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• v.43(12); 2018 Dec

The Extraordinary Importance of Sleep

New sleep deprivation studies confirm the relationship between inadequate sleep and a wide range of disorders, such as hypertension, obesity and type-2 diabetes, cardiovascular disease, impaired immune functioning, and more.

In the inaugural issue of the Journal of Clinical Sleep Medicine (2005), a feature article 1 traced early milestones in the developing field of sleep medicine, which slowly emerged from the older field of sleep research during the 1970s and 1980s. Sleep medicine, the article noted, was closely linked with and made possible by the discovery of electrical activity in the brain. The examination of electroencephalogram (EEG) patterns that occur during sleep led to the classification of stages of sleep, which in turn created an important foundation for probing human sleep, discerning abnormalities, and discovering significant relationships between sleep and health. By 2005, scientists and clinicians had not only identified and clearly defined a large number of sleep disorders but had discovered that many of them were highly prevalent.

The pace of research and discovery has only accelerated since 2005, and the number of peer-reviewed sleep journals has more than tripled. Today, researchers are more deeply probing the cellular and subcellular effects of disrupted sleep, as well as the effects of sleep deprivation on metabolism, hormone regulation, and gene expression. Newer studies are strengthening known and suspected relationships between inadequate sleep and a wide range of disorders, including hypertension, 2 obesity and type-2 diabetes, 3 impaired immune functioning, 4 cardiovascular disease and arrhythmias, 5 , 6 mood disorders, 7 neurodegeneration and dementia, 8 , 9 and even loneliness. 10

Research findings continue to underscore early concerns about public safety that were first raised when major industrial disasters such as the Exxon Valdez oil spill were linked to inadequate sleep. 11 Related research sponsored by major organizations, including the U.S. Department of Transportation, the U.S. Department of Defense, the National Institutes of Health, and the National Aeronautics and Space Administration (NASA), has helped to inspire national initiatives aimed at improving public safety and health. However, despite the astounding acceleration in research during the past few decades, inadequate sleep due to sleep disorders, work schedules, and chaotic lifestyles continues to threaten both health and safety.

“Pushing against the wave of accelerated growth in the field has been a shoreline of indifference,” says David F. Dinges, PhD, Professor and Chief of the Division of Sleep and Chronobiology in the Department of Psychiatry at the University of Pennsylvania Perelman School of Medicine. “Modern industrial pressures to use time 24 hours a day have led to shiftwork and a world in which virtually everything—law Susan L. Worley is a freelance medical writer who resides in Pennsylvania. enforcement, airports and all kinds of transportation, industrial operations, and hospitals—operates 24/7. People have come to value time so much that sleep is often regarded as an annoying interference, a wasteful state that you enter into when you do not have enough willpower to work harder and longer.”

David F. Dinges, PhD

It has become increasingly clear, however, that no matter how hectic our lives may be, we can no longer afford to ignore what research is telling us about the importance of sleep for our safety and mental and physical well-being.

Impact on Attention, Cognition, and Mood

While scientists are still working to identify and clarify all of the functions of sleep, 12 decades of studies—many of which have used the method of disrupting sleep and examining the consequences—have confirmed that sleep is necessary for our healthy functioning and even survival.

“We know for sure that sleep serves multiple functions,” says Dr. Dinges. “Nature tends to be very parsimonious in that it often uses a single system or biology in multiple ways to optimize the functioning of an organism. We know, for example, that sleep is critical for waking cognition—that is, for the ability to think clearly, to be vigilant and alert, and sustain attention. We also know that memories are consolidated during sleep, and that sleep serves a key role in emotional regulation.”

Studies conducted by Dr. Dinges and other scientists have shown that cognitive performance and vigilant attention begin to decline fairly quickly after more than 16 hours of continuous wakefulness, and that sleep deficits from partial sleep deprivation can accumulate over time, resulting in a steady deterioration in alertness. The widely used psychomotor vigilance test (PVT), a simple neurocognitive test developed by Dr. Dinges and colleagues that assesses an individual’s ability to sustain attention and respond to signals in a timely manner, has proven to be an exceptionally sensitive tool for capturing dose–response effects of sleep loss on neurobehavioral functioning. 13 The PVT also reliably detects sleep deficits caused by disrupted or fragmented sleep, and/or poorly timed sleep, which is important because a growing body of evidence suggests that the continuity and timing (or circadian alignment) of sleep may be as important as the total amount of time spent sleeping.

“We know that sleep is much more restorative of waking functions and health when it is consolidated and not fragmented,” explains Dr. Dinges. “That is, when sleep goes through the appropriate physiological sequences of non-REM (rapid eye movement) and REM states at night, and occurs when human sleep is temporally programmed by our circadian clock to occur. Such consolidated sleep is typically of a longer duration and better sleep quality than sleep taken at other times of the day, such as that which occurs with nightshift work, jet lag, and other conditions of circadian misalignment.”

Dr. Dinges and his colleagues have found that people whose daily sleep duration is inadequate, or repeatedly disrupted (e.g., by obstructive sleep apnea, restless legs syndrome, pain or stress, or shiftwork or jet lag), often are not aware of their accumulating sleep deficits or the toll that these deficits can take on their waking cognitive functions, including their performance, working memory, cognitive speed, and accuracy. Inadequate sleep also can take a toll on psychological well-being, significantly affecting our emotional and psychosocial interpretation of events and exacerbating our stress levels. Studies have indicated that changes in mood may be due in part to the effects of sleep deprivation on the processing of emotional memory—in other words, our tendency to select and remember negative memories after inadequate sleep. 14

In one study conducted by Dr. Dinges and colleagues, participants’ mood was observed after they were confronted with “high” and “low” performance demands, following varying degrees of sleep deprivation. 15

“To our surprise, those who were sleep-deprived responded to low stressors in much the same way that people without any sleep deprivation tended to respond to high stressors,” said Dr. Dinges. “In other words, we tend to become much more sensitive emotionally and socially when we are sleep-deprived. That is what I like to call the ‘who was at my desk or who touched my coffee cup?’ phenomenon. I think we all have experienced having an extreme reaction or a very negative emotional response to a mild stressor when we have not had enough sleep.”

Aiming for the Sweet Spot

How much sleep is enough? After decades of investigation, it appears that scientists have gathered enough evidence to begin to answer that question. 16

“When duration of sleep drops below seven hours, and especially when it starts to move toward six and half hours or less, a number of different disorders begin to increase in prevalence,” says Dr. Dinges. “Most experts would agree that there is a kind of sweet spot that most people should aim for, and for the average healthy adult that zone is ideally somewhere between 7 and 7 and a half hours. That is what the consensus evaluations of more than a thousand scientific articles have yielded—the consensus of evaluations conducted by the AASM (American Academy of Sleep Medicine) and Sleep Research Society jointly.”

Numerous large U.S. surveys—beginning with a 1982 survey by the American Cancer Society—have been used to estimate the number of hours that most people spend sleeping. Many surveys have identified a worrisome prevalence of “short” sleepers (people who sleep 6 hours or less) among respondents, and a general trend toward decreasing sleep duration between 1975 and 2006. More recently, however, an analysis of the American Time Use Survey (ATUS), spearheaded by Mathias Basner, MD, PhD, at the University of Pennsylvania 17 , has suggested that there may be cause for optimism.

“The analysis shows that there is a slight but steady increase in sleep time that stretches back to about 2003 or 2004,” says Dr. Dinges. “We think this increase, which is modest—at most a minute or two more per year—is due in part to the development of the field of sleep medicine, and public and scientific reports in the media about sleep loss contributing to accidents and catastrophes, and so forth. Ever so slowly, the message that it is important not to get sleep deprived, and to get help if you have a sleep disorder, has begun to penetrate to the public.”

The analysis notes that one sign of greater interest in sleep on the part of the public has been a significant increase in Google searches containing the word “sleep” since 2004. Data from the ATUS also suggest that over time, people have been willing to trade some of their daily activities in exchange for more sleep. It is important to note, says Dr. Dinges, that self-reports of time spent sleeping are not always accurate—they can be off by a half an hour or more, usually with people tending to estimate that they slept more than they did. He also notes that there is still a fairly large population sleeping 6 hours or less.

“Although there are signs that sleep time is increasing, it is not happening at nearly the dramatic rate that most experts would like to see,” says Dr. Dinges. “This is especially true for vulnerable populations. There is concern about school start times and bus times affecting the sleep of children and adolescents, and about extracurricular activities at the end of the school day sometimes leading to a delay in bed times for teenagers. All of this is an ongoing, evolving picture, with more research results coming out all the time, and with consequent changes in recommendations, to make sure that at least our most vulnerable populations are getting adequate sleep.”

Interindividual Differences in Vulnerability to Sleep Loss

While it is well established that the effects of sleep loss accumulate over time, with repeated exposure to inadequate, fragmented, or disrupted sleep, the degree to which individuals demonstrate adverse effects of inadequate sleep can vary considerably. 18

“We have learned that there are astonishingly mysterious phenotypes, or trait-like differences, in how vulnerable people are to sleep loss,” says Dr. Dinges. “This is still a relatively new area of research, and it has only been in the past few years that scientists have begun to replicate early findings regarding these phenotypic differences in vulnerability to the negative neurobehavioral effects of sleep loss. The interindividual differences that have been observed so far raise some extremely provocative scientific questions. We may find that there is something in waking biology that can substitute for, or somehow reduce, the impact of sleep loss on waking functioning, but thus far there is no evidence as to what that might be.”

Differences among individuals exist with regard to both the effects of sleep loss and the ability to recover from the effects of sleep loss. Differences in performance also have been shown to be task-dependent, suggesting that people who are vulnerable to the effects of sleep loss in one or more cognitive or neurobehavioral domains may be resistant to the effects of sleep loss in others. To better understand interindividual variability, scientists are investigating possible genetic mechanisms that may underlie complex interactions between circadian and sleep homeostatic systems—the systems that affect our drive for sleep as well as our alertness and performance during waking hours. A current goal is to discover biomarkers that may help predict individual performance after varying degrees of sleep loss. 19 And one hope is that biomarkers—ideally in the form of a simple “roadside” test such as a breathalyzer—may eventually be used to detect sleep loss-related impairment in drivers or in individuals responsible for operating sophisticated equipment or machinery. To date, no viable candidates have been found.

Investigators also are shedding light on the role that age may play in resilience to sleep loss. The results of one recent study indicate that younger adults are more vulnerable to the adverse effects of chronic sleep loss and recurring circadian disruption than older adults. 20 Although the neurobiological basis for these age-related differences is not yet understood, such findings may help to inform new approaches to the prevention of drowsy driving and related motor-vehicle accidents among young drivers.

Dr. Dinges emphasizes that findings regarding interindividual differences in response to sleep loss and in recovery from sleep loss should not diminish the message that adequate sleep is critical for everyone.

