car accidents due to sleep deprivation occur at a similar or greater rate than fatal accidents caused by alcohol intoxication [8]. Drunk driving is vilified by the public and government agencies, yet the same attitude is hardly directed toward sleep-deprived driving. In fact, working excessive hours while sleep deprived (and subsequently commuting while sleep deprived) is often glorified because it is a trait of the “hard-working American” cultural archetype.
Dawson and Reid (1997) found that being awake for 24 continuous hours causes hand-eye coordination impairments comparable to having a 0.10% blood alcohol level [27] (the legal threshold for drunk driving is 0.08% [28]). The same researchers also found that moderate levels of fatigue due to partial sleep deprivation can actually cause greater hand-eye coordination impairments than a blood alcohol level associated with intoxication. In addition, work days missed due to insomnia occur at a similar rate to work days missed due to lung disease or diabetes [17,29]. These are just a few examples of the negative consequences of sleep deprivation.
This 14-part article series will first address the negative consequences of sleep deprivation in more detail, and then describe different methods for improving sleep quality. All articles in this series will blend cohesively into one another and share citations, as if all 14 parts represent a single, giant article.
Master List of References (the references below represent all citations placed throughout all 14 parts of this article series):
1. Spiegel, K., Leproult, R., & Van Cauter, E. (1999). Impact of sleep debt on metabolic and endocrine function. The Lancet, 354(9188), 1435-1439.
2. Knutson, K. L., Spiegel, K., Penev, P., & Van Cauter, E. (2007). The metabolic consequences of sleep deprivation. Sleep Medicine Reviews, 11(3), 163-178.
3. Altevogt, B. M., & Colten, H. R. (Eds.). (2006). Sleep disorders and sleep deprivation: an unmet public health problem. National Academies Press.
4. Mullington, J. M., Haack, M., Toth, M., Serrador, J. M., & Meier-Ewert, H. K. (2009). Cardiovascular, inflammatory, and metabolic consequences of sleep deprivation. Progress in Cardiovascular Diseases, 51(4), 294-302.
5. Sapolsky, R. M. (2004). Why zebras don't get ulcers: The acclaimed guide to stress, stress-related diseases, and coping-now revised and updated. Holt Paperbacks.
6. Banks, S., & Dinges, D. F. (2007). Behavioral and physiological consequences of sleep restriction. Journal of Clinical Sleep Medicine: Official Publication of the American Academy of Sleep Medicine, 3(5), 519.
7. Durmer, J. S., & Dinges, D. F. (2005, March). Neurocognitive consequences of sleep deprivation. Seminars in Neurology, 25(1), 117-129.
8. Pack, A. I., Pack, A. M., Rodgman, E., Cucchiara, A., Dinges, D. F., & Schwab, C. W. (1995). Characteristics of crashes attributed to the driver having fallen asleep. Accident Analysis & Prevention, 27(6), 769-775.
9. Peigneux, P., Laureys, S., Fuchs, S., Collette, F., Perrin, F., Reggers, J., ... & Luxen, A. (2004). Are spatial memories strengthened in the human hippocampus during slow wave sleep? Neuron, 44(3), 535-545.
10. Walker, M. P. (2009). The role of slow wave sleep in memory processing. Journal of clinical sleep medicine: Journal of Clinical Sleep Medicine: Official Publication of the American Academy of Sleep Medicine, 5(2 Suppl), S20.
11. Joo, E. Y., Yoon, C. W., Koo, D. L., Kim, D., & Hong, S. B. (2012). Adverse effects of 24 hours of sleep deprivation on cognition and stress hormones. Journal of Clinical Neurology, 8(2), 146-150.
12. Marshall, L., Helgadóttir, H., Mölle, M., & Born, J. (2006). Boosting slow oscillations during sleep potentiates memory. Nature, 444(7119), 610.
13. Acheson, A., Richards, J. B., & de Wit, H. (2007). Effects of sleep deprivation on impulsive behaviors in men and women. Physiology & Behavior, 91(5), 579-587.
