Tired? Who isn't — especially this year. 2020 has been exhausting, and statistically, Americans aren't getting enough sleep in general (and we're trending in the wrong direction). In 1910, Americans were getting nine hours of sleep on average, but today we're getting seven or less, says clinical psychologist Kevin Gilliland, Psy.D., Executive Director of Innovation360 in Dallas, TX. And this actually has a name: "chronic partial sleep loss" — and about 70 million Americans are dealing with it, he adds.
This is more serious than most of us realize; we're dealing with legitimate sleep deprivation, which can lead to significant health problems over time (if they haven't already). "We don't pay enough attention to sleep, but it is so critical. Sleep is power — for our psychological and physical health — it does as much as counseling and medication," says Gilliland.
Ahead, more info on what sleep deprivation really is, causes, consequences (it's dark), symptoms and warning signs, and how to deal with it — i.e., become a sleep pro.
What Actually Is Sleep Deprivation?
Most of us think that sleep deprivation is not sleeping at all — but that's just one type. So when do we pass the threshold of just being kind of under-rested to sleep-deprived? Almost immediately after losing a night of good quality sleep. "It's shocking how quickly it happens," says Gilliland.
There are two kinds of sleep loss: partial and total, Gilliland explains. The "total" kind is the all-nighter, didn't-sleep-for-a-minute sleep loss, which is rare, he explains. Where most of us struggle as humans is with partial sleep loss, meaning we're in the seven-and-less range on a regular basis, he adds. "With daily stress, we've gotta be at eight hours. Our physical and psychological health depends on it."
This is true for all age ranges, according to Gilliland, who dispels the common myth that you need less sleep as you get older. He encourages everyone to get eight hours or more, especially because aging populations tend to have other sleep-related issues.
In simple terms, sleep deprivation happens when you don't get enough 'quality sleep' and "subsequently, have characteristic daytime impairments resulting from the fatigue, sleepiness, loss of energy, concentration, and impaired memory that are produced by not getting adequate sleep," says Eric Nofzinger, M.D., founder and chief medical officer of sleep tech company Ebb Therapeutics. "The barometer for whether or not someone is getting enough sleep is the degree to which they experience these daytime impairments." (More on that below.)
“Sleep deprivation occurs when an individual does not get the right amount of ‘quality sleep’ — and they subsequently have characteristic daytime impairments resulting from the fatigue, sleepiness, loss of energy, concentration, and impaired memory that are produced by not getting adequate sleep.”
Who Is Most At Risk For Sleep Deprivation?
"There is a correlation between lower socioeconomic status and insufficient sleep," says board-certified behavioral sleep medicine expert Allison Siebern, Ph.D., and Head Sleep Science Advisor at Proper. "Certainly those working multiple jobs to make ends meet while trying to balance everyday life and the needs of a family can struggle," says Siebern.
Some other groups prone to sleep deprivation: a medical resident doing shift work who can't get the necessary seven to eight hours of sleep because they are on a rotating shift schedule, an on-duty firefighter who gets calls in the middle of the night to respond to an alarm, and teenagers, who often stay up late and have to wake up early for school, Siebern explains.
Sleep Deprivation vs. Insomnia
While sleep deprivation (and its adjacent symptoms), can be a result of insomnia Siebern says, these two are categorically different from one another."Insomnia is a clinical sleep disorder, in which someone has trouble falling and or staying asleep, despite their best efforts," she explains.
Think of it this way: "Sleep deprivation is someone who has a baseline sleep need of seven hours but is only in bed six hours a night. Insomnia is when someone is in bed trying to sleep seven hours a night, but only sleeps six hours of that time."
Sleep Quality Matters, Too
This is important: "Sleep quality is as important as sleep quantity," says Alex Dimitriu, M.D., a double board-certified psychiatrist and sleep medicine doctor, and founder of Menlo Park Psychiatry & Sleep Medicine.
"It's important to note that the key measure is not the actual number of minutes you are sleeping, but whether or not you are getting a good quality of sleep to feel rested," says Dr. Nofzinger. "Having said that, it's important to note that not all sleep is alike. Getting eight hours of 'poor sleep' can be like getting no sleep at all and can lead to sleep deprivation."
This is why spending more time in bed is important. "Each night we have micro awakenings — if you're in bed for eight hours, you're for sure getting less than seven hours of sleep," says Gilliland. He suggests aiming to be in bed for nine hours (or more!) in order to get the necessary eight hours of sleep.
