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A Good Night's Sleep for a Healthier Population
Letters to the Editor
A Good Night’s Sleep for a Healthier Population To the Editor: Sleep curtailment has become an endemic condition of modern societies, with population statistics1 revealing that sleep duration has decreased by more than 1 hour over the past few decades. Factors responsible for this situation include, but are not limited to, extended work schedules, jet lag, and shift work, all of which can result in irregular sleep patterns, and lifestyle choices, including late-night TV watching, Internet use, and consumption of caffeine and/or other stimulants.2 A growing body of evidence3 shows that sleep loss is associated with mental distress, depression, anxiety, obesity, hypertension, diabetes, high cholesterol levels, premature death, and adverse health behaviors such as cigarette smoking, physical inactivity, and heavy drinking. Thus, sleep loss is an under-recognized public health problem that has a cumulative effect on physical and mental health. Recent experimental studies have provided a mechanistic explanation of the deleterious effects of sleep restriction on health. Indeed, these physiologic data4 have shown that short-term, partial sleep restriction leads to striking alterations in metabolic and endocrine functions, including decreased glucose tolerance, increased sympathetic tone, elevated cortisol concentrations, elevated levels of pro-inflammatory cytokines, and decreased leptin and increased ghrelin levels.4 Hence, chronic lack of sleep is stressful, biologically demanding, and must not be included in the package for good health. On the other hand, the positive impact of a good night’s sleep is well demonstrated. From a physiologic standpoint, it has been known for several decades that sleep exerts profound modulatory effects on hormones and metabolism. In addition, decreased core body temperature, decreased heart rate, decreased blood pressure, decreased sympathetic nerve activity, increased vagal tone, and decreased cerebral glucose utilization are all observed during sleep.5 Sleep is not a waste of time; its benefıcial effects go well beyond its role in cognitive per-
formance, alertness, risk of accidents, and the overall feeling of well-being. Of course, there are still questions to be answered regarding sleep, and it is generally agreed that sleep is not a panacea for all health issues. However, no one can effectively argue that lack of sleep is healthy, and therefore there is minimal risk in taking a pragmatic approach and encouraging a good night’s sleep as an adjunct to other health promotion measures. Sleep is a modifıable risk factor, and the benefıts of increasing sleep duration in at-risk individuals outweigh the harms. Although objective purists may not agree with the idea of advocating that better sleep hygiene advice be provided as a means to promote overall health, I nevertheless believe that the population as a whole will be healthier by taking such advice. Jean-Philippe Chaput, PhD Department of Human Nutrition University of Copenhagen Rolighedsvej 30, DK-1958 Frederiksberg C, Denmark E-mail: [email protected].
No fınancial disclosures were reported by the author of this paper. doi:10.1016/j.amepre.2009.10.043
References 1. National Sleep Foundation. Sleep in America poll. Washington DC: National Sleep Foundation, 2002. www.sleepfoundation.org/ article/sleep-america-polls/2002-adult-sleep-habits. 2. Chokroverty S, ed. Sleep disorders medicine: basic science, technical considerations, and clinical aspects. Boston MA: Butterworth and Heinemann, 1999: p. 1–178. 3. IOM. Sleep disorders and sleep deprivation: an unmet public health problem. Washington DC: The National Academies Press, 2006. www.iom.edu/cms/3740/23160/33668.aspx. 4. Knutson KL, Spiegel K, Penev P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Med Rev 2007;11: 163–78. 5. Van Cauter E, Holmbäck U, Knutson K, et al. Impact of sleep and sleep loss on neuroendocrine and metabolic function. Horm Res 2007;67(1S):2–9.
© 2010 American Journal of Preventive Medicine • Published by Elsevier Inc.
Am J Prev Med 2010;38(3)349 349
A Good Night’s Sleep for a Healthier Population To the Editor: Sleep curtailment has become an endemic condition of modern societies, with population statistics1 revealing that sleep duration has decreased by more than 1 hour over the past few decades. Factors responsible for this situation include, but are not limited to, extended work schedules, jet lag, and shift work, all of which can result in irregular sleep patterns, and lifestyle choices, including late-night TV watching, Internet use, and consumption of caffeine and/or other stimulants.2 A growing body of evidence3 shows that sleep loss is associated with mental distress, depression, anxiety, obesity, hypertension, diabetes, high cholesterol levels, premature death, and adverse health behaviors such as cigarette smoking, physical inactivity, and heavy drinking. Thus, sleep loss is an under-recognized public health problem that has a cumulative effect on physical and mental health. Recent experimental studies have provided a mechanistic explanation of the deleterious effects of sleep restriction on health. Indeed, these physiologic data4 have shown that short-term, partial sleep restriction leads to striking alterations in metabolic and endocrine functions, including decreased glucose tolerance, increased sympathetic tone, elevated cortisol concentrations, elevated levels of pro-inflammatory cytokines, and decreased leptin and increased ghrelin levels.4 Hence, chronic lack of sleep is stressful, biologically demanding, and must not be included in the package for good health. On the other hand, the positive impact of a good night’s sleep is well demonstrated. From a physiologic standpoint, it has been known for several decades that sleep exerts profound modulatory effects on hormones and metabolism. In addition, decreased core body temperature, decreased heart rate, decreased blood pressure, decreased sympathetic nerve activity, increased vagal tone, and decreased cerebral glucose utilization are all observed during sleep.5 Sleep is not a waste of time; its benefıcial effects go well beyond its role in cognitive per-
formance, alertness, risk of accidents, and the overall feeling of well-being. Of course, there are still questions to be answered regarding sleep, and it is generally agreed that sleep is not a panacea for all health issues. However, no one can effectively argue that lack of sleep is healthy, and therefore there is minimal risk in taking a pragmatic approach and encouraging a good night’s sleep as an adjunct to other health promotion measures. Sleep is a modifıable risk factor, and the benefıts of increasing sleep duration in at-risk individuals outweigh the harms. Although objective purists may not agree with the idea of advocating that better sleep hygiene advice be provided as a means to promote overall health, I nevertheless believe that the population as a whole will be healthier by taking such advice. Jean-Philippe Chaput, PhD Department of Human Nutrition University of Copenhagen Rolighedsvej 30, DK-1958 Frederiksberg C, Denmark E-mail: [email protected].
No fınancial disclosures were reported by the author of this paper. doi:10.1016/j.amepre.2009.10.043
References 1. National Sleep Foundation. Sleep in America poll. Washington DC: National Sleep Foundation, 2002. www.sleepfoundation.org/ article/sleep-america-polls/2002-adult-sleep-habits. 2. Chokroverty S, ed. Sleep disorders medicine: basic science, technical considerations, and clinical aspects. Boston MA: Butterworth and Heinemann, 1999: p. 1–178. 3. IOM. Sleep disorders and sleep deprivation: an unmet public health problem. Washington DC: The National Academies Press, 2006. www.iom.edu/cms/3740/23160/33668.aspx. 4. Knutson KL, Spiegel K, Penev P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Med Rev 2007;11: 163–78. 5. Van Cauter E, Holmbäck U, Knutson K, et al. Impact of sleep and sleep loss on neuroendocrine and metabolic function. Horm Res 2007;67(1S):2–9.
© 2010 American Journal of Preventive Medicine • Published by Elsevier Inc.
Am J Prev Med 2010;38(3)349 349