Sleep. Why aren’t you getting enough?

Ashley Clay, MSPAS, PA-C
Medcor Provider

Every human requires air, water, food, and sleep. Of course, each person and situation is unique, but researchers refer to the “rule of threes” when discussing air, water, and food.1 A person can survive approximately:

Sleep. Why aren’t you getting enough?
  • Three minutes without air
  • Three days without water
  • Three weeks without food

Therefore, the question is: How long can a person live without sleep?

The answer is, just as with air, water, and food: Don’t attempt it to find out. In 1965 a 17-year-old, Randy Gardner, became the world-record holder for the longest amount of time without sleep. He remained awake for 264.4 hours or 11 days and 25 minutes.2 More than fifty years have passed, and there has been no other documented person who has stayed awake to beat his record. It seems likely that side effects from sleep deprivation have stopped others from surpassing his record, and for good reason—by going stretches without sleep, you can harm yourself (even die) and inadvertently cause harm to others.

Consequences of Sleep Deprivation

In as little as 24 hours without sleep you may develop side effects such as difficulty concentrating, impaired judgement, and delayed hand-eye coordination. A person can begin hallucinating after three days without sleep.3

Poor sleep quality or lack of sleep can impact the workforce. Studies confirm that workers who do not get adequate sleep are more likely to make errors while at work, have decreased productivity rates, and are more likely to have work-related injuries.4 More than 1 in 10 Americans say they sleep less than 6 hours each night.5 Employees sleeping less than 6 hours per night lose six workdays of productivity annually.6

Lack of sleep is also a public safety concern. A survey completed by the National Sleep Foundation found that 60% of adult Americans admitted to driving while drowsy within the last month.7 The National Institute of Medicine estimates that nearly 20% of annual motor vehicle accidents are related to drowsy driving, resulting in 8,000 deaths per year.8

Long periods with insufficient sleep also are associated with chronic medical conditions such as:

  • Type II Diabetes
  • High blood pressure (hypertension)
  • Heart disease
  • Obesity
  • Mood disorders (depression, anxiety)9

Ultimately, sleep deprivation and/or disorders can combine with or exacerbate chronic illnesses and reduce your overall length of life.

Let’s review the recommended amount of time we should be spending asleep.

Sleep Requirements

Research suggests that the average person spends roughly 26 years of their life asleep and another 7 years trying to fall asleep, for a total of 33 years in bed.10  Both the quantity and the quality of sleep are important.

Sleeping the recommended amount of time is important for every aspect of your life and plays a role in your overall health status (immunity, fertility, weight) and mental health (cognition, memory, awareness).

How much sleep you need changes as you age. The following chart lists evidence-based recommendations from the National Sleep Foundation for every age group.11 Infants, toddlers and children have varying sleep requirements; sleep recommendations and/or concerns about sleep should be addressed with their pediatrician.

Causes for Lack of Sleep

An estimated 50 to 70 million Americans suffer from some type of sleep disorder12; however, many do not mention sleep issues to their healthcare provider. Problems with daytime fatigue, falling or staying asleep, and snoring are examples of reasons to have an open and honest discussion.

Below are some quick facts associated with common causes for lack of sleep, including sleep disorders, shift work, parenting, traveling, diet, gender, environment, age, and dreaming. Speak with your healthcare provider if you are experiencing signs of sleep disorders or sleep deprivation.

Major Sleep Disorders13

Since sleep disorders are common among Americans, understanding key disorders will enable you to make healthier life choices and recognize symptoms that may be impairing your life.

Insomnia. Insomnia ischaracterized by an inability to fall or stay asleep, despite adequate opportunities. It results in decreased function and excessive sleepiness during the day. Medical conditions, medications, and substance abuse need to be ruled out or addressed as causes of insomnia.

Narcolepsy. Hallmarks of this disorder include excessive daytime sleepiness, and sudden muscle weakness. resulting in the inability to resist falling asleep (often brought on by strong emotions or surprise). Some refer to these as “sleep attacks,” which can occur at random or odd intervals, such as while an individual is walking. Narcolepsy is often misdiagnosed and 50% of people with narcolepsy do not have a formal diagnosis.