14. Killgore, W. D., Kahn-Greene, E. T., Lipizzi, E. L., Newman, R. A., Kamimori, G. H., & Balkin, T. J. (2008). Sleep deprivation reduces perceived emotional intelligence and constructive thinking skills. Sleep Medicine, 9(5), 517-526.
15. Maquet, P., Degueldre, C., Delfiore, G., Aerts, J., Péters, J. M., Luxen, A., & Franck, G. (1997). Functional neuroanatomy of human slow wave sleep. Journal of Neuroscience, 17(8), 2807-2812.
16. Siebern, A. T., Suh, S., & Nowakowski, S. (2012). Non-pharmacological treatment of insomnia. Neurotherapeutics, 9(4), 717-727.
17. Simon, G. E., & VonKorff, M. (1997). Prevalence, burden, and treatment of insomnia in primary care. American Journal of Psychiatry, 154(10), 1417.
18. Walsh, J. K., & Engelhardt, C. L. (1999). The direct economic costs of insomnia in the United States for 1995. Sleep, 22, S386-93.
19. Webb, W. B., & Agnew, H. W. (1975). Are we chronically sleep deprived? Bulletin of the Psychonomic Society, 6(1), 47-48.
20. National Sleep Foundation. “Sleep in America” poll. Washington DC: National Sleep Foundation; 2006.
21. Chesson Jr, A. L., Anderson, W. M., Littner, M., Davila, D., Hartse, K., Johnson, S., ... & Rafecas, J. (1999). Practice parameters for the nonpharmacologic treatment of chronic insomnia. Sleep, 22(8), 1128-1133.
22. Irwin, M. R., Cole, J. C., & Nicassio, P. M. (2006). Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychology, 25(1), 3-14.
23. Jacobs, G. D., Pace-Schott, E. F., Stickgold, R., & Otto, M. W. (2004). Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Archives of Internal Medicine, 164(17), 1888-1896.
24. Vgontzas, A. N., Zoumakis, E., Bixler, E. O., Lin, H. M., Follett, H., Kales, A., & Chrousos, G. P. (2004). Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. Journal of Clinical Endocrinology & Metabolism, 89(5), 2119-2126.
25. Van Dongen, H. P., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep, 26(2), 117-126.
26. Brown, F. C., Buboltz Jr, W. C., & Soper, B. (2002). Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students. Behavioral Medicine, 28(1), 33-38.
27. Dawson, D., & Reid, K. (1997). Fatigue, alcohol and performance impairment. Nature, 388(6639), 235.
28. DUI & DWI Laws & Enforcement. (n.d.). Retrieved from https://www.dmv.org/automotive-law/dui.php
29. Wells, K. B., Stewart, A., Hays, R. D., Burnam, M. A., Rogers, W., Daniels, M., ... & Ware, J. (1989). The functioning and well-being of depressed patients: results from the Medical Outcomes Study. Journal of the American Medical Association, 262(7), 914-919.
30. Belenky, G., Wesensten, N. J., Thorne, D. R., Thomas, M. L., Sing, H. C., Redmond, D. P., ... & Balkin, T. J. (2003). Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: A sleep dose‐response study. Journal of Sleep Research, 12(1), 1-12.
31. Lockley, S. W., Barger, L. K., Ayas, N. T., Rothschild, J. M., Czeisler, C. A., & Landrigan, C. P. (2007). Effects of health care provider work hours and sleep deprivation on safety and performance. The Joint Commission Journal on Quality and Patient Safety, 33(11), 7-18.
32. LaBerge, S., & Rheingold, H. (1991). Exploring the world of lucid dreaming. New York: Ballantine Books.
33. Van Cauter, E., Leproult, R., & Plat, L. (2000). Age-related changes in slow wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men. Journal of the American Medical Association, 284(7), 861-868.
34. Roth, T. (2009). Slow wave sleep: does it matter?. Journal of clinical sleep medicine: Journal of Clinical Sleep Medicine: Official Publication of the American Academy of Sleep Medicine, 5(2 Suppl), S4.