“Research has shown us that sleep is not an optional activity,” says Dr. Dinges. “There is no question that sleep is fundamentally conserved across species and across lifespans, and that any effort to eliminate it has been unsuccessful. We must plan our lives in the time domain with a serious consideration for sleep—planning when to sleep, ensuring that we get adequate sleep, and making sure that our sleep is not disturbed by disorders or diseases, whether or not they are sleep-related.”

Addressing Sleep Disorders

As connections between sleep disruption and both disease and mortality have become more firmly established, accurate and efficient diagnosis and management of sleep disorders (see Table 1 ) have become increasingly critical. Recent directions in the field of sleep medicine include a move toward patient-centered care, greater collaboration between specialists and primary care physicians, and the incorporation of new tools—including home-based diagnostic tests and novel electronic questionnaires—in the effort to create a comprehensive yet more personalized approach to assessment and treatment.

ICSD-3 Major Diagnostic Sections *

A chief goal is to improve the diagnosis of sleep disorders. Although approximately 70 million people in the U.S. have at least one sleep disorder, experts estimate that up to 80% of sleep disorders may go undetected or undiagnosed. One major challenge that clinicians face during the initial assessment of people with sleep disorders is the process of identifying and sorting out comorbidities. Untangling the causes and effects in bidirectional comorbidities can be particularly difficult. For example, insomnia—by far the most common sleep disorder—often is complicated by the presence of another sleep disorder, such as sleep apnea or restless legs syndrome.

“Some experts have even suggested that all cases of insomnia coexist with, or are caused by, another sleep disorder, most commonly sleep apnea,” says Clete A. Kushida, MD, PhD, Professor of Psychiatry and Behavioral Sciences at Stanford, and Division Chief and Medical Director of Stanford Sleep Medicine. “I’m not sure I would go quite that far, but certainly bidirectional comorbidities among individuals who experience sleep disorders are common. For example, pain syndromes—including back pain and limb pain, especially among older patients—are common comorbidities in patients with insomnia. Mood disorders also frequently occur in patients who experience insomnia.”

Comorbidities can complicate treatment and often require sleep specialists to collaborate with not only primary care physicians but also specialists in other therapeutic areas.

“If, for example, a person with insomnia also has been diagnosed with depression by a psychiatrist,” says Dr. Kushida, “our goal is to work hand in hand with the psychiatrist to find the right medication. There are both sedating and alerting antidepressants, and a patient may need to try one medication for a couple of weeks to months, slowly increasing the dose to a therapeutic level, until the effect on both the depression and the patient’s sleep can be determined. For some individuals, an alerting antidepressant can cause poor sleep, which in turn can exacerbate the depression. The process of achieving the right dose of the right medication can be complex, and benefits from a collaboration between specialists.”

Undetected obstructive sleep apnea (OSA) in patients with chronic pain, or other serious illnesses, can result in potentially dangerous comorbidities. Opioids, for example, are known to have adverse effects on respiration, and can lead to central sleep apnea (CSA)—shallow and irregular or interrupted breathing and sustained hypoventilation—a potentially lethal condition that can intensify the consequences of OSA. These risks underscore the need to improve methods for identifying and properly diagnosing the estimated 23.5 million U.S. adults with OSA. Public education and advocacy efforts are already helping to improve detection—in part by helping to address misconceptions about OSA.

“One of the biggest misconceptions is that only people who are significantly overweight experience sleep apnea,” says Dr. Kushida. “In fact, only up to 67% of people who have OSA are overweight, the rest are of normal weight. OSA also can be caused by craniofacial dysmorphism, or a defect of the airway that occurs during development. A narrow airway caused by deficient growth of the craniofacial skeleton, particularly the jaws, can become narrower and more prone to collapse with age, leading to sleep apnea.”

Treating Insomnia: The Value of Cognitive Behavioral Therapy

Insomnia, the most prevalent sleep disorder, affects approximately one third of all adults and is the most common condition that family and primary-care physicians encounter. According to the International Classification of Sleep Disorders (ICSD-3), chronic insomnia is the inability to attain sufficient sleep (despite adequate opportunity) for at least three nights per week for three months or longer, with negative daytime consequences. For most people, the disorder is transient, but for approximately 10% to 15% of those who experience insomnia (around 30 million people) it becomes chronic. Although pharmacologic treatments for insomnia ( Table 2 ) can be effective, most experts now recommend against the long-term use of pharmacotherapy.

Selected Pharmaceutical Treatments for Insomnia 21 , 27

“If a person has been diagnosed with chronic insomnia, the only treatment that has been shown to have long-term benefit is cognitive behavioral therapy, “says Dr. Kushida. “Medications really should be considered short-term treatments, because patients tend to develop dependence on, or tolerance to, hypnotic drugs. In our clinic, we commonly see that, over time, medications stop having an effect, and that means that patients may try higher doses of a medication, or keep switching to different medications. So, medications are a temporary solution—they just put a Band-Aid on the problem of insomnia, whereas cognitive behavioral therapy targets one of the pathways toward success.”

Cognitive behavioral therapy (CBT), which involves techniques that work in part by reducing cognitive and somatic arousal, is estimated to be effective in approximately 70% to 80% of people who experience chronic insomnia. Dr. Kushida notes that while drugs can sometimes be useful in the treatment of acute insomnia, they become problematic after acute insomnia transitions to chronic insomnia.

“A person might be an OK sleeper for several years, and then suddenly experience a traumatic event, such as the loss of a job, a divorce, or the death of a loved one, resulting in very poor sleep,” says Dr. Kushida. “Down the road, that person might obtain a better job, overcome grief, or find a new relationship, but continue to experience insomnia. We think in some cases the transition from acute insomnia to chronic insomnia occurs because the behavioral event triggers something in the person’s physiology that may lead to long-term changes. Once they are in a chronic insomnia phase, we tell patients that CBT is the only truly effective intervention.”

If a patient is already taking hypnotics, Dr. Kushida says that he will gradually wean the patient off medications while introducing CBT. He notes that often it is necessary for sleep specialists to manage the expectations of chronic sufferers.

Clete A. Kushida, MD, PhD

“We sometimes have to let patients with chronic insomnia know that we may never get them back to where they were when they had optimal sleep,” Dr. Kushida explains. “The behavioral methods we use work well, and usually we can get patients to the point where the insomnia is having less of an impact on their quality of life. Our inability to completely restore the patient’s ability to sleep well may partly be explained by as yet unidentified changes in his or her neurophysiology or neurochemistry. Some patients with chronic insomnia can begin to sleep normally again, but for the vast majority, we aim to make insomnia less of a burden on a patient’s daily life.”

Improving Clinical Research

In the field of sleep medicine, as in many other therapeutic areas, future directions in clinical trial research will place an emphasis on patient engagement and patient-centered outcomes.

“Perhaps the most important aim these days when developing and implementing any type of large-scale clinical research study is to incorporate the patient’s perspective,” says Dr. Kushida, who is currently analyzing the results of a comparative effectiveness sleep study sponsored by the Patient-Centered Outcomes Research Institute (PCORI). 22 The study, designed and conducted by a team at Stanford, introduced a new model of patient-centered, coordinated care and tested it against conventional outpatient treatment for sleep disorders.

“The patient’s perspective is so invaluable in guiding the success of a study that ideally it should be incorporated right at the inception of a research question or idea,” says Dr. Kushida. “When you are designing an especially complicated trial, for example, it is easy to incorporate a lot of tests and measures without being aware of the burden these can place on the participants. It’s critical to learn from patients whether they are overwhelmed by the number of tests, or whether travel time or the amount of time they need to take off from work may be impractical.”

Other efforts to improve clinical research include those focused on correcting for and/or eliminating several confounding variables that tend to plague sleep research. The surprising power of the placebo effect, 23 the related disconnect between objective and subjective evaluations of sleep loss and recovery from sleep loss, variable adherence to treatments, and, more recently, deceptive practices among clinical trial participants, are a few examples.

The placebo effect, which refers to any outcome that may be attributable to the expectations of clinical trial participants rather than to the drug or device being tested, can be especially problematic in experimental protocols that involve self-reports of sleep quality.

“Clinical trials involving patients with disorders such as insomnia or RLS that rely solely on subjective measures, or ratings of severity based on patient report, are particularly vulnerable to the placebo effect,” says Dr. Kushida. “It has been demonstrated that when these patients believe that they are receiving the study drug or device the likelihood of their experiencing a positive effect can increase significantly. There have been efforts to develop or introduce new objective endpoints in these studies, which may help with this problem.”

Achieving the right balance of subjective and objective measures of sleep is an important goal in both research and clinical practice. The current gold standard for objective assessment of sleep is polysomnography (PSG), which includes electrophysiological recordings of brain activity (EEG), muscle activity (EMG), and eye movements (EOG). A valuable, non-invasive method for determining sleep continuity and sleep architecture, PSG has been an indispensable objective endpoint in clinical trials, but it is expensive and not always practical. Novel approaches to objective measurement, including actigraphy, which may be used to help minimize recall bias and complement subjective measures of sleep (e.g., sleep logs or diaries), still have drawbacks. 24

“The problem with wearable devices right now,” says Dr. Kushida, “is that they tend to overestimate sleep, sometimes by as much as an hour. They also are not yet capable of accurately detecting different stages of sleep, such as non-REM and REM sleep. Because of our proximity to Silicon Valley, our laboratory tests a lot of these new devices, and often by the time we have finished testing one prototype, new ones have emerged. The product cycles are rapid, and the companies keep incorporating newer and newer technology. So, down the road, within about five to ten years, I think these devices will likely estimate sleep and detect sleep stages with precision.”

Also, objective tools are needed for addressing problems with adherence to treatment. One important current aim is to detect and correct for non-obvious factors that result in failure to adhere to treatment, whether unintended or deliberate, to ensure that trial outcomes accurately reflect the efficacy of a drug, medical device, or behavioral intervention. 25 A related problem is deliberate deception by trial participants. As part of a National Heart, Lung, and Blood Institute (NHLBI)-supported study focused on detecting and correcting for adherence problems, Dr. Kushida and colleagues began to explore the prevalence of deceptive practices among clinical trial participants. 26

“We found that deception among clinical trial participants is pretty common and that there is quite a range of deceptive practices, “says Dr. Kushida. “They include underreported drug holidays, fabrication or withholding of medical histories, pill dumping, exaggerated symptoms, and falsification of current health status. It’s important that we find a way to address these deceptive practices because both the integrity of research data and the safety of participants are at risk.”

Dr. Kushida adds that newer tools, such as electronic monitoring of pill dispensing and statistical predictive adherence models, may uncover and remedy pressing problems related to adherence and deceptive practices. “It already takes about 12 years for a new drug to be approved, and about three to five years for a new device to be approved. When deceptive practices are discovered too late, it can lead to the invalidation of research findings and further delays in approving much-needed treatments.”

Enhancing clinical research in the field will require a cooperative, international effort focused on advancing knowledge about sleep, circadian rhythms, and sleep disorders worldwide. During Dr. Kushida’s tenure as inaugural president of the World Sleep Society (WSS), he led an initiative to create international sleep fellowships to prepare physicians and scientists from various countries for future leadership roles in basic and/or clinical sleep research. He also oversaw the development of an International Sleep Research Network, designed to help sleep scientists and clinicians find collaborators with similar clinical/research interests. As the WSS continues to offer new services and expand its programs, it will be with an awareness of the needs of disadvantaged populations and the importance of access to appropriate treatment.

