November 4, 2015

The Cost of Sleep Debt: Can You Recover?

Woman Sleeping on Bed

Most adults (and adolescents) aren’t getting enough sleep. No surprise, right? I’m certainly guilty. This easily qualifies the majority of us as “sleep deprived.”

Sometimes I make the choice to sleep less in order to mindlessly scroll through social media, catch up on favorite TV programs