35. Kundermann, B., Spernal, J., Huber, M. T., Krieg, J. C., & Lautenbacher, S. (2004). Sleep deprivation affects thermal pain thresholds but not somatosensory thresholds in healthy volunteers. Psychosomatic Medicine, 66(6), 932-937.
36. Lautenbacher, S., Kundermann, B., & Krieg, J. C. (2006). Sleep deprivation and pain perception. Sleep Medicine Reviews, 10(5), 357-369.
37. Onen, S. H., Alloui, A., Gross, A., Eschallier, A., & Dubray, C. (2001). The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects. Journal of Sleep Research, 10(1), 35-42.
38. Moldofsky, H. (2001). Sleep and pain. Sleep Medicine Reviews, 5(5), 385-396.
39. Adam, T. C., & Epel, E. S. (2007). Stress, eating and the reward system. Physiology & Behavior, 91(4), 449-458.
40. Groesz, L. M., et al. (2012). What is eating you? Stress and the drive to eat. Appetite, 58(2), 717-721.
41. Torres, S. J., & Nowson, C. A. (2007). Relationship between stress, eating behavior, and obesity. Nutrition, 23(11), 887-894.
42. Dündar, Y., Dodd, S., Strobl, J., Boland, A., Dickson, R., & Walley, T. (2004). Comparative efficacy of newer hypnotic drugs for the short‐term management of insomnia: a systematic review and meta‐analysis. Human Psychopharmacology: Clinical and Experimental, 19(5), 305-322.
43. Omvik, S., Pallesen, S., Havik, O. E., Kvale, G., & Nordhus, I. H. (2006). Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. Journal of the American Medical Association, 295(24), 2851-2858.
44. Smith, M. T., Perlis, M. L., Park, A., Smith, M. S., Pennington, J., Giles, D. E., & Buysse, D. J. (2002). Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. American Journal of Psychiatry, 159(1), 5-11.
45. LeBourgeois, M. K., Giannotti, F., Cortesi, F., Wolfson, A. R., & Harsh, J. (2005). The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents. Pediatrics, 115(Supplement 1), 257-265.
46. Glass, J., Lanctôt, K. L., Herrmann, N., Sproule, B. A., & Busto, U. E. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. British Medical Journal, 331(7526), 1169.
47. Buscemi, N., Vandermeer, B., Friesen, C., Bialy, L., Tubman, M., Ospina, M., ... & Witmans, M. (2007). The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. Journal of General Internal Medicine, 22(9), 1335.
48. Huedo-Medina, T. B., Kirsch, I., Middlemass, J., Klonizakis, M., & Siriwardena, A. N. (2012). Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. British Medical Journal, 345, e8343.
49. Turek, F. W., & Gillette, M. U. (2004). Melatonin, sleep, and circadian rhythms: rationale for development of specific melatonin agonists. Sleep Medicine, 5(6), 523-532.
50. Zhdanova, I. V., Wurtman, R. J., Lynch, H. J., Ives, J. R., Dollins, A. B., Morabito, C., ... & Schomer, D. L. (1995). Sleep‐inducing effects of low doses of melatonin ingested in the evening. Clinical Pharmacology & Therapeutics, 57(5), 552-558.
51. Kabuto, M., Namura, I., & Saitoh, Y. (1986). Nocturnal enhancement of plasma melatonin could be suppressed by benzodiazepines in humans. Endocrinologia Japonica, 33(3), 405-414.
52. Holbrook, A. M., Crowther, R., Lotter, A., Cheng, C., & King, D. (2000). Meta-analysis of benzodiazepine use in the treatment of insomnia. Canadian Medical Association Journal, 162(2), 225-233.