“One initiative of the WSS involves reviewing current published guidelines in various countries, to determine whether they meet international standards,” says Dr. Kushida. “Many guidelines are region-specific and list only medications approved in specific countries or regions. As we review the guidelines, we endorse them with caveats; we may note that particular treatments for insomnia are recommended, and when these are not available we recommend acceptable substitutes. The goal is to ensure that specialists can use practice guidelines in whichever country they practice sleep medicine, and that patients are receiving the best possible treatment available.”

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Good Sleep for Good Health

Get the Rest You Need

Sometimes, the pace of modern life barely gives you time to stop and rest. It can make getting a good night’s sleep on a regular basis seem like a dream.

But sleep is as important for good health as diet and exercise. Good sleep improves your brain performance, mood, and health.

Not getting enough quality sleep regularly raises the risk of many diseases and disorders. These range from heart disease and stroke to obesity and dementia.

There’s more to good sleep than just the hours spent in bed, says Dr. Marishka Brown, a sleep expert at NIH. “Healthy sleep encompasses three major things,” she explains. “One is how much sleep you get. Another is sleep quality—that you get uninterrupted and refreshing sleep. The last is a consistent sleep schedule.”

People who work the night shift or irregular schedules may find getting quality sleep extra challenging. And times of great stress—like the current pandemic—can disrupt our normal sleep routines. But there are many things you can do to improve your sleep.

Sleep for Repair

Why do we need to sleep? People often think that sleep is just “down time,” when a tired brain gets to rest, says Dr. Maiken Nedergaard, who studies sleep at the University of Rochester.

“But that’s wrong,” she says. While you sleep, your brain is working. For example, sleep helps prepare your brain to learn, remember, and create.

Nedergaard and her colleagues discovered that the brain has a drainage system that removes toxins during sleep.

“When we sleep, the brain totally changes function,” she explains. “It becomes almost like a kidney, removing waste from the system.”

Her team found in mice that the drainage system removes some of the proteins linked with Alzheimer’s disease. These toxins were removed twice as fast from the brain during sleep.

Everything from blood vessels to the immune system The system that protects your body from invading viruses, bacteria, and other microscopic threats. uses sleep as a time for repair, says Dr. Kenneth Wright, Jr., a sleep researcher at the University of Colorado.

“There are certain repair processes that occur in the body mostly, or most effectively, during sleep,” he explains. “If you don’t get enough sleep, those processes are going to be disturbed.”

Sleep Myths and Truths

How much sleep you need changes with age. Experts recommend school-age children get at least nine hours a night and teens get between eight and 10. Most adults need at least seven hours or more of sleep each night.

There are many misunderstandings about sleep. One is that adults need less sleep as they get older. This isn’t true. Older adults still need the same amount. But sleep quality can get worse as you age. Older adults are also more likely to take medications that interfere with sleep.

Another sleep myth is that you can “catch up” on your days off. Researchers are finding that this largely isn’t the case.

“If you have one bad night’s sleep and take a nap, or sleep longer the next night, that can benefit you,” says Wright. “But if you have a week’s worth of getting too little sleep, the weekend isn’t sufficient for you to catch up. That’s not a healthy behavior.”

In a recent study, Wright and his team looked at people with consistently deficient sleep. They compared them to sleep-deprived people who got to sleep in on the weekend.

Both groups of people gained weight with lack of sleep. Their bodies’ ability to control blood sugar levels also got worse. The weekend catch-up sleep didn’t help.

On the flip side, more sleep isn’t always better, says Brown. For adults, “if you’re sleeping more than nine hours a night and you still don’t feel refreshed, there may be some underlying medical issue,” she explains.

Sleep Disorders

Some people have conditions that prevent them from getting enough quality sleep, no matter how hard they try. These problems are called sleep disorders.

The most common sleep disorder is insomnia. “Insomnia is when you have repeated difficulty getting to sleep and/or staying asleep,” says Brown. This happens despite having the time to sleep and a proper sleep environment. It can make you feel tired or unrested during the day.

Insomnia can be short-term, where people struggle to sleep for a few weeks or months. “Quite a few more people have been experiencing this during the pandemic,” Brown says. Long-term insomnia lasts for three months or longer.

Sleep apnea is another common sleep disorder. In sleep apnea, the upper airway becomes blocked during sleep. This reduces or stops airflow, which wakes people up during the night. The condition can be dangerous. If untreated, it may lead to other health problems.

If you regularly have problems sleeping, talk with your health care provider. They may have you keep a sleep diary to track your sleep for several weeks. They can also run tests, including sleep studies. These look for sleep disorders.

Getting Better Sleep

If you’re having trouble sleeping, hearing how important it is may be frustrating. But simple things can improve your odds of a good night’s sleep. See the Wise Choices box for tips to sleep better every day.

Treatments are available for many common sleep disorders. Cognitive behavioral therapy can help many people with insomnia get better sleep. Medications can also help some people.

Many people with sleep apnea benefit from using a device called a CPAP machine. These machines keep the airway open so that you can breathe. Other treatments can include special mouthguards and lifestyle changes.

For everyone, “as best you can, try to make sleep a priority,” Brown says. “Sleep is not a throwaway thing—it’s a biological necessity.”

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Your Health

More than a third of u.s. adults don't get enough sleep. here's how to get the rest we need.

Sacha Pfeiffer

NPR's Sacha Pfeiffer talks with Lauren Whitehurst, a cognitive neuroscientist specializing in sleep, about who in our society doesn't get enough sleep and why that's a problem.

Copyright © 2022 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Problem of Sleep Deprivation Cause and Effect Essay

Introduction.

• What is Sleep Deprivation?

Causes of Sleep Deprivation

Effects of sleep deprivation, managing sleep deprivation, works cited.

The functioning of the human body is influenced by a number of factors, which are mainly determined by the health status of an individual. Oftentimes, people seek medication when the body deviates from its normal and usual functioning mechanisms. Through different activities and processes, the body is able to use energy and replenish itself. Sleeping is one of the activities that has a direct effect on the functioning of the body.

This sleep deprivation essay explores how the functioning of the human body is influenced by various factors, primarily determined by an individual’s health status. While most people do not understand the implications of sleep, human effectiveness solely depends on the amount of time dedicated to sleeping. However, for various reasons, people fail to get enough sleep daily, weekly, or on a regular basis.

What Is Sleep Deprivation?

This cause and effect of sleep deprivation essay defines sleep deprivation as a condition occurring among human beings when they fail to get enough sleep. Sleep deprivation is defined as a condition that occurs when human beings fail to get enough sleep. Many experts argue that sleep deficiency is widespread even though most people do not consider it to be a serious issue, which affects their (Gaine et al.). Sleep deprivation has become a major problem in the United States, with almost 47 million suffering from the condition (Wang and Xiaomin). This lack of sleep can lead to a variety of physical and mental health issues, impacting daily functioning and quality of life.

The present essay about sleep deprivation defines sleep deprivation as a condition that occurs among human beings when they fail to get enough sleep. Many experts argue that sleep deficiency is widespread even though most people do not consider it to be a serious issue that affects their lives. Sleep deprivation has become a major problem in the United States, with almost forty-seven million suffering from the condition (Wang and Xiaomin). Among other reasons, one may get insufficient sleep in a day as a result of various factors. Some people sleep at the wrong time due to busy daily schedules, while others have sleep disorders, which affect their sleeping patterns. The following segment of the paper discusses the causes of deprivation.

Sleep deprivation may occur as a result of factors that are not known to the patients. This is based on the fact that sleep deprivation may go beyond the number of hours one spends in bed. In some cases, the quality of sleep matters in determining the level of deprivation.

In this context, it is possible for one to be in bed for more than eight hours but suffer from the negative effects of sleep deprivation. Whilst this is the case, there are people who wake every morning feeling tired despite having spent a recommended number of hours in bed (Griggs et al.14367).

Sleep deprivation can be caused by medical conditions, which may include but are not limited to asthma, arthritis, muscle cramps, allergies, and muscular pain. These conditions have been classified by researchers as common medical conditions that largely contribute to most of the cases of sleep deprivation being witnessed in the United States.

Similarly, these medical conditions have a direct impact on not only the quality but also the time one takes in bed sleeping. It is worth noting that sometimes people are usually unconscious to realize that their sleep is not deep enough (Wang and Xiaomin). This also explains the reason why it is not easy for a person to recall any moment in life when he or she moved closer to waking up.

Treatment of cases like sleep apnea is important because it affects the quality of sleep without necessarily awakening the victim. This is because medical surveys have revealed fatal effects of sleep apnea, especially on the cardiovascular system. Besides these, one is likely to experience breathing difficulties caused by insufficient oxygen.

Even though the treatment of sleep deprivation is important, it has been found that some drugs used to treat patients may worsen the case or lead to poor quality of sleep. It is, therefore, necessary for the doctor to determine the best drugs to use. Discussions between doctors and victims are imperative in order to understand patients’ responses (Conroy et al. 185).

Sleep deprivation is also caused by sleep cycle disruptions, which interfere with the fourth stage of sleep. Oftentimes, these disruptions are described as night terrors, sleepwalking, and nightmares.

Though these disorders are known not to awaken a person completely, it is vital to note that they may disrupt the order of sleep cycles, forcing a person to move from the fourth stage to the first one. Victims of these disruptions require attention in order to take corrective measures.

In addition, there are known environmental factors which contribute to several cases of sleep deprivation. However, doctors argue that the impact on the environment is sometimes too minimal to be recognized by people who are affected by sleep deficiency (Gaine et al.). In other words, these factors affect the quality of sleep without necessarily arousing a person from sleep.

Common examples include extreme weather conditions, like high temperatures, noise, and poor quality of the mattress. As a result, they may contribute to a person’s awakening, depending on the intensity when one is sleeping.

Moreover, the impact of these factors may develop with time, thus affecting one’s quality of sleep. In addition, most of the environmental factors that contribute to sleep deprivation can be fixed easily without medical or professional skills. Nevertheless, the challenge is usually how to become aware of their existence.

Lastly, sleep deprivation is caused by stress and depression, which have been linked to other health disorders and complications. Together with some lifestyles in America, these factors are heavily contributing to sleep deficiency in most parts of the world. Even though they might not be acute enough to awaken an individual, their cumulative effects usually become significant.

There are countless stressors in the world that affect youths and adults. While young people could be concerned with passing exams, adults are normally preoccupied with pressure to attain certain goals in life. These conditions create a disturbed mind, which may affect a person’s ability to enjoy quality sleep.

Sleep deprivation has a host of negative effects which affect people of all ages. The commonest effect is stress. Most people who suffer from sleep deficiency are likely to experience depression frequently as compared to their counterparts who enjoy quality sleep (Conroy et al. 188). As a result, stress may lead to poor performance among students at school.

