Monday, August 26, 2013

You don't snooze, you lose

- Jennifer Middleton, MD, MPH

The consequences of insufficient sleep can be significant.  Children and teens who don't get enough sleep not only get worse grades in school but are also more likely to have parents who worry about their mood and behavior.  Sleep-deprived adults are more likely to be involved in a motor vehicle or work accident, are more likely to have hypertension, and are more likely to be obese (even controlling for changes in diet patterns).  Perhaps logically, then, sleep-deprived adults incur higher health care costs than adults who get at least 6 hours of sleep a night.

The August 15, 2013 AFP featured an article regarding the Management of Common Sleep Disorders. The first section of this article dealt with insomnia; I don't know about you, but I see a lot of patients in the office who are struggling with falling and staying asleep at night. The authors wisely suggest reframing patients' thoughts about sleep using Cognitive Behavioral Therapy (CBT), and Table 4 contains most of the advice that I routinely dispense to patients: limit caffeine and stop nicotine, only use the bedroom for sleep and sex, get up if you haven't fallen asleep within 20 minutes, etc. I liked how the authors cited evidence showing that these simple physician interventions can be quite effective.

Decreasing time with electronics (TV, computers, tablets, mobile phones) may also help.  The American Sleep Foundation's annual poll in 2011 found that use of a smartphone, computer, and/or television the in hour before falling asleep correlated with lower quality sleep.  They also reported that the average number of caffeinated beverage servings among adolescents and adults was around 3 a day - perhaps to make up for the fatigue from decreased sleep quality?

I recommend that patients get television sets and other electronics out of the bedroom if at all possible, and spend the last hour of the day disconnected from technology.  You can probably imagine how my patients often respond to that advice; smartphones, computers, and televisions seem to be ubiquitous in the US, and certainly have many positives regarding inter-connectivity and just plain old entertainment.

But, as the above studies demonstrate, helping our patients to get restful sleep may help prevent a lot of problems.  There are AFP by Topics on sleep disorders for both adults and children if you'd like to check out more resources about this issue.

Do you have any special advice for your patients regarding sleep?

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