Can You Overcome Sleep Debt?

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 
Epidemiology | Causes of Poor Sleep | What is Sleep Debt? | Restorative Sleep for Health | Get Back to Sleep

Overview

Getting good sleep is essential in achieving good health status and maintaining a healthy lifestyle.

It plays a crucial role in protecting mental and physical health and is as vital as physical activity and a balanced diet. 

Although sleep needs vary between one person and another, the American Academy of Sleep Medicine (AASM) and the Sleep Research Society recommend that adults consistently sleep seven or more hours per night to improve their health.^[1]

Good quality sleep consists of two components: duration and depth. Insufficiency of either of those two components might lead to sleep insufficiency.

Definition

Sleep insufficiency is defined as a lack of adequate, consistent sleep, resulting in decreased alertness, performance, and health due to an insufficient amount of the following:

• Quantity: decreased sleep duration, usually less than six or seven hours of total sleep time per night.
• Quality: repetitive short sleep interruptions, also known as fragmentation of sleep.
  
  

Epidemiology 

Sleep insufficiency is relatively prevalent. Adults who reported a sleep duration of fewer than seven hours per night exceeded one-third of the American population.^[2]

Interestingly enough, sleep health disparities were found among different groups of people. 

For example, studies have shown sleep deprivation to be more prevalent among young people (<65 years old), males, African Americans, people with low socioeconomic status, full-time workers, and college students.^[3][4][5]

Causes of Poor Sleep

As mentioned above, sleeping for long hours alone is not enough to avoid sleep deprivation. 

You can sleep eight or more hours and yet end up sleep deprived due to disturbances leading to poor sleep quality.^[6] 

Sleep quality is fixed mainly on the number of episodes of arousals during the night; five or more arousals per hour of sleep can lead to performance deficits.^[7] Those episodes of arousals can be caused by but not limited to: 

• Acute illness (e.g., cough, sore throat, fever) 
• Chronic health issues (e.g., sleep apnea, restless leg syndrome) 
• Lifestyle habits (e.g., smoking, alcohol, caffeine, illicit drugs) 
• Taking care of a baby or a child

What is Sleep Debt? 

This article is looking at sleep debt, or in other words, accumulated sleep deprivation. 

Acute sleep deficit can occur when a full night of sleep is missed, or it may gradually develop over multiple nights of partially disrupted sleep, called sleep debt. 

Although a slight reduction in sleep hours may not have apparent effects on performance or health, an accumulation of sleep deficit over multiple nights will negatively impact health as much as missing a full night of sleep.^[8] 

To avoid sleep debt, you should compensate for that deficit by taking naps or sleeping more on the weekends, which may restore full alertness.

Restorative Sleep for Health

Diagnostic criteria for insufficient sleep syndrome specify that a lack of sleep results in daytime sleepiness leading to:  

• Cognitive Impairment: Studies showed that sleep deprivation affects cognition and work performance as sleep-deprived individuals tend to take more time to respond to stimuli and complete tasks.^[9]
• Affected mood and Judgement: Sleep deprivation may cause psychological symptoms similar to depression, such as irritability, decreased libido, fatigue, and poor judgment.^[10]
• Sleepiness and Microsleeps: Sleep deprivation results in a desperate need for sleep that cannot always be controlled. Daytime sleepiness and microsleeps can have life-threatening consequences (e.g., car accidents).
• Cardiovascular Morbidity: As stated by the American Heart Association, sleep deprivation is considered one of the risk factors for cardiovascular disease, and healthy sleep is recommended to promote cardiac health. ^[11] The consequences mentioned above concerning sleep deprivation massively affect individuals in terms of health, productivity, safety, and happiness. Therefore, having a sufficient amount of sleep is crucial in maintaining a good quality of life and enhancing health.
  
  

Get Back to Sleep

Although the consequences of sleep deprivation can be catastrophic, getting sleep back on track can reverse them. The following are a few tips to overcome sleeping problems:  

• Maintain good sleep hygiene
• Avoid naps in the late afternoon
• Exercise daily
• Minimize light and noise as they significantly impact sleep
• Avoid cigarettes, caffeine, and heavy meals in the evening
• Avoid alcohol. While alcohol use seems to help some individuals fall asleep, studies have shown that alcohol intake can increase episodes of fragmented sleep, reducing sleep quality. ^[12]
• Practice quiet activities that may enhance sleep, such as reading with a dim light.
• Avoid the use of electronics at least 30 minutes before bedtime.  