Research has revealed that students who spend very few hours in bed or experience disruptions during sleep are likely to register poor performance in their class assignments and final exams. Additionally, sleep deprivation causes inefficiency among employees.

For instance, drivers who experience this disorder are more likely to cause accidents as compared to those who are free from it (Griggs et al.14367). This is based on the fact that un-refreshed people have poor concentration and low mastery of their skills.

Besides stress and anxiety, sleep deprivation has a wide-range of health-related effects. For instance, medical experts argue that people who spend less than six hours in bed are likely to suffer from high blood pressure. Quality sleep gives the body an opportunity to rest by slowing down the rate at which it pumps blood to the rest of the body (Wang and Xiaomin).

Inadequate sleep implies that the heart has to work without its normal and recommended rest. Additionally, sleep deprivation is known to affect the immune system. People who experience this disorder end up with a weakened immune system, leaving the body prone to most illnesses. This reduced immune response accumulates and may become fatal with time.

Sleep paralysis is also a common effect of inadequate sleep. This is due to disruption of the sleep cycle. It primarily occurs when the body is aroused during the fourth stage of the sleep cycle. In this case, the body is left immobile as the mind regains consciousness. Due to this conflict, one may experience pain and hallucinations.

Based on the negative effects of sleep deprivation, there is a need to manage this disorder among Americans. Firstly, it is necessary for people to seek medical advice concerning certain factors which could be contributing to this condition, like stress and infections (Wang and Xiaomin).

Proper counseling is also vital in stabilizing a person’s mental capacity. Physical exercises are also known to relieve a person from stressful conditions, contributing to sleep deficiency. Lastly, it is essential to ensure that the environment is free from noise and has regulated weather conditions.

Sleep deprivation remains a major problem in America, affecting millions of people. As discussed above, sleep deprivation is caused by a host of factors, ranging from environmental to health-related issues. Moreover, sleep deficiency has countless effects, most of which may become fatal in cases where the disorder is chronic.

Conroy, Deirdre A., et al. “ The Effects of COVID-19 Stay-at-home Order on Sleep, Health, and Working Patterns: A Survey Study of US Health Care Workers. ” Journal of Clinical Sleep Medicine , vol. 17, no. 2, Feb. 2021, pp. 185–91.

Gaine, Marie E., et al. “ Altered Hippocampal Transcriptome Dynamics Following Sleep Deprivation. ” Molecular Brain, vol. 14, no. 1, Aug. 2021.

Griggs, Stephanie, et al. “ Socioeconomic Deprivation, Sleep Duration, and Mental Health During the First Year of the COVID-19 Pandemic. ” International Journal of Environmental Research and Public Health, vol. 19, no. 21, Nov. 2022, p. 14367.

Wang, Jun, and Xiaomin Ren. “ Association Between Sleep Duration and Sleep Disorder Data From the National Health and Nutrition Examination Survey and Stroke Among Adults in the United States .” Medical Science Monitor , vol. 28, June 2022.

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Why a Good Night’s Sleep Is Important for Your Health

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How to Improve Your Sleep

Sleep is important due to the impact it has on your overall health. Appropriate sleep is needed for mental focus and memory, managing stress, maintaining proper body weight, boosting the immune system, and a host of other wellness needs. Some studies suggest sleep can help to prevent illness, such as diabetes or obesity .

Adults aged 18 to 60 years should get at least seven hours of sleep each night in order to achieve the benefits of sleep. If not, you run the risk of becoming sleep-deprived .

This article explains the role of sleep in overall health and offers tips on how to improve your sleep. Research on sleep and sleep cycles has elevated awareness about sleep hygiene (healthy sleep habits) and the quality of sleep.

 Illustration by Emily Roberts for Verywell Health

Sleep Is Restorative

When you sleep, you allow your body to repair and rebuild. During this time, the body is able to clear debris from the lymphatic system, which boosts the immune system.

While you sleep, there are many important processes that happen, including:

• Muscle repair
• Protein synthesis
• Tissue growth
• Hormone release

Sleep Reduces Stress

Sleep is a powerful stress reliever. It improves concentration, regulates mood, and sharpens judgment and decision-making. A lack of sleep not only reduces mental clarity but the ability to cope with stressful situations.

This is due, in part, to changes in cortisol levels. Typically, your cortisol levels fall in the evening hours, as one element of the body’s natural preparation for sleep. When sleep is lost, cortisol levels remain high and interfere with the release of melatonin, a hormone that is essential for the regulation of sleep-wake cycles.

Some studies suggest these changes could even be used to evaluate depression in people with bipolar disorder. Other studies demonstrate a link between sleep, chronic stress, and depression with an eye on heart rate changes.

Sleep Improves Your Memory

The link between sleep and memory processing is well established. Sleep serves as an opportunity for the mind to process all the stimuli taken in while awake. It triggers changes in the brain that strengthen neural connections helping us to form memories.

Sleep quality is important when learning new information and using memory. Numerous research studies find that electrophysiological, neurochemical, and genetic mechanisms that take place during the slow-wave sleep stage of sleep are key.

Sleep Helps You Maintain a Healthy Body Weight

When you are sleep deprived, your body alters the hormones that regulate hunger and appetite. These hormones include:

• Leptin: This hormone suppresses appetite and encourages the body to expend energy.
• Ghrelin: This hormone triggers feelings of hunger.

Both of these hormones are thrown off when you are short on sleep—leptin goes down and ghrelin goes up. Obstructive sleep apnea , a serious sleep disorder, is linked with obesity as well.

Sleep and Appetite

Sleep deprivation can activate the endocannabinoid (eCB) system in the brain (the same areas activated by marijuana) which increases hunger and appetite. Stimulating the eCB reward system makes you more likely to crave junk food.  You are also more likely to make these unhealthy lifestyle choices when you are tired. If that's often the case, it can lead to weight gain or diabetes over time.  

Sleep May Prevent Illnesses

Sleep deprivation can have very detrimental health impacts and has been linked to chronic diseases such as diabetes and heart disease. Here are some of the health conditions in which it may play a role.

Respiratory Illness and Infection

Lack of sleep makes you more vulnerable to respiratory illness and infection. A study of more than 600,000 people found that insomnia was a contributing cause when catching a cold or the flu , as well as a factor in how severe the infection became.

Obstructive sleep apnea, a common sleep disturbance, is linked with a number of cardiovascular (heart and blood vessel) diseases. For example, 40% to 60% of people experiencing symptomatic heart failure also are diagnosed with sleep-disordered breathing.

Other heart conditions linked with sleep apnea include:

• Coronary artery disease
• Pulmonary hypertension
• High blood pressure
• Heart arrhythmias

There's no direct evidence to suggest that sleep quantity or quality affects the risk of cancer, although studies have looked at the role of sleep in developing breast cancer , lung cancer , and more.

For example, research on lung cancer suggests a relationship between lack of sleep and adenocarcinoma risk, but more research on sleep traits (how long you sleep, whether you take naps) is needed.

Studies also are exploring the role of sleep in those already diagnosed with cancer, especially because difficulty sleeping affects up to 95% of people receiving cancer treatment and care. Sleep deprivation may affect the body's ability to fight cancer and lead to a poor prognosis, which was the conclusion of researchers focused on liver cancer .

A number of studies have shown that sleep deprivation leads to reduced glucose tolerance and impaired insulin sensitivity in humans. Additional studies suggest the risk of type 2 diabetes rises due to inadequate sleep, with seven or eight hours considered the optimal amount.

Researchers also think the timing of sleep may have impacts, too. Disruptions in circadian rhythm, with many people working at night or otherwise "living against the clock" of natural sleep cycles, also have impacts. Sleep disruption appears to affect metabolism and related diseases.

Neurodegenerative Disease

Sleep plays a key role in how your body produces cerebrospinal fluid (CSF), what it's composed of, and how the CSF is distributed in your brain and spinal cord. A number of studies have looked at how components in CSF, like amyloid-beta levels, might be linked to Alzheimer's disease and other neurodegenerative disorders.

The research results are mixed, but there is evidence to suggest that sleep patterns affect levels of amyloid-beta, orexin, tau proteins, interleukin 8 (IL-8), and other components. This may influence the development of Lewy body dementia, Parkinson's, or Alzheimer's disease, or it may contribute to sleep disruptions that are common in people living with these disorders.

Researchers also are investigating the role of CSF, sleep, and the early development of autism .

Sleep Is Important for Your Mental Health

Evidence suggests lack of sleep contributes to the formation of new mental health problems and to the maintenance of existing ones, but the magnitude of its effect is difficult to estimate and may be different across mental health conditions.

Sleep problems are very common in those with mental illness. In fact, disrupted sleep is commonly seen as both a symptom and consequence of mental health disorders, although sleep deprivation is rarely treated as the cause of mental health conditions.

The most common sleep problem associated with poor mental health is insomnia, with symptoms of:

• Not feeling well-rested after a night's sleep
• Daytime tiredness or sleepiness
• Irritability, depression, or anxiety
• Difficulty paying attention, focusing on tasks, or remembering
• Increased errors or accidents
• Ongoing worries about sleep

You may experience insomnia for a number of reasons, but the most common culprits are: 

• Work schedule
• Poor sleep habits
• Excessive alcohol or caffeine use at night 
• Habitual nighttime screen use

Illustration by JR Bee for Verywell Health

Small changes to your nighttime routine can result in a huge health benefit:

• Establish a realistic bedtime and stick to it every night, even on the weekends.
• Maintain comfortable temperature settings and low light levels in your bedroom.
• Consider a “screen ban” on televisions, computers and tablets, cell phones, and other electronic devices in your bedroom.
• Abstain from caffeine, alcohol, and large meals in the hours leading up to bedtime.
• Refrain from using tobacco at any time of day or night.
• Exercise during the day; this can help you wind down in the evening and prepare for sleep.

Sleep is vital to maintaining health, and most adults need seven or more hours each day. There is increasing evidence that adequate, high-quality sleep can help prevent illnesses like respiratory infection as well as limit the risk of diabetes, heart disease, and other serious conditions.

Memory, mood, and mental health also are affected by sleep deprivation and other sleep disorders.

There are lifestyle steps you can take to improve sleep. Talk to your healthcare provider if you have concerns or questions about how sleep patterns are affecting your health.

Antza C, Kostopoulos G, Mostafa S, Nirantharakumar K, Tahrani A. The links between sleep duration, obesity and type 2 diabetes mellitus . J Endocrinol . 2021 Dec 13;252(2):125-141. doi:10.1530/JOE-21-0155.

Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al . Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society . Sleep . 2015 Jun 1;38(6):843-4. doi:10.5665/sleep.4716.

Chong PLH, Garic D, Shen MD, Lundgaard I, Schwichtenberg AJ. Sleep, cerebrospinal fluid, and the glymphatic system: A systematic review . Sleep Med Rev . 2022 Feb;61:101572. doi:10.1016/j.smrv.2021.101572. 