53. Prescription sleeping pills: What's right for you? (2014, December 27th). Retrieved from https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/sleeping-pills/art-20043959
54. What is Cognitive Behavior Therapy (CBT)? (n.d.). Retrieved from http://www.abct.org/Help/?m=mFindHelp&fa=WhatIsCBTpublic
55. Spielman, A. J., Yang, C. M., & Glovinsky, P. B. (2011). Sleep restriction therapy. Behavioral Treatments for Sleep Disorders. Oxford: Elsevier.
56. Werth, E., Dijk, D. J., Achermann, P., & Borbely, A. A. (1996). Dynamics of the sleep EEG after an early evening nap: experimental data and simulations. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 271(3), R501-R510.
57. Mastin, D. F., Bryson, J., & Corwyn, R. (2006). Assessment of sleep hygiene using the Sleep Hygiene Index. Journal of Behavioral Medicine, 29(3), 223-227.
58. Riedel, B.W. (2000). Sleep hygiene. In Lichstein, K. L., and Morin, C. M. (Eds.), Treatment of Late-life Insomnia, Sage, Thousand Oaks, CA, pp. 125–146.
59. Gellis, L. A., & Lichstein, K. L. (2009). Sleep hygiene practices of good and poor sleepers in the United States: an internet-based study. Behavior Therapy, 40(1), 1-9.
60. Jefferson, C. D., Drake, C. L., Scofield, H. M., Myers, E., McClure, T., Roehrs, T., & Roth, T. (2005). Sleep hygiene practices in a population-based sample of insomniacs. Sleep, 28(5), 611-615.
61. Stepanski, E. J., & Wyatt, J. K. (2003). Use of sleep hygiene in the treatment of insomnia. Sleep Medicine Reviews, 7(3), 215-225.
62. Arendt, J. (2006). Melatonin and human rhythms. Chronobiology International, 23(1-2), 21-37.
63. Gastel, J. A., Roseboom, P. H., Rinaldi, P. A., Weller, J. L., & Klein, D. C. (1998). Melatonin production: proteasomal proteolysis in serotonin N-acetyltransferase regulation. Science, 279(5355), 1358-1360.
64. Berson, D. M., Dunn, F. A., & Takao, M. (2002). Phototransduction by retinal ganglion cells that set the circadian clock. Science, 295(5557), 1070-1073.
65. Czeisler, C. A., Allan, J. S., Strogatz, S. H., Ronda, J. M., Sanchez, R., Rios, C. D., ... & Kronauer, R. E. (1986). Bright light resets the human circadian pacemaker independent of the timing of the sleep-wake cycle. Science, 233, 667-672.
66. Nagendra, R. P., Maruthai, N., & Kutty, B. M. (2012). Meditation and its regulatory role on sleep. Frontiers in Neurology, 3.
67. Black, D. S., O’Reilly, G. A., Olmstead, R., Breen, E. C., & Irwin, M. R. (2015). Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. Journal of the American Medical Association Internal Medicine, 175(4), 494-501.
68. Pattanashetty, R., Sathiamma, S., Talakkad, S., Nityananda, P., Trichur, R., & Kutty, B. M. (2010). Practitioners of vipassana meditation exhibit enhanced slow wave sleep and REM sleep states across different age groups. Sleep and Biological Rhythms, 8(1), 34-41.
69. Sulekha, S., Thennarasu, K., Vedamurthachar, A., Raju, T. R., & Kutty, B. M. (2006). Evaluation of sleep architecture in practitioners of Sudarshan Kriya yoga and Vipassana meditation. Sleep and Biological Rhythms, 4(3), 207-214.
70. Ong, J. C., Shapiro, S. L., & Manber, R. (2009). Mindfulness meditation and cognitive behavioral therapy for insomnia: a naturalistic 12-month follow-up. Explore: The Journal of Science and Healing, 5(1), 30-36.
71. Mason, L. I., Alexander, C. N., Travis, F. T., Marsh, G., Orme-Johnson, D. W., Gackenbach, J., ... & Walton, K. G. (1997). Electrophysiological Correlates of Higher States of Consciousness During Sleep in Long-Term: Practitioners of the Transcendental Meditation Program. Sleep, 20(2), 102-110.