Restless Leg Syndrome (RLS). This is a sleep-related movement disorder; those affected will get an urge to move their legs to relieve discomfort. Legs begin to feel restless after periods of inactivity, especially in the evening. People will often kick their legs or walk to ease the aches/pains and this movement results in difficulties falling asleep. This disorder is often associated with dopamine (a neurotransmitter that carries messages in the brain).

Sleep Apnea. Morethan 18 million American adults have sleep apnea. Sleep apnea happens when breathing is interrupted during sleep. Characteristics of sleep apnea include obesity, tobacco abuse, and snoring or “gasping” for air. Men are more susceptible to sleep apnea than women. With sleep apnea, individuals awake from sleep and do not feel well rested. This condition is often underdiagnosed and not discussed or mentioned during primary care visits.

Shift Work

Night and rotating shift workers miss twice as many days of work as day-shift workers, increasing costs, and is associated with absenteeism. Shifts that are 10 or more hours are linked to higher injury rates and decreased performance.14

The National Safety Council estimates that more than $1 million is lost on an annual basis because of fatigue.The loss of money is associated with absenteeism and healthcare costs.15 Optimizing sleep health could drive down costs to employers.

Parenting

Parents of newborns lose on average of two hours of sleep each night for the first 24 months. Recent studies speculate that parents will not get a good night’s sleep for 6 years after their baby is born.16

Traveling

Adjusting to a different time zone can be challenging—your body’s internal clock (circadian rhythm) can get confused causing a disturbance in your sleep and wake times.It is more difficult to travel from west to east because moving your sleep time earlier is more challenging than having a later time. To minimize jet lag, consider these tips:17

Plan. Adjust your bedtime and wake time 3-5 days prior to travel; waking up and going to bed earlier or later based on the time zone of your destination.

Avoid napping. If you must take a nap—keep it short (twenty minutes or less).

Exposure to light. 1) If it is daylight when you arrive, take a walk outside and expose yourself to sun; 2) If your arrival time is at night, shift your gears down and prepare yourself for sleep—relax, dim your lights, avoid heavy meals; 3) For the first few days immediately after you wake up—get direct sunlight. Exposure to light signals your brain that it is time to wake up. Exposure to dark signals your body that it is time to sleep, causing your body to release melatonin.

Melatonin. Melatonin, a hormone supplement, may be useful to sync your body to a new time zone. Melatonin is naturally produced within your body and causes a feeling of sleepiness. Light signals your body to naturally switch off your melatonin supply and decreasing melatonin levels cause you to feel more awake. Darkness signals your body to release melatonin and increased melatonin levels cause you to feel sleepy. Studies suggest that when administered during the day, melatonin may increase your likelihood of falling sleep; when administered at night, the amount of sleep is not affected.18 Melatonin is an over-the-counter medication (not regulated by the FDA); you should consult with your healthcare provider prior to use.

Diet

What you eat and drink can impact your ability to fall asleep.

Caffeine. 50% of the caffeine you drink stays in your body for up to 6 hours; that means if you have a drink with caffeine at 2 p.m. half of that caffeine will be in your body at 8 p.m. Avoid drinks with caffeine in the afternoon.19

Alcohol. Alcoholic beverages may affect the chemicals in your body responsible for regulating sleep/wake cycle triggers. Alcohol can ultimately cause you to awaken in the middle of the night without being able to fall back asleep.20

Food. Changing the timing of meals can directly affect sleeping patterns. Meals earlier or later in the day may change when you naturally feel awake or tired. Eating later in the day may cause your body’s internal clock to shift back, resulting in a later bedtime. While eating earlier may result in going to sleep earlier.

Men and Women

Sleep/wake patterns are different for men and women; the internal clock for men is six minutes longer than women.21 Since women have a shorter circadian rhythm, issues with insomnia are more common because women are more likely to wake up earlier. Women are more likely to be early risers and men are more likely to stay up later. Women tend to recover more quickly from a lack of sleep. While losing sleep causes more work performance issues with men. Women are more affected by sleeping surfaces than men.22Women are more likely to be diagnosed with a sleep disorder than men. Women working shift work are more likely to be involved in work-related injuries because energy levels trend down at night more so for women than men. Men are more likely to be diagnosed with sleep apnea and report symptoms of snoring.