"If your time in bed is artificially disrupted, say even by 30 minutes to an hour, by personal, work, or social demands, then you are likely to feel sleep-deprived," says Dr. Nofzinger. "And this is more the case if these disruptions occur on a regular basis, night after night."
These Are the Signs You’re Sleep Deprived
Depending on caffeine may seem like an obvious sign, but it bears emphasizing. "If you're drinking more than one cup of coffee or Red Bull to get through the day, chances are, you're sleep-deprived," says Dr. Dimitriu.
The other one? Yawning and dreaming of laying down on the couch in your office (ahem, living room) the whole day. How you feel in the afternoon specifically is a dead giveaway for the quality of last night's shuteye, Dr. Dimitriu says. While everyone gets a dip in energy in the afternoon, if you're sleep-deprived, it's like trying to run a marathon through wet cement wearing a lead backpack (after eating a jar of melatonin gummies).
“If you’re drinking more than one cup of coffee or Red Bull to get through the day, chances are, you’re sleep-deprived.”
"When someone is sleeping well at night and they have allowed themselves an adequate amount of time in bed to feel rested, they typically would not feel the desire to lay down, or rest, or sleep, during the daytime; Individuals who are sleep deprived do," Dr. Nofzinger says. Makes sense. (Important distinction: Sleepiness, which means you could actually fall asleep if allowed to do so, is different from fatigue, a common symptom of depression and anxiety, Dr. Dimitriu says.)
So, What Happens If We Don’t Get Our Sh*t Together?
"Chronic sleep deprivation can have serious, long term negative health effects on memory, mood, and health status," says Siebern. "Studies show that individuals who suffer from chronic sleep deprivation are more likely to have health problems including diabetes, cardiovascular disease, and mental illness," she adds.
Spiked Stress Hormones
"Sleep deprivation puts our bodies into 'fight or flight to survive' mode," says Dr. Dimitriu. "This means [your body is producing] higher levels of stress hormones, like cortisol and adrenaline to stay awake throughout the day. Higher [levels of] stress hormones mean higher blood pressure, higher heart rate, higher sugar levels, and even increased craving for carbohydrates (for a quick energy boost)." Yayyyy.
Increased Risk of Life-Threatening Disease and Shorter Life Expectancy
Not to get grim, but this legitimately is life-threatening. "Sleep-deprived people are prone to weight gain and metabolic syndrome — [this includes] high blood pressure, glucose, and cholesterol," says Dr. Dimitriu. "Chronic sleep deprivation may increase the risk of metabolic syndrome, substance abuse, depression, anxiety, ADHD-like symptoms, and may increase the likelihood of dementia. Not to mention that sleepy people get into more car accidents, and driving sleep-deprived may be as bad or worse than driving drunk."
When sleep deprivation becomes prolonged in duration over extended periods of one's life, "major organs can be impacted such as the cardiovascular system, contributing to significant reductions in longevity," says Dr. Nofzinger. On a very serious note, "Short sleep, for example, has been linked with lower life expectancies in the most extreme of cases."
Poor sleep can also exacerbate pre-existing conditions, like hypertension, Type II diabetes, and cardiovascular disease, Siebern says. "On the flip-side, quality sleep can help prevent and manage these illnesses."
Compromised Immune System — Including Increased Risk for Coronavirus
All the experts we spoke with emphasized that the immune system takes a hit when sleep is sacrificed. "There are sleep deprivation studies that show with sleep loss the risk of infection can increase and immune response drops," says Siebern. And when it comes to our health this year, specifically the global COVID-19 pandemic, sleep is fundamental for our immune system, says Gilliland. "We want to get enough sleep to ensure we don't get the virus, but if we do get it we want to be able to successfully fight it."
“If you’re committed to distancing, wearing a mask, and washing hands, you’re poking holes in your bucket by depriving yourself of sleep.”
There are studies on the common cold, Gilliland says, showing that when patients get less than six hours of sleep per night, "you're almost four times as likely to get the common cold as those who got seven to eight hours." A single hour makes one hell of a difference, apparently.
According to Gilliland, sleep hygiene is as good, if not better, a defense against coronavirus as wearing a mask (but urges you to still wear a mask). "If you're committed to distancing, wearing a mask, and washing hands, you're poking holes in your bucket by depriving yourself of sleep."
But … Why Are We Like This?
So, why do we keep doing this to ourselves? The answer is not so straightforward — and a lot of it comes down to our culture, technology, prioritization of productivity over health, and (you guessed it) stress.
