AANP: Sleep Debt Can Bankrupt Mind and Body, But the Account Can Be Replenished

INDIANAPOLIS, June 22 -- More than a third of U.S. adults report problems falling asleep or daytime sleepiness, and lack of sleep is linked to one in five serious motor vehicle accidents.

Sleep deprivation can affect a person's ability to function mentally and physically, Margee Krebs, M.S., WHNP, told attendees at the American Academy of Nurse Practitioners meeting here.

"Sleep is like a bank account; you need to deposit 8 hours of sleep to compensate for 16 hours of wakefulness," she said. "If you don't, you go into debt. Sleep debt is cumulative so if you lose an hour of sleep every night, by the end of the week it's like being awake for 24 hours straight. Being sleepy is an indication of a sleep debt, just like thirst is a sign you need water."

Lack of sleep has been shown to decrease alertness, impair judgment, interfere with memory, and bring about moodiness or depression, Krebs said, noting that studies have shown that as sleep deprivation builds, people make more mistakes, and are less able to realize that a mistake has been made.

As the sleep debt piles up, there are also changes in how the body works Krebs explained. Stress hormones increase and there is an increase in hunger and appetite, which can lead to weight gain.

In addition, she said, pain can be worsened, and there is evidence linking lack of sleep to inflammation markers, which, in turn, have been linked to heart disease, stroke, and some forms of cancer.

To eliminate sleep debt, Krebs has some specific suggestions:

• Go to bed earlier instead of trying to sleep later.
• Nap, but for no more than 15 minutes; midday is best.
• Get back to a normal schedule as soon as possible.

Noting that dependence can be an issue with non-benzodiazepine hypnotic sleep aids, Krebs listed the peak activity and half-life of zolpidem (1.6 hours; 2.5-2.8 hours), eszopiclone (1 hour; 6 hours), and Zaleplon (1 hour; 6 hours).

All of them, she pointed out, are schedule IV drugs and should be used with caution in older patients and those with respiratory issues.

Addressing non-pharmaceutical sleep aids, Krebs noted a number of strategies. Among them: meditative relaxation, exercise, mental stimulation during the daytime, reducing caffeine and nicotine intake, and establishing a bedtime routine.

Key ways to stay out of sleep debt, she said are:

• Get an adequate amount of sleep each night.
• Establish a regular sleep schedule,

Get continuous sleep; six straight hours is better than eight interrupted ones.

"Light is the most powerful cue that the body uses to reset your internal clock," said Krebs, so she suggests keeping the bedroom dark.

If a person is having trouble getting to sleep, bright lights early in the morning may help, she said. On the other hand, if staying asleep is the concern, lights should be used in the evening.

"Most people think of insomnia as a disease,"said Krebs. "However, it is not a disease, it is a symptom. It is important to get at the root of the insomnia and then pick out the sleep strategies that best address the actual causes."