Environment

Temperatures below 54o or above 75o Fahrenheit can keep people awake.23 Altitude affects sleep and is thought to be related to oxygen levels.  Disturbances in sleep are greater when altitudes exceed 13,200 feet because of these decreased oxygen levels. Typically, people adjust to variations in altitude after 2-3 weeks.24

Noise

Decibel levels between 40 and 70 will generally keep you awake.Studies have found that people can adapt to noises, resulting in better quality sleep, by adapting and blocking out noises that can potentially keep them awake or awaken them from sleep. For example, you will likely adjust to traffic noise within one week and no longer lose sleep from sirens or horns. Interestingly, what a person considers an “important” or familiar noise can easily awaken a person and disrupt sleep patterns. Often “important” noises are those that may have an emotional connection to us. Examples include: Crying babies, smoke detectors, and ones’ own name being spoken. White noise or background noise is believed to block out unwanted noises and can result in you falling asleep faster.These sounds can induce sleep cycles.25 Examples include: Static from televisions, ceiling fans, or air conditioner units.

Age

Aging may affect sleep-wake cycles, resulting in inconsistences. This may explain why older adults frequently complain of inadequate sleep and daytime fatigue. Routines are important at every age: It is recommended that everyone and especially older adults. wake up and go to sleep at the same time each day. Pre-sleep rituals help align your brain and body for sleep; this routine may include dimming lights, reading a book, or taking a relaxing bath.26

Dreaming

Typically, a person dreams two hours per night,even if you do not remember dreaming. Dreaming, whether good or bad, effects the quality of sleep.27 Studies indicate positive dreams are linked to satisfaction levels and happiness in life. The happier you are during the day, the more likely you will experience pleasant dreams while you are asleep. Decreasing stress and anxiety during the day will decrease your odds of having a nightmare at night. Nightmares can result in poor moods the following day and cause difficulties with falling asleep There are two stages of sleep REM (rapid-eye movement, recognizable to the observer by the eyes darting back and forth) and NREM (non-rapid eye movement). Your body alternates between REM and NREM sleep approximately every 90 minutes. REM stages account for 25% of your sleep at night.28 Dreams occur during the REM stage.

Promote Your Sleep

Dr. William Dement, the father of modern sleep medicine, beautifully summarizes the importance of sleep: “You’re not healthy, unless your sleep is healthy.” If you are experiencing difficulty with sleep or feel excessively fatigued during the day, make an appointment with your healthcare provider to discuss causes, treatments, and your overall health status.

Some tips to promote better quality sleep include:

  • Adapting your bedroom to enhance your success for sleep. Adjust your thermostat between 60 and 67o Fahrenheit. Sleep in a dark room without noisy distractions. Consider purchasing curtains to block out bright lights or a sound machine with “white noise.” Encourage your body to slow down for the day by dimming lights one hour before you intend to fall asleep. Limit screen time before bed. 29
  • Be mindful, positive, and energetic.Focus on positive aspects of your day to increase satisfactory sleep. Avoid focusing on negative thoughts or feelings. Get enough sunlight: Pull your curtains back in the early morning. Get enough exercise: Consider exercising in the morning.30
  • Consider short naps (twenty minutes or less). Shorter naps decrease the likelihood of feeling groggy when you wake. Naps can boost your alertness, improve your mood, increase productivity, and decrease the chance of making mistakes because of fatigue.31

Medcor’s four guiding health principles include eating real food, moving more, sleeping better, and living a life of mindfulness—each cultivate a healthier, happier lifestyle and promote a culture of wellbeing and self-awareness. Understanding each of these principles allows for continual self-inventory. Self-awareness coupled with our ability for continual learning is allowing us to live longer and healthier.

This article is not intended to diagnose or treat any condition or to give medical advice. Always consult your primary care provider for healthcare instructions. External links are provided as references and do not indicate an endorsement by Medcor. External links are subject to other sites’ terms of use and privacy policies.