Walker WH 2nd, Walton JC, DeVries AC, Nelson RJ. Circadian rhythm disruption and mental health . Transl Psychiatry . 2020 Jan 23;10(1):28. doi:10.1038/s41398-020-0694-0. 

da Estrela C, McGrath J, Booij L, Gouin JP. Heart Rate Variability, Sleep Quality, and Depression in the Context of Chronic Stress . Ann Behav Med . 2021 Mar 16;55(2):155-164. doi:10.1093/abm/kaaa039.

Tucker MA, Humiston GB, Summer T, Wamsley E. Comparing the effects of sleep and rest on memory consolidation . Nature and Science of Sleep . 2020 Feb 3;12:79-91. doi:10.2147/NSS.S223917

Rasch B, Born J. About sleep’s role in memory .  Physiological Reviews . 2013;93(2):681-766. doi: 10.1152/physrev.00032.2012 

Chaput JP, McHill AW, Cox RC, Broussard JL, Dutil C, da Costa BGG, Sampasa-Kanyinga H, Wright KP Jr. The role of insufficient sleep and circadian misalignment in obesity . Nat Rev Endocrinol . 2023 Feb;19(2):82-97. doi:10.1038/s41574-022-00747-7.

Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, et al . Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association . Circulation . 2021 Jul 20;144(3):e56-e67. doi:10.1161/CIR.0000000000000988.

Hanlon EC, Tasali E, Leproult R, Stuhr KL, Doncheck E, de Wit H, Hillard CJ, Van Cauter E.  Sleep restriction enhances the daily rhythm of circulating levels of endocannabinoid 2-arachidonoylglycerol . 2016 Mar 1;39(3):653-64. doi:10.5665/sleep.5546

Jones SE, Maisha FI, Strausz SJ, Lammi V, Cade BE, Tervi A, et al . The public health impact of poor sleep on severe COVID-19, influenza and upper respiratory infections . EBioMedicine . 2023 Jul;93:104630. doi:10.1016/j.ebiom.2023.104630

Wang J, Tang H, Duan Y, Yang S, An J. Association between Sleep Traits and Lung Cancer: A Mendelian Randomization Study . J Immunol Res . 2021 Jun 21;2021:1893882. doi:10.1155/2021/1893882. 

Büttner-Teleagă A, Kim YT, Osel T, Richter K. Sleep Disorders in Cancer-A Systematic Review . Int J Environ Res Public Health . 2021 Nov 7;18(21):11696. doi:10.3390/ijerph182111696.

Huang J, Song P, Hang K, Chen Z, Zhu Z, Zhang Y, et al . Sleep Deprivation Disturbs Immune Surveillance and Promotes the Progression of Hepatocellular Carcinoma . Front Immunol . 2021 Sep 3;12:727959. doi:10.3389/fimmu.2021.727959.

Parameswaran G, Ray DW. Sleep, circadian rhythms, and type 2 diabetes mellitus . Clin Endocrinol (Oxf) . 2022 Jan;96(1):12-20. doi:10.1111/cen.14607. 

Chasens ER, Imes CC, Kariuki JK, Luyster FS, Morris JL, DiNardo MM, et al . Sleep and Metabolic Syndrome . Nurs Clin North Am . 2021 Jun;56(2):203-217. doi:10.1016/j.cnur.2020.10.012.

Scott AJ, Webb TL, Rowse G. Does improving sleep lead to better mental health? A protocol for a meta-analytic review of randomised controlled trials . BMJ Open. 2017;7(9):e016873. Published 2017 Sep 18. doi:10.1136/bmjopen-2017-016873

By Shamard Charles, MD, MPH Shamard Charles, MD, MPH is a public health physician and journalist. He has held positions with major news networks like NBC reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.

Healthy Living

Get Enough Sleep

Take Action

It's important to get enough sleep. Sleep helps keep your mind and body healthy.

How much sleep do I need?

Most adults need 7 or more hours of good-quality sleep on a regular schedule each night.

Getting enough sleep isn’t only about total hours of sleep. It’s also important to get good-quality sleep on a regular schedule so you feel rested when you wake up.

If you often have trouble sleeping — or if you often still feel tired after sleeping — talk with your doctor.

How much sleep do children need?

Kids need even more sleep than adults:

• Teens need 8 to 10 hours of sleep each night
• School-aged children need 9 to 12 hours of sleep each night
• Preschoolers need to sleep between 10 and 13 hours a day (including naps)
• Toddlers need to sleep between 11 and 14 hours a day (including naps)
• Babies need to sleep between 12 and 16 hours a day (including naps)
• Newborns need to sleep between 14 and 17 hours a day

Health Benefits

Why is getting enough sleep important.

Getting enough sleep has many benefits. It can help you:

• Get sick less often
• Stay at a healthy weight
• Lower your risk for serious health problems, like diabetes and heart disease 
• Reduce stress and improve your mood
• Think more clearly and do better in school and at work
• Get along better with people
• Make good decisions and avoid injuries — for example, drowsy drivers cause thousands of car accidents every year

Sleep Schedule

Does it matter when i sleep.

Yes. Your body sets your “biological clock” according to the pattern of daylight where you live. This helps you naturally get sleepy at night and stay alert during the day.

If you have to work at night and sleep during the day, you may have trouble getting enough sleep. It can also be hard to sleep when you travel to a different time zone.

Get sleep tips to help you:

• Work the night shift
• Deal with jet lag (trouble sleeping in a new time zone)

Trouble Sleeping

Why can’t i fall asleep.

Many things can make it harder for you to sleep, including:

• Stress or anxiety
• Certain health conditions, like heartburn or asthma
• Some medicines
• Caffeine (usually from coffee, tea, and soda)
• Alcohol and other drugs
• Untreated sleep disorders, like sleep apnea or insomnia

If you're having trouble sleeping, try making changes to your routine to get the sleep you need. You may want to:

• Change what you do during the day — for example, get your physical activity in the morning instead of at night
• Create a comfortable sleep environment — for example, make sure your bedroom is dark and quiet
• Set a bedtime routine — for example, go to bed at the same time every night

Sleep Disorders

How can i tell if i have a sleep disorder.

Sleep disorders can cause many different problems. Keep in mind that it’s normal to have trouble sleeping every now and then. People with sleep disorders generally experience these problems on a regular basis.

Common signs of sleep disorders include:

• Trouble falling or staying asleep
• Still feeling tired after a good night's sleep
• Sleepiness during the day that makes it difficult to do everyday activities, like driving or concentrating at work
• Frequent loud snoring
• Pauses in breathing or gasping while sleeping
• Tingling or crawling feelings in your legs or arms at night that feel better when you move or massage the area
• Feeling like it’s hard to move when you first wake up

If you have any of these signs, talk to a doctor or nurse. You may need testing or treatment for a sleep disorder.

To learn more about sleep disorders:

• Check out this guide to healthy sleep [PDF - 451 KB]
• Read about common sleep disorders

Daytime Habits

Making small changes to your daily routine can help you get the sleep you need.

Change what you do during the day.

• Try to spend some time outdoors in the daylight — earlier in the day is best
• Plan your physical activity for earlier in the day, not right before you go to bed
• Stay away from caffeine (including coffee, tea, and soda) late in the day
• If you have trouble sleeping at night, limit daytime naps to 20 minutes or less
• If you drink alcohol, drink only in moderation (less than 1 drink in a day for women and less than 2 drinks in a day for men) — alcohol can keep you from sleeping well
• Don’t eat a big meal close to bedtime
• If you smoke, make a plan to quit — the nicotine in cigarettes can make it harder for you to sleep

Get tips for: 

• Drinking alcohol only in moderation
• Quitting smoking

Nighttime Habits

Create a good sleep environment..

• Make sure your bedroom is dark — if there are streetlights near your window, try putting up light-blocking curtains
• Keep your bedroom quiet
• Consider keeping electronic devices — like TVs, computers, and smartphones — out of your bedroom

Set a bedtime routine.

• Go to bed at the same time every night
• Try to get the same amount of sleep each night
• Avoid eating, talking on the phone, or reading in bed
• Avoid using computers or smartphones, watching TV, or playing video games at bedtime
• If you find yourself up at night worrying about things,  use these tips to help manage stress

If you’re still awake after staying in bed for more than 20 minutes, get up. Do something relaxing, like reading or meditating, until you feel sleepy.

See a Doctor

If you're concerned about your sleep, see a doctor..

Talk with a doctor or nurse if you have any of the following signs of a sleep disorder:

• Still feeling tired after a good night’s sleep
• Trouble staying awake during the day

Even if you don’t have these problems, talk with a doctor if you feel like you often have trouble sleeping.

Keep a sleep diary [PDF - 53 KB]  for a week and share it with your doctor. A doctor can suggest different sleep routines or medicines to treat sleep disorders. Talk with a doctor before trying over-the-counter sleep medicine.

Content last updated August 4, 2023

Reviewer Information

This information on sleep was adapted from materials from the National Heart, Lung and Blood Institute and the National Institute on Aging.

Reviewed by: Marishka Brown, Ph.D National Center on Sleep Disorders Research Division of Lung Diseases National Heart, Lung and Blood Institute

August 2021

You may also be interested in:

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MORE INFORMATION

Sleep Deprivation and Deficiency How Sleep Affects Your Health

Language switcher.

Getting enough quality sleep at the right times can help protect your mental health, physical health, quality of life, and safety.

How do I know if I’m not getting enough sleep?

Sleep deficiency can cause you to feel very tired during the day. You may not feel refreshed and alert when you wake up. Sleep deficiency also can interfere with work, school, driving, and social functioning.

How sleepy you feel during the day can help you figure out whether you're having symptoms of problem sleepiness.

You might be sleep deficient if you often feel like you could doze off while:

• Sitting and reading or watching TV
• Sitting still in a public place, such as a movie theater, meeting, or classroom
• Riding in a car for an hour without stopping
• Sitting and talking to someone
• Sitting quietly after lunch
• Sitting in traffic for a few minutes

Sleep deficiency can cause problems with learning, focusing, and reacting. You may have trouble making decisions, solving problems, remembering things, managing your emotions and behavior, and coping with change. You may take longer to finish tasks, have a slower reaction time, and make more mistakes.

Symptoms in children

The symptoms of sleep deficiency may differ between children and adults. Children who are sleep deficient might be overly active and have problems paying attention. They also might misbehave, and their school performance can suffer.

Sleep-deficient children may feel angry and impulsive, have mood swings, feel sad or depressed, or lack motivation.

Sleep and your health

The way you feel while you're awake depends in part on what happens while you're sleeping. During sleep, your body is working to support healthy brain function and support your physical health. In children and teens, sleep also helps support growth and development.

The damage from sleep deficiency can happen in an instant (such as a car crash), or it can harm you over time. For example, ongoing sleep deficiency can raise your risk of some chronic health problems. It also can affect how well you think, react, work, learn, and get along with others.

Mental health benefits

Sleep helps your brain work properly. While you're sleeping, your brain is getting ready for the next day. It's forming new pathways to help you learn and remember information.

Studies show that a good night's sleep improves learning and problem-solving skills. Sleep also helps you pay attention, make decisions, and be creative.