2020 isn't making our sleep recovery any easier, either. "Stressors — like dealing with the uncertainties of elections, or the societal changes associated with a pandemic — can lead to an impairment in the brain's ability to successfully restore brain and bodily functions during sleep," says Dr. Nofzinger. "In these cases, the mind can still be working too hard, despite being "asleep" and lead to feelings of sleep deprivation the following day."
“Stressors — like dealing with the uncertainties of elections, or the societal changes associated with a pandemic — can lead to an impairment in the brain’s ability to successfully restore brain and bodily functions during sleep.”
Both Dr. Nofzinger and Dr. Dimitriu cite anxiety as a chief contributor to the loss of sleep hours and quality. "Anxiety can often lead to insomnia, which can impact the amount and depth of sleep — and our 24/7 inboxes certainly do not give us a break," says Dr. Dimitriu. "I often joke with my patients that our days are so busy, 'they have squeezed out our nights.'" (*laughs in anxiety*) "There simply isn't time or reward for sleeping more (in the short term at least)." This is where culture plays a large role in sleep deprivation.
Some of this is our own doing, though. Dr. Dimitriu says that many of us are guilty of staying up late often as a form of procrastination. "It's easier (and more fun) to stay up later than it is to call it a day and start a new one tomorrow. But what if the whole next day was 20 percent better if you got one extra hour of sleep? It helps to also realize it may take more than one night of good sleep to catch up, so I advise everyone to try to sleep an extra hour for about a week, and judge how their days go."
Mental and physical health conditions can also make it harder to get the best quality sleep — this includes "psychiatric conditions such as depression, anxiety disorders, substance use, dementia, or primary sleep disorders such as sleep apnea syndrome (a sleep disorder in which breathing is disrupted while sleeping), or restless legs/periodic limb movement disorder," according to Dr. Nofzinger. "With each of these disorders, the ability of the brain to fully serve the function of restoration that sleep should provide becomes impaired," he says. "Eight hours of sleep that is punctuated by a worrisome mind or breathing irregularities is not going to feel restful and will lead to feelings of sleep deprivation."
OK… So How Do We Cure Our Sleep Deprivation?
Hopefully, by now, you're ready to turn your life around and become a sleep pro. Here's how you do it (cue: Montell Jordan). When it comes to sleep "debt" from skimping on snoozing hours, you can't make it up in one day. "You can't steal sleep all week and make it up on the weekends — the ole' five-and-two —It usually takes several days to recover sleep debt," Gilliland says. Dr. Dimitriu agrees, and encourages you to aim for eight hours "for at least a week, recognizing it may take about a week or longer to catch up."
“You can’t steal sleep all week and make it up on the weekends — the ole’ five-and-two —It usually takes several days to recover sleep debt.”
1. Assess The Situation
Gilliland advises you to monitor your sleep for a while, noting when you get in bed and when you wake up. Consider how you feel during the day, as well. "First, it helps to gauge just how sleepy you are — start by asking the 'would I sleep?' question, while in line at the coffee shop," says Dr. Dimitriu. "See how you feel at the gym or on a run — how long do you last?"
"Checking in with your sleep on a regular basis can be one of the most effective clues as to whether or not other aspects of life are being lived successfully," says Dr. Nofzinger. "If you're not sleeping well, go through a checklist of your physical and emotional health. Are you going through some sort of stress that you may or may not be aware of that is impacting your moods or anxiety levels? Has anyone mentioned that you snore or have irregular breathing during your sleep? Have any medical issues arisen that you may not be aware of? Prolonged periods of poor-quality sleep or feelings of sleep deprivation that don't resolve within a few days may be your best clue to have a full check-up."
Note: how quickly do you fall asleep? "Another interesting metric is how long it takes you to fall asleep," says Dr. Dimitriu. (Gilliland brought this up as well, noting that it should take about 15 to 20 minutes for you to fall asleep if you're not in "sleep debt"). "Exhausted people tend to fall asleep fast, sometimes too fast to even think of having sex with their partner," says Dr. Dimitriu.
ID Your Biggest Hurdles to Dreamland. Dr. Nofzinger believes that "the key to getting back on track is to first identify the most likely culprit producing a poor quality or inadequate duration of sleep." In other words, be you need to be your own doctor first and try to figure out what's potentially causing your sleep deprivation. Do you have good sleep habits? Do you have a set bedtime? Are you partaking in too many mentally stimulating activities before bed, or drinking alcohol?