1 Sean Kane, “Here’s the longest people have survived without air, food, water, sunshine, or sleep,” Business Insider, June 9, 2016, https://www.businessinsider.com/longest-survival-records-water-food-sleep-breathing-2016-5

2 Carly Vandergriendt, “How Long Can You Go Without Sleep? Function, Hallucination, and More,” Healthline, March 26, 3018, https://www.healthline.com/health/healthy-sleep/how-long-can-you-go-without-sleep

3 “How Long Can You Go Without Sleep? Body Functions and Hallucinations,” Purple, July 5, 2018, https://purple.com/blog/how-long-can-you-go-without-sleep

4 “Sleep, Performance, and Public Safety,” The Division of Sleep Medicine at Harvard Medical School, December 18, 2007, http://healthysleep.med.harvard.edu/healthy/matters/consequences/sleep-performance-and-public-safety

5 National Safety Council, “What is Fatigue Costing Your Company?,” https://www.nsc.org/work-safety/safety-topics/fatigue/cost

6 Ibid.

7 “Sleep, Performance, and Public Safety.”

8 Ibid.

9 “Sleep and Disease Risk,” The Division of Sleep Medicine at Harvard Medical School, December 18, 2007, http://healthysleep.med.harvard.edu/healthy/matters/consequences/sleep-and-disease-risk

10 Gemma Curtis, “Your Life in Numbers,” Sleep Matters Club, https://www.dreams.co.uk/sleep-matters-club/your-life-in-numbers-infographic/

11 National Sleep Foundation, “How Much Sleep Do We Really Need?,” https://www.sleepfoundation.org/excessive-sleepiness/support/how-much-sleep-do-we-really-need

12 “Sleep and Disease Risk,” The Division of Sleep Medicine at Harvard Medical School.

13 Centers for Disease Control and Prevention, “Key Sleep Disorders,” https://www.cdc.gov/sleep/about_sleep/key_disorders.html

14 “What is Fatigue Costing Your Company?”

15 Ibid.

16 Alan Mozes, “New Parents Can Expect to Lose Sleep for 6 Years,” WebMd, March 5, 2019, https://www.webmd.com/parenting/news/20190305/new-parents-can-expect-to-lose-sleep-for-6-years#1

17 National Sleep Foundation, “Sleep Better When Switching Time Zones,” https://www.sleepfoundation.org/articles/sleep-better-when-switching-time-zones

18 National Sleep Foundation, “Jet Lag and Sleep,” https://www.sleepfoundation.org/articles/jet-lag-and-sleep

19 National Sleep Foundation, “Beverages to Avoid to Sleep Soundly While Traveling,” https://www.sleepfoundation.org/articles/beverages-avoid-sleep-soundly-while-traveling

20 Ibid.

21 National Sleep Foundation, “How Sleep Is Different for Men and Women,” https://www.sleepfoundation.org/articles/how-sleep-different-men-and-women

22 National Sleep Foundation, “Jet Lag and Sleep.”

23 National Sleep Foundation, “The Sleep Environment,” https://www.sleepfoundation.org/articles/sleep-environment

24 National Sleep Foundation, “Jet Lag and Sleep.”

25 Ibid.

26 National Sleep Foundation, “How Age Affects Your Circadian Rhythm,” https://www.sleepfoundation.org/articles/how-age-affects-your-circadian-rhythm

27 National Sleep Foundation, “Do Dreams Affect How Well You Sleep?,” https://www.sleepfoundation.org/articles/do-dreams-affect-how-well-you-sleep

28 National Sleep Foundation, “What Happens When You Sleep?,” https://www.sleepfoundation.org/articles/what-happens-when-you-sleep

29 National Sleep Foundation, “How to Feel Satisfied with Your Sleep” https://www.sleepfoundation.org/articles/how-feel-satisfied-your-sleep

30 Kirsten Nunez, “13 Benefits of Working Out in the Morning,” Healthline, July 10, 2019, https://www.healthline.com/health/exercise-fitness/working-out-in-the-morning#benefits

31 National Sleep Foundation, “Napping,” https://www.sleepfoundation.org/articles/napping