Studies also show that sleep deficiency changes activity in some parts of the brain. If you're sleep deficient, you may have trouble making decisions, solving problems, controlling your emotions and behavior, and coping with change. Sleep deficiency has also been linked to depression, suicide, and risk-taking behavior.

Children and teens who are sleep deficient may have problems getting along with others. They may feel angry and impulsive, have mood swings, feel sad or depressed, or lack motivation. They also may have problems paying attention, and they may get lower grades and feel stressed.

Physical health benefits

Sleep plays an important role in your physical health.

Good-quality sleep:

• Heals and repairs your heart and blood vessels.
• Helps support a healthy balance of the hormones that make you feel hungry (ghrelin) or full (leptin): When you don't get enough sleep, your level of ghrelin goes up and your level of leptin goes down. This makes you feel hungrier than when you're well-rested.
• Affects how your body reacts to insulin: Insulin is the hormone that controls your blood glucose (sugar) level. Sleep deficiency results in a higher-than-normal blood sugar level, which may raise your risk of diabetes.
• Supports healthy growth and development: Deep sleep triggers the body to release the hormone that promotes normal growth in children and teens. This hormone also boosts muscle mass and helps repair cells and tissues in children, teens, and adults. Sleep also plays a role in puberty and fertility.
• Affects your body’s ability to fight germs and sickness: Ongoing sleep deficiency can change the way your body’s natural defense against germs and sickness responds. For example, if you're sleep deficient, you may have trouble fighting common infections.
• Decreases   your risk of health problems, including heart disease, high blood pressure, obesity, and stroke.

Research for Your Health

NHLBI-funded research found that adults who regularly get 7-8 hours of sleep a night have a lower risk of obesity and high blood pressure. Other NHLBI-funded research found that untreated sleep disorders rase the risk for heart problems and problems during pregnancy, including high blood pressure and diabetes.

Daytime performance and safety

Getting enough quality sleep at the right times helps you function well throughout the day. People who are sleep deficient are less productive at work and school. They take longer to finish tasks, have a slower reaction time, and make more mistakes.

After several nights of losing sleep — even a loss of just 1 to 2 hours per night — your ability to function suffers as if you haven't slept at all for a day or two.

Lack of sleep also may lead to microsleep. Microsleep refers to brief moments of sleep that happen when you're normally awake.

You can't control microsleep, and you might not be aware of it. For example, have you ever driven somewhere and then not remembered part of the trip? If so, you may have experienced microsleep.

Even if you're not driving, microsleep can affect how you function. If you're listening to a lecture, for example, you might miss some of the information or feel like you don't understand the point. You may have slept through part of the lecture and not realized it.

Some people aren't aware of the risks of sleep deficiency. In fact, they may not even realize that they're sleep deficient. Even with limited or poor-quality sleep, they may still think they can function well.

For example, sleepy drivers may feel able to drive. Yet studies show that sleep deficiency harms your driving ability as much or more than being drunk. It's estimated that driver sleepiness is a factor in about 100,000 car accidents each year, resulting in about 1,500 deaths.

Drivers aren't the only ones affected by sleep deficiency. It can affect people in all lines of work, including healthcare workers, pilots, students, lawyers, mechanics, and assembly line workers.

Lung Health Basics: Sleep

People with lung disease often have  trouble sleeping. Sleep is critical to overall health, so take the first step to sleeping better: learn these sleep terms, and find out about treatments that can help with sleep apnea.

CCSU SET Department

Top 10 Benefits of Getting Enough Sleep

Sleep is a fundamental component of one’s overall health, yet it remains one of the most overlooked aspects of wellness. Millions of people suffer from sleep issues and inadequate rest, with consequences extending far beyond mere tiredness.

Reports highlight that 34.8 percent of adults do not get enough sleep. This data highlights a widespread public health issue. This chronic deprivation not only saps our energy but significantly impacts various facets of our health and daily functioning.

Poor sleep can impair brain function and systemic health. Not getting enough sleep isn’t merely an inconvenience but a significant detriment to one’s quality of life.

Benefits of Quality Sleep

What benefits can you get by getting enough quality sleep? Here are some data backed by science:

1. Enhanced brain function

Sleep is essential for cognitive processes. During sleep, the brain forms pathways necessary for learning and creating new memories, enhancing one’s ability to absorb and retain information. Sleep is also crucial for reorganizing and optimizing synaptic connections, which improve problem-solving skills and enhance creativity.

Further, sleep deprivation can impair judgment and delay reaction times which can be dangerous in situations that require quick decision-making. A well-rested mind is more adept at making complex decisions, navigating challenges, and engaging in critical thinking.

2. Better mood regulation

Inadequate sleep can significantly impact your mood, resulting in irritability and an increased risk of depression and anxiety .

Sleep affects various brain chemicals, including serotonin, dopamine, and cortisol, which affect mood and anxiety. Balancing the levels of these neurotransmitters promotes a stable and positive mood.

Moreover, sleep helps to mitigate the emotional response to negative stimuli. A rested brain is better equipped to cope with stress and recover from emotional distress, improving overall mental health. In short, sleep helps manage mood and maintain long-term emotional resilience.

3. Improved immune function

During sleep, the body produces cytokines, a protein that targets infection and inflammation, effectively creating an immune response. Cytokines are crucial in fighting off infections, illnesses, and stress. Sleep deprivation affects the production of these protective cytokines and infection-fighting antibodies and cells, making you more susceptible to diseases.

Studies have shown that people who don’t get enough sleep have a higher likelihood of getting sick after exposure to a virus. Adequate sleep, on the other hand, can help to fortify the body’s immune response, protecting against colds and flu. It also enhances the body’s response to vaccines.

4. Good weight management

Sleep influences metabolism and regulates hormones that affect hunger. Ghrelin, the hormone that stimulates appetite, and leptin, the hormone that transmits satiety to the brain, are both influenced by sleep. When you are deprived of sleep, ghrelin and leptin levels go down, making you feel hungrier than when you’re well-rested.

5. Promote heart health

Sleep strengthens the body’s ability to regulate stress hormones and maintain blood pressure at a healthy level. Having adequate sleep each night allows the body to regulate these stress hormones and support heart health.

Research also indicates that sleep affects cholesterol levels which are significant in heart disease. Adequate sleep may also reduce the risk of developing chronic diseases and conditions, including cardiovascular disease. As such, maintaining a regular sleep pattern can prevent heart disease.

6. Reduced risk of diabetes

Sleep affects the body’s release of insulin, the hormone that lowers blood glucose. Sleep deprivation can lead to higher insulin levels post-prandial, which can lead to fat storage and risk of type 2 diabetes.

Proper sleep can thus help control weight by regulating hormone levels and can reduce the risk of developing associated metabolic disorders.

In addition, sleep deprivation affects the body’s use of glucose and ability to function under stress. Both of these factors are linked to glucose intolerance and type 2 diabetes.

7. Improved pain management and tolerance

Sleep can increase your pain threshold. When you sleep more, you may require less pain medication. This is likely due to how sleep interacts with neurotransmitters in the brain that perceive pain. A good night’s sleep can help diminish the perception of pain which is important for those suffering from chronic pain conditions.

Moreover, sleep facilitates the body’s healing processes, vital for recovery from physical injuries and chronic conditions.

8. Better physical performance

Sleep is fundamental for physical recovery and muscle repair, which are crucial for athletes. During the deeper stages of sleep the body increases blood flow to muscles, which helps repair and rebuild tissues and bones. Furthermore, sleep helps to optimize the secretion of human growth hormone, which is essential for athletic performance.

Inadequate sleep leads to fatigue, lower energy levels, and poor focus—all of which can impair athletic performance. Moreover, having enough sleep has been linked to better game-time performance, faster sprint times, and overall higher efficiency in athletic activities.

9. Improved mental resilience

Sleep is incredibly beneficial for mental health. It helps the brain process emotional information. During sleep, the brain reorganizes and recharges itself, removing toxic waste byproducts which accumulate throughout the day. This process helps regulate emotions and cope with stress more effectively.

Persistent sleep disruptions can lead to long-term mood disorders and are strongly linked to increased anxiety and depression. Conversely, regular sleep patterns help foster mental resilience reducing the risk of stress and anxiety. Well-regulated sleep supports emotional stability and psychological health.

10. Promotes longevity

There’s a well-established link between sufficient sleep and a longer lifespan. Sleep is a restorative function for the body, repairing cells and tissues and rejuvenating the body for another day. It also balances hormones that affect nearly every tissue and system in the body, from brain function to immune system effectiveness.

Sleep also reduces inflammation, a root cause of many chronic diseases and premature aging. Thus, regular, uninterrupted sleep improves and can extend the quality of life. Research suggests that consistently getting enough sleep best correlates with longevity emphasizing the importance of sleep in the overall health equation.

Quality Sleep for Better Health

Embracing good sleep habits is not merely about avoiding the grogginess of a sleep-deprived state. It must also set the foundation for better health and a vibrant life.

Sleep means giving your body the chance to heal, your mind the opportunity to reset, and your emotions the space to balance. Each hour of rest contributes to more robust immune function and many other benefits that resonate through every aspect of health.

Aim to have seven to eight hours of quality sleep per night. More than that, the sleep schedule should be consistent, and any sleep disturbances should be with a healthcare provider. Also, don’t be afraid to indulge in sleep. Invest in premium bedding to make the most of your sleep.

This proactive approach can improve your quality of life and health, keeping you vibrant and energetic.

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Many people complain that they have difficulties getting enough sleep - Task 2 Essay Sample Band 9

You should spend about 40 minutes on this task.

Write about the following topic:

Nowadays many people complain that they have difficulties getting enough sleep.

What problems can lack of sleep cause?

What can be done about lack of sleep?

Give reasons for your answer and include any relevant examples from your own knowledge and experiences.

You should write at least 250 words.

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Sample Essay 1

In today's fast-paced world, an increasing number of individuals find themselves wrestling with the challenge of securing adequate sleep, a predicament that gives rise to myriad complications. This essay posits that insufficient sleep can have severe repercussions on both physical health and mental well-being, and advocates for a multifaceted approach to ameliorate this issue, encompassing lifestyle adjustments and societal interventions.

The ramifications of sleep deprivation extend far beyond mere tiredness, infiltrating various facets of health and daily functionality. Physiologically, chronic sleep shortages can precipitate a host of ailments, including but not limited to cardiovascular diseases, obesity, and weakened immune responses. This is attributed to the body's compromised ability to undergo essential repair and rejuvenation processes during sleep. Mentally, the lack of sleep exacerbates stress levels, impairs cognitive functions, and increases the risk of mental health disorders such as depression and anxiety. For instance, research indicates that individuals who consistently sleep less than six hours per night exhibit a significantly higher susceptibility to stress-related conditions, underscoring the indispensable role of sleep in maintaining mental equilibrium.