2. Catch Up With Some Power Naps
Power naps are good, advises Gilliland — but not the fix, nor the permanent solution. He notes that a five-minute nap is "useless," and anything beyond 20 minutes can be disruptive to your circadian rhythm and sleep health. He recommends the sweet spot of 10-15 minutes. "There have been studies that show a quick power nap is better than a cup of coffee." Easier on your adrenals, too.
3. Implement a Bedtime Routine
Good sleep practices (sometimes called sleep hygiene) such as maintaining a regular sleep schedule and employing a wind-down period (disconnected from your devices) prior to bedtime are crucial, Dr. Nofzinger says. "This helps lower that sympathetic activation that can run interference with sleep onset and sleep continuity," Siebern explains.
"Shut down conversations, information, TV shows, at least an hour before bed; Treat yourself like a kid. Give yourself a gentle transition to bed," Gilliland suggests.
He recommends a warm shower, relaxing scents via a lotion or candle, some gentle stretching, and meditation — but it's really about finding out what relaxes you personally. "Everyone is very different in what they find relaxing, so it may be a process of exploration." For example, some people find baths or yoga to be relaxing and others do not," Siebern explains. It's all about finding out what helps you fall asleep and stay asleep.
4. Try These Sleep Hygiene Mainstays
Put screens away. This one is worth repeating. Siebern and Gilliland recommend limiting blue light exposure, as well as disconnecting from stimulating online content (hello, political and pandemic news) one hour before bed.
Adjust your meal times. "Schedule big meals at least three hours before bedtime, suggests Siebern. It's in your best interest not to eat a large meal right before bed, so try to plan accordingly.
Stop drinking alcohol before bed (sorry). Several experts shared this one. "Alcohol and certain sedatives can actually deprive us of deep restorative sleep, and this is often felt the next day," says Dimitriu. Gilliland echoes this: "Alcohol disrupts REM sleep — where our mind gets recharged — and deep sleep — where our body gets recharged," he says. "You may fall asleep a little bit easier, but your quality of sleep is worse. You're creating more of a problem for yourself."
Cut caffeine. "A lot of us, when we have sleep loss, have way too much caffeine the next day; that disrupts your sleep," says Gilliland. "This is user error. Don't course-correct with caffeine, it's disruptive and causes problems."
Don't hit the snooze button. Once the alarm goes off, you have to get up. You're not even getting more sleep. "We only get 18 minutes of sleep for an hour of snoozing," says Gilliland.
Sleep in a dark, quiet room. Gilliland recommends shutting out as much light as possible to signal to your brain and body that it's time for shuteye.
Set the temperature to 65ºF if you're able. "Our body starts to cool naturally as we fall asleep; if the room is cool, it fosters the cooling of our body to go to sleep," says Gilliland.
5. Get Help
When do you need to call for backup? It's case by case, as you may have guessed. Dr. Nofzinger suggests first asking yourself: "Are there immediate stressors that I can work on, either personally, or with the assistance of friends or professional guidance?" If you think the issue might be a primary sleep disorder such as sleep apnea or restless legs, a visit to your physician can help clarify and provide the appropriate medical therapy, he adds.
"If you often find yourself dozing off during daily activities such as driving or are experiencing mental fogginess in addition to poor sleep, schedule an appointment with your primary care provider who can determine the source of the problem as well as advise on treatments and specialists to address the issue," Siebern says. In addition to visiting your doc, finding a sleep coach (for example, through Proper) can also be helpful to help you implement healthier habits and techniques.
The Life-Changing Magic of Actually Getting Some Sleep
Do you want to feel better? Think better? Heal faster? Get sick less? Manifest a rich husband? The answer is sleep! "Specifically with sleep deprivation, it is important to allow for enough time to sleep rather than prioritizing other activities," says Siebern. "Recognizing this and prioritizing is extremely important."
While it's tough with everything going on in the world, this will have a profound impact on your health, mood, quality of life, relationships — everything. "When we focus on it and we get those eight hours, it's shocking how our energy starts to increase, fatigue less, our concentration improves, impulsivity and emotional reactivity declines," says Gilliland. "Can you think of two more important things right now than a strong immune system and a good mood with decreased stress? Eight hours of consistent, good sleep positively impacts all of this. Sleep is power."
Keep checking in with yourself. "Think of checking in with your sleep as a form of taking your temperature on your overall well-being," says Dr. Nofzinger. "If you're sleeping well and not feeling sleep deprived in the day, then you're likely doing well physically and mentally and living a successful and healthy life."
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