Conclusion

Sleep helps you heal from all the physical and psychological stress experienced throughout your day and prepare you to start your next day with optimal energy and concentration. 

Moreover, it protects your body and your brain from the catastrophic side effects of sleep deprivation. 

Sleeping problems should never be ignored. Seeing a doctor specializing in sleep is recommended if you continue to have difficulty obtaining sufficient sleep despite previously mentioned tips. 

References:

1. Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., & Tasali, E. (2015). Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep, 38(6), 843–844. https://doi.org/10.5665/sleep.4716
2. Liu, Y., Wheaton, A. G., Chapman, D. P., Cunningham, T. J., Lu, H., & Croft, J. B. (2016). Prevalence of Healthy Sleep Duration among Adults–United States, 2014. MMWR. Morbidity and mortality weekly report, 65(6), 137–141. https://doi.org/10.15585/mmwr.mm6506a1
3. Carnethon, M. R., De Chavez, P. J., Zee, P. C., Kim, K. Y., Liu, K., Goldberger, J. J., Ng, J., & Knutson, K. L. (2016). Disparities in sleep characteristics by race/ethnicity in a population-based sample: Chicago Area Sleep Study. Sleep medicine, 18, 50–55. https://doi.org/10.1016/j.sleep.2015.07.005
4. Luckhaupt, S. E., Tak, S., & Calvert, G. M. (2010). The prevalence of short sleep duration by industry and occupation in the National Health Interview Survey. Sleep, 33(2), 149–159. https://doi.org/10.1093/sleep/33.2.149
5. Matricciani, L., Olds, T., & Petkov, J. (2012). In search of lost sleep: secular trends in the sleep time of school-aged children and adolescents. Sleep medicine reviews, 16(3), 203–211. https://doi.org/10.1016/j.smrv.2011.03.005
6. Martin, S. E., Engleman, H. M., Deary, I. J., & Douglas, N. J. (1996). The effect of sleep fragmentation on daytime function. American journal of respiratory and critical care medicine, 153(4 Pt 1), 1328–1332. https://doi.org/10.1164/ajrccm.153.4.8616562
7. Martin SE, Wraith PK, Deary IJ, Douglas NJ. The effect of nonvisible sleep fragmentation on daytime function. Am J Respir Crit Care Med. 1997 May;155(5):1596-601. doi: 10.1164/ajrccm.155.5.9154863. PMID: 9154863.
8. Horne J. (2011). The end of sleep: ‘sleep debt’ versus biological adaptation of human sleep to waking needs. Biological psychology, 87(1), 1–14. https://doi.org/10.1016/j.biopsycho.2010.10.004
9. 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. https://doi.org/10.1093/sleep/26.2.117
10. Pires, G. N., Bezerra, A. G., Tufik, S., & Andersen, M. L. (2016). Effects of acute sleep deprivation on state anxiety levels: a systematic review and meta-analysis. Sleep medicine, 24, 109–118. https://doi.org/10.1016/j.sleep.2016.07.019
11. St-Onge, M. P., Grandner, M. A., Brown, D., Conroy, M. B., Jean-Louis, G., Coons, M., Bhatt, D. L., & American Heart Association Obesity, Behavior Change, Diabetes, and Nutrition Committees of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council (2016). Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circulation, 134(18), e367–e386. https://doi.org/10.1161/CIR.0000000000000444
12. Spadola, C. E., Guo, N., Johnson, D. A., Sofer, T., Bertisch, S. M., Jackson, C. L., Rueschman, M., Mittleman, M. A., Wilson, J. G., & Redline, S. (2019). Evening intake of alcohol, caffeine, and nicotine: night-to-night associations with sleep duration and continuity among African Americans in the Jackson Heart Sleep Study. Sleep, 42(11), zsz136. https://doi.org/10.1093/sleep/zsz136