Addressing the quandary of insufficient sleep necessitates a holistic strategy that acknowledges the complexity of sleep as a biological necessity. Individually, adopting a disciplined sleep schedule, creating a conducive sleeping environment free from electronic distractions, and engaging in regular physical activity are pivotal steps toward enhancing sleep quality. Societally, it is imperative for workplaces and educational institutions to recognize the importance of sleep, potentially by advocating for flexible scheduling to accommodate natural sleep cycles. Furthermore, public health campaigns can play a crucial role in elevating awareness about the importance of sleep hygiene, thereby cultivating a culture that venerates rather than neglects sleep.

In conclusion, the perils of sleep deprivation are profound and far-reaching, affecting individuals' health and their capacity to function optimally. It is through the collective effort of personal lifestyle changes and societal support mechanisms that the tide can be turned, ensuring that sufficient sleep becomes a cornerstone of public health. As this essay elucidates, prioritizing sleep is not merely a personal preference but a critical investment in one’s overall well-being.

Sample Essay 2

The modern lifestyle, characterized by its incessant demands, has led to a widespread struggle with obtaining sufficient sleep, a dilemma fraught with negative implications. This essay asserts that sleep deprivation not only undermines physical health and cognitive performance but also suggests a comprehensive strategy for mitigation, emphasizing personal routines and systemic policy shifts.

Foremost, the physical consequences of sleep deficiency are alarming, manifesting as heightened risks of chronic conditions such as hypertension, diabetes, and obesity. Sleep serves as a critical period for the body to repair heart and blood vessels, and the deprivation thereof disrupts these processes. Equally concerning are the cognitive repercussions, where insufficient sleep impairs memory, decision-making abilities, and emotional regulation. Illustratively, a study found that individuals operating on less than five hours of sleep perform as poorly on concentration tasks as those legally intoxicated, highlighting the severe impact on daily functioning.

To counteract these issues, individual responsibility towards sleep hygiene cannot be overstated. Establishing a regular sleep schedule, minimizing blue light exposure before bedtime, and engaging in relaxation techniques can significantly enhance sleep quality. Concurrently, there is an urgent need for societal reforms. Workplaces and educational institutions should adapt their schedules to align with circadian rhythms, promoting flexibility and acknowledging sleep’s critical role in health and productivity. Public health initiatives aimed at educating the populace about the importance of sleep and the dangers of its neglect could further reinforce these efforts.

Addressing sleep deprivation requires both personal dedication to sleep hygiene and societal reforms. Recognizing sleep's essential role in physical and mental health is crucial. By integrating individual efforts with changes in societal norms, we can tackle this widespread issue, leading to a healthier, more efficient society. This call for a holistic approach underscores the urgent need to prioritize sleep.

Sample Essay 3

Lack of sleep is a common problem that people are facing all over the world. This sleep deprivation can cause a serious damage in our physical and mental health. However, reduced rate of caffeine consumption and less time spent on TV screen could be very effective to address this issue.

Sleep disorder directly impacts our mental and physical status. The people who do not have enough sleep are more prone to serious medical conditions. That means, insufficient sleep can lead up to a lack of concentration, behavioural anomalies, obesity, type 2 diabetes, and cardiovascular diseases. In fact, a continuous sleep deprivation can cause a chronic damage in terms of lower fertility rates, weak immune system, memory loss or decreased brain function etc. For example, if I cannot sleep well in a night, my thought process slows down and I am unable to pay full attention at my work on the next day.

However, reduced amount of caffeine intake and screen time could be the best possible solutions to address sleeplessness. In other words, if we can avoid caffeine consumption within the few hours before the bedtime, it can improve the quality of our sleep, because caffeine is a stimulus ingredient that reinvigorates our physic, hampering a proper sleep. That means, someone stimulated by caffeine cannot have a sound sleep. In addition, if we decrease TV screen time in the hours leading up to sleep, it would be helpful for availing a proper sleep, because the light from a screen impairs the secretion of the hormone melatonin, which is really important for a quality sleep.

In conclusion, sleep deprivation is one of the root causes behind different chronic diseases, including but not limited to, brain and heart. However, a smart schedule of caffeine intake and the proper management for screen time can help with a quality sleep.

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Ielts essay # 1250 - many people have difficulties getting enough sleep, ielts writing task 2/ ielts essay:, nowadays many people complain that they have difficulties getting enough sleep., what problems can lack of sleep cause what can be done about lack of sleep.

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IELTS Charlie

Your Guide to IELTS Band 7

IELTS Model Essay: Lack of Sleep

This  IELTS model essay  is on the topic of  sleeping . It’s an IELTS Problem Solution essay question from the General Training Test. It is taken from  Cambridge IELTS 15 .

Nowadays many people complain that they have difficulties getting enough sleep. What problems can lack of sleep cause? What can be done about lack of sleep?

( Cambridge IELTS General Training 15 Test 2 )

In this lesson, I will take you through my 4 Step Planning Process for this essay, I will show you my completed essay. After that I will give you a list of the useful vocabulary I used in the essay and finally I have an activity for you to try. Enjoy and I hope you find it useful!

Step 1: Understand Task

The task is asking you to write about 2 things:

Firstly , you need to write about the problems caused by lack of sleep. Many students will read this question quickly, and they will see the word “cause”, and then they will write about the causes of lack of sleep (e.g. drinking too much caffeine, using their phone late at night, etc).

The wording of the question is certainly tricky. The question says: “what problems can lack of sleep cause?” Another way of wording this question is: “what problems are caused by lack of sleep?” So the task statement is saying that the the cause of the problems is lack of sleep, but you need to say what those problems are. In other words, the task is NOT asking you about the causes of lack of sleep, but the consequences .

Secondly , you need to suggest some solutions – “what can be done…?” – to the problem of lack of sleep.

Step 2: Decide Position

Your position is simply your answers to the 2 questions.

Personally, I think this:

Problems caused by lack of sleep:

• poor concentration
• poor health

Solutions :

• evening habits

These are my main ideas.

Step 3: Extend Ideas

Now I need to expand these ideas.

• lack of sleep affects concentration
• major problem in jobs requiring concentration, e.g. doctors, drivers
• body needs sleep to rejuvenate
• lack of sleep can help cause diabetes, cancer
• irritability
• drugs (e.g. temazepam), hormones (melatonin), herbal (chamomile tea)
• wind down in evening, read, relax, avoid screens

You will see that I’ve already used some high level vocabulary in my plan above: e.g. requiring concentration, rejuvenate, irritability, medication, chamomile tea, wind down. The planning step is a good time to think about words and phrases to help you to explain your ideas.

Step 4: Structure Essay

I’m going to use a simple 4 paragraph structure:

• Paragraph 1: introduction
• Paragraph 2: problems
• Paragraph 3: solutions
• Paragraph 4: conclusion

But it would also be fine to split paragraph 2 and  3 into shorter paragraphs. It really depends how long each paragraph will be.

So here is my final essay…

People are increasingly reporting difficulties sleeping, often as a result of our modern 24/7 lifestyle. This essay will consider the problems caused by lack of sleep, along with some solutions.

Lack of sleep obviously causes tiredness, but perhaps more importantly, to reduced ability to concentrate. When tired, the brain will struggle to focus for any length of time and this can be a serious issue for workers who need to concentrate intensely, such as drivers and doctors. Sleep also helps the body to rejuvenate and heal, so anyone who gets inadequate sleep may start suffering from poor health. Indeed, studies show that lack of sleep may contribute to diabetes and cancer. In addition to physical health, failing to get a good night’s sleep can also affect your mental health. Tired people are more prone to irritability and a short temper.

A couple of broad solutions may help people who can’t get enough sleep. The first is medication. Powerful drugs like temazepam can assist people in getting to sleep, while levels of the natural sleep-inducing hormone, melatonin, can be taken in tablet form. But even herbal remedies can help: a drink of chamomile tea in the evening, for example, can help ready the body and mind for sleep. A second, and perhaps better, solution, may be to develop evening habits that prepare you for sleep. People need to wind down and relax during the evening if they are to get to sleep properly, so we should avoid computer screens or any activities that may stimulate the brain. Reading a good novel can be one of the best sleep aids for many people.

To conclude, lack of sleep can impact both physical and mental health, but medication and a relaxing evening routine can help overcome the problem.

(295 words)

I used a lot of natural, precise vocabulary in my essay, along with many complex structures. Here is a list of some of the words and phrases I used:

• reporting difficulties sleeping
• our modern 24/7 lifestyle
• reduced ability to concentrate
• struggle to focus
• for any length of time
• a serious issue for
• workers who need to concentrate intensely
• helps the body to rejuvenate and heal
• inadequate sleep
• failing to get a good night’s sleep
• a short temper
• people who can’t get enough sleep [Note: this is an example of a defining relative clause – the information after ‘people’ is essential to understanding who I am talking about]
• powerful drugs
• the natural sleep-inducing hormone, melatonin
• tablet form
• herbal remedies
• a drink of chamomile tea
• ready the body and mind for sleep
• habits that prepare you for sleep
• avoid computer screens
• activities that may stimulate the brain
• physical and mental health
• overcome the problem

Now try out this activity!

Without looking at the essay, try to fill in the blank spaces.

Paragraph 1

Paragraph 2.

The missing words

Paragraph 3

Paragraph 4, share this:.

• Click to share on Facebook (Opens in new window)
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About the author

Charlie is a former IELTS Examiner with 25 years' teaching experience all over the world. His courses, for both English language learners and teachers, have been taken by over 100,000 students in over 160 countries around the world.

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Ditch the Melatonin and Try These 7 All-Natural Sleep Aid Alternatives Instead

From herbal tea to CBD, these natural remedies can help you beat insomnia and achieve deep, restful sleep.

• Carl R. Greer/Andrew D. Hepburn Award for Best Nonfiction Essay (Miami University, 2020)

These natural solutions may help you achieve that coveted REM sleep. 

It's no secret how vital sleep is to your day-to-day functioning. Sleep strengthens your immune system, boosts  heart health , repairs muscle tissue, promotes memory and even bolsters your  mental health . Despite sleep being essential to our overall well-being,  one-third of adults have insomnia symptoms . And if you're one of them, getting that all-important shut-eye may seem impossible at times. Even  the classic tricks , such as reading in a room other than your bedroom and avoiding blue light, can prove ineffective. Before you know it, sleep deprivation turns you into a cranky, dazed, unhealthy version of yourself. 

When you search the internet for natural remedies for sleep disturbance,  melatonin  supplements are usually the first recommendation. However, if you're  skeptical about sleep supplements , experience  the side effects  or would just rather not take any pills that may leave you groggy in the morning, here are seven natural sleep aids and techniques to try to help ease your insomnia.

For more tips on better sleep, check out the best food to eat before bed , how to take a coffee nap and how to create the perfect sleep playlist . 

Use CBD oils, gummies or creams

CBD, also known as cannabidiol, is derived from hemp plants. CBD is a  safe and effective   treatment for insomnia  that contains almost no THC, the substance in marijuana that alters one's mental state. Many studies suggest that CBD is very  effective in promoting sleep  and  decreasing anxiety . It comes in many forms, such as oils and lotions. Use before bed to promote sleepiness and relaxation.