72. Kaul, P., Passafiume, J., Sargent, R. C., & O'Hara, B. F. (2010). Meditation acutely improves psychomotor vigilance, and may decrease sleep need. Behavioral and Brain Functions, 6(1), 47.
73. Brandon, C. (2017, September 4th). The Benefits of Breathing Meditation for Stress Management. Retrieved from https://www.colinbrandon.com/wellness/2017/9/4/the-benefits-of-breathing-meditation-for-stress-management
74. Feldman, G., Greeson, J., & Senville, J. (2010). Differential effects of mindful breathing, progressive muscle relaxation, and loving-kindness meditation on decentering and negative reactions to repetitive thoughts. Behaviour Research and Therapy, 48(10), 1002-1011.
75. Erisman, S. M., & Roemer, L. (2010). A preliminary investigation of the effects of experimentally induced mindfulness on emotional responding to film clips. Emotion, 10(1), 72.
76. Garland, E. L. (2007). The meaning of mindfulness: A second-order cybernetics of stress, metacognition, and coping. Complementary Health Practice Review, 12(1), 15-30.
77. Burg, J. M., & Michalak, J. (2011). The healthy quality of mindful breathing: associations with rumination and depression. Cognitive Therapy and Research, 35(2), 179-185.
78. Paul, G., Elam, B., & Verhulst, S. J. (2007). A longitudinal study of students' perceptions of using deep breathing meditation to reduce testing stresses. Teaching and Learning in Medicine, 19(3), 287-292.
79. Barnhofer, T., Chittka, T., Nightingale, H., Visser, C., & Crane, C. (2010). State effects of two forms of meditation on prefrontal EEG asymmetry in previously depressed individuals. Mindfulness, 1(1), 21-27.
80. Vøllestad, J., Sivertsen, B., & Nielsen, G. H. (2011). Mindfulness-based stress reduction for patients with anxiety disorders: Evaluation in a randomized controlled trial. Behaviour Research and Therapy, 49(4), 281-288.
81. Tang, Y. Y., Ma, Y., Fan, Y., Feng, H., Wang, J., Feng, S., ... & Zhang, Y. (2009). Central and autonomic nervous system interaction is altered by short-term meditation. Proceedings of the National Academy of Sciences, 106(22), 8865-8870.
82. Chaiopanont, S. (2008). Hypoglycemic effect of sitting breathing meditation exercise on type 2 diabetes at Wat Khae Nok Primary Health Center in Nonthaburi province. Medical Journal of the Medical Association of Thailand, 91(1), 93.
83. Jerath, R., Edry, J. W., Barnes, V. A., & Jerath, V. (2006). Physiology of long pranayamic breathing: neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Medical Hypotheses, 67(3), 566-571.
84. Burg, J. M., Wolf, O. T., & Michalak, J. (2012). Mindfulness as self-regulated attention. Swiss Journal of Psychology.
85. Moss, D. (2004). Heart rate variability (HRV) biofeedback. Psychophysiology Today, 1(1), 4-11.
86. Zhdanova, I. V., Wurtman, R. J., Morabito, C., Piotrovska, V. R., & Lynch, H. J. (1996). Effects of low oral doses of melatonin, given 2–4 hours before habitual bedtime, on sleep in normal young humans. Sleep, 19(5), 423-431.
87. Cajochen, C., Kräuchi, K., & Wirz‐Justice, A. (2003). Role of melatonin in the regulation of human circadian rhythms and sleep. Journal of Neuroendocrinology, 15(4), 432-437.
88. Stone, B. M., Turner, C., Mills, S. L., & Nicholson, A. N. (2000). Hypnotic activity of melatonin. Sleep, 23(5), 663-669.
89. Lewy, A. J., & Sack, R. L. (1997). Exogenous melatonin's phase-shifting effects on the endogenous melatonin profile in sighted humans: a brief review and critique of the literature. Journal of Biological Rhythms, 12(6), 588-594.