Brew a hot cup of herbal tea

Brewing tea is an ancient practice. Chamomile , valerian root and magnolia tea are all natural remedies for anxiety, stress and insomnia. Drink a cup of one of these herbal teas at least an hour to two before bed -- this gives you time to relax, enjoy the tea and use the bathroom before lights off. Be sure to look at the nutrition label to make sure no caffeine has been added to the ingredients.

Put a drop of lavender oil on your pillow

One of the more popular household remedies -- essential oils. If tea is not your favorite way to relax before bedtime, floral and herbal fragrances are good ways to aid sleep . Some popular essential oils for sleep are lavender, chamomile, and bergamot. Essential oils should never be ingested, but you can put a little drop on your pillow at night. You can also diffuse essential oils into the air or use dried lavender to make a tea. 

Pro Sleep Tip

Put a few drops of this lavender essential oil in a diffuser to help you drift off. You can also dilute in water and spray a little on your pillow.

Drink tart cherry juice

Sour cherry juice from tart cherries can  increase melatonin production  in those who consume it before bedtime. In the same study, the group that drank the cherry juice spent more time in bed and asleep and achieved higher overall sleep efficiency. This suggests that tart cherry juice has the potential to aid insomnia. 

Try dried passionflower or extract oil

Not to be confused with passionfruit -- passionflower is a fast-growing vine that produces vibrant flowers. Not only is the plant beautiful, but it can even help you fall asleep through herbal tea or extract oil. A recent study concluded that passionflower has  the potential to treat insomnia . However, it isn't recommended for those who are pregnant. 

Make sure you're getting enough magnesium

Magnesium , a powerful nutrient, is responsible for regulating hundreds of processes in the body -- including sleep . Magnesium is found naturally in foods such as nuts and seeds, spinach, soy milk, yogurt and whole grains. Try lightly snacking on foods high in magnesium an hour or two before bed. If you believe that you aren't getting enough magnesium in your diet and suspect it could help your sleep, try adding a supplement . 

Focusing on your breathing can help you relax before bed. 

Practice yoga and meditation before bedtime

Strenuous exercise before bed is not always a good idea , but practicing light yoga or meditation before bed has been linked to decreased insomnia and better sleep. Go through simple yoga poses , such as cat-cow, forward fold or bridge, focusing on your breath and feeling the stretch. There are also many self-guided meditation apps available.

For more health tips, here's how to create the ideal environment for better sleep and how to sleep cooler without air conditioning .

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Women who have trouble sleeping may want to check their blood pressure. A new study shows not enough sleep is linked to high blood pressure in women. The study tracked women who slept less than seven to eight hours a night and struggled to fall and stay asleep. Dr. Carlos Ince, the chief of cardiology at Mercy Medical Center in Baltimore, said anyone who notices a lack of sleep that's affecting their daily life should seek help. He said he always starts with lifestyle changes.

Here's One More Reason You Really Need to Get Enough Sleep

Researchers found even more proof that getting enough sleep is important.

Not getting enough sleep is linked to several health issues , and now, researchers have identified one more reason to encourage you to get regular shut-eye — especially if you’re a woman.

A new study , published Tuesday in Diabetes Care, found that chronic sleep deprivation can increase insulin resistance, which in turn may increase the risk of developing type 2 diabetes for otherwise healthy women.  

That’s because when you don’t get enough sleep,  the body isn’t able to effectively use insulin to maintain healthy blood sugar levels. Insulin resistance occurs when your cells don’t respond well to insulin and don’t easily uptake glucose from your blood. As a result, the pancreas might start producing more insulin to try to help glucose get to your cells and maintain a steady blood sugar range, according to the National Institutes of Health.

Researchers found that postmenopausal women were particularly susceptible.

“Women report poorer sleep than men, so understanding how sleep disturbances impact their health across the lifespan is critical, especially for postmenopausal women,” Marishka Brown, Ph.D., director of the National Center on Sleep Disorder Research at the National Heart, Lung, and Blood Institute (NHLBI), which co-funded the study, said in a statement.

Forty women between the ages of 20 and 75 enrolled in the study. They reported having healthy sleep schedules — defined by researchers as seven to nine hours per night — and normal fasting glucose levels, but were at elevated risks for cardiometabolic disease either due to being overweight, obese, or having a family history of type 2 diabetes, for example. 

Participants wore a sensor on their wrists for two weeks to record sleep patterns and kept nightly sleep logs. Afterward, participants randomly completed two six-week study phases: Some began with continuing to follow their healthy sleep patterns, while others restricted their sleep by an hour and a half, and then switched after a six-week recalibration break. 

Before and after each phase of the study, researchers tested participants’ glucose and insulin blood levels and conducted an MRI to measure their body composition. Getting 6.2 hours or less of sleep over a prolonged period of time increased insulin resistance by nearly 15% for both pre- and postmenopausal women. 

But for postmenopausal women, those effects were more severe, researchers said: Some increased insulin resistance up to 20%.

The good news: Once participants returned to sleeping seven to nine hours a night, their insulin and glucose levels went back to normal. 

Previously, research has shown links between sleep deprivation and increased risk for cardiovascular disease, hypertension , and disordered glucose metabolism . But, the study noted, most of the studies only focused on men, or the implications of more severe sleep restriction. 

“This study provides new insight into the health effects of even small sleep deficits in women across all stages of adulthood and racial and ethnic backgrounds,” Corinne Silva, Ph.D., program director at the National Institute of Diabetes and Digestive and Kidney Diseases, which also co-funded the study, said in a statement. “Researchers are planning additional studies to further understand how sleep deficiency affects metabolism in men and women, as well as explore sleep interventions as a tool in type 2 diabetes prevention efforts.”

Diabetes is a common condition that affects some 37 million Americans, according to the Centers for Disease Control and Prevention. About 90%-95% of people who have diabetes have type 2 diabetes, which is defined by insulin resistance. One of the first lines of defense is typically lifestyle interventions, which can include diet modifications and increasing physical activity.  

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• About Healthy Growth and Weight
• Water and Healthier Drinks
• Healthy Eating for a Healthy Weight
• Steps for Losing Weight
• Tips for Physical Activity and Your Weight
• Tips for Parents and Caregivers
• External Resources
• Be Sugar Smart
• Rethink Your Drink

Tips to Support Healthy Routines for Children and Teens

Healthy habits are the building blocks of lifelong well-being for children and teens. Parents, guardians, and teachers can help children and teens develop healthy habits.

Why it matters

Healthy eating and physical activity are important for growth and development and prevention of chronic health conditions. They can also help boost students' academic performance. For good mental and physical health, kids also need plenty of sleep and limited screen time.

Parents, guardians, and teachers can help children and teens develop healthy habits with these tips.

Make sure they get enough sleep

Children and teens need more sleep than adults, and the amount varies by age. Too little sleep is associated with obesity, partly because inadequate sleep may make us eat more and be less physically active. See the recommended amounts of sleep by age and suggested habits to improve sleep.

Reduce their screen time

In young people, too much screen time is associated with poor sleep, weight gain, lower grades in school , and poor mental health. Reducing screen time can help free time for other activities and improve sleep. Cutting back on screen time also limits cues to eat unhealthy food. See Screen Time Vs Lean Time.

Limit the time children and teens watch television, play video games, or use a smartphone or tablet. Instead, encourage children and teens to do fun activities with their friends and family members. Or encourage them to move more in their independent activities.

Help them develop healthy habits

To help children and teens develop healthy eating habits:

• Provide plenty of vegetables, fruits, and whole-grain products.
• Choose lean meats, poultry, fish, lentils, and beans for protein.
• Include low-fat or non-fat milk or dairy products, such as cheese and yogurt.
• Encourage your family to drink water instead of sugary drinks.

Additionally, you can:

• Encourage kids to eat a healthy breakfast and lunch whether at home or at school.
• Review school menus with your kids and encourage them to try new foods.
• Model healthy eating at home.

Remember that small changes every day can lead to success!

Limit salt, added sugar, and saturated fat

Limiting foods with high amounts of saturated fat , added sugar , and salt can help support healthy eating habits. If these foods are eaten less often, they will truly be treats! For everyday snacks, try these easy-to-prepare options.

• 1 cup carrots, broccoli, or bell peppers with 2 tablespoons hummus.
• A medium apple or banana with 1 tablespoon peanut butter.
• 1 cup blueberries or grapes with 1/2 cup plain, low-fat yogurt.
• 1/4 cup of tuna wrapped in a lettuce leaf.

Help children and teens stay active

In addition to being fun, regular physical activity has many health benefits , including:

• Strengthening bones and muscles.
• Decreasing blood pressure.
• Reducing risk of several chronic diseases, including type 2 diabetes and obesity.
• Reducing risk of depression.
• Boosting academic performance by improving attention and memory.
• Helping regulate body weight and reduce body fat.

Children 3 to 5 should be active throughout the day. Children and adolescents 6 to 17 should be physically active at least 60 minutes each day. They need aerobic activity, which is anything that makes their heart beat faster. They also need bone-strengthening activities such as running or jumping and muscle-strengthening activities such as climbing or push-ups. See details .

To help children and teens get enough physical activity:

• Make physical activity part of your family's daily routine by taking walks or playing active games together.
• Help children and teens find fun activities to do on their own or with friends and family, such as walking or riding bikes.
• Take young people to places where they can be active, such as public parks or playgrounds, community baseball fields, or community basketball courts.
• Encourage your child to participate in school or community physical activity or sports programs.

Remember that children imitate adults. Start adding physical activity to your own routine and encourage your child to join you.

Healthy eating

• Benefits of Healthy Eating for Children
• Healthy Eating Tips – Choosing healthy foods and drinks.
• Good Nutrition Starts Early – How to include a variety of fruits and vegetables in your child's diet.
• My Plate Kids – Includes games, activity sheets, videos, and songs.
• Dietary Guidelines for Americans, 2020-2025

Physical activity

• Health Benefits of Physical Activity for Children
• Physical Activity for Everyone – Recommendations by age.
• Tips for Getting More Active Minutes – Ways to find more time for physical activity.
• Best Bones Forever! – Children learn why calcium, vitamin D, and bone-strengthening activity are essential.
• Benefits of School-Based Physical Activity – How physical activity can benefit a student's health, teachers, and the community.

Social and emotional wellness

• BAM! Body and Mind – Classroom resources for teachers of grades 4 through 8.
• Give Your Kids a Healthy Body and Mind This Summer – Learn ways to support your child's physical and emotional well-being.
• Parents for Healthy Schools – Resources to encourage parent involvement in school health.

Maintaining a healthy weight

• Preventing Childhood Obesity – Things you can do at home.
• Child and Teen BMI (Body Mass Index) Calculator – BMI screens for obesity but is not a diagnostic tool. See more about BMI for children and teens.
• We Can! – National education program designed for adults to help children 8 to 13 stay at a healthy weight.

Healthy Weight and Growth

Eating well and being physically active contribute to healthy growth in childhood and good health throughout life. See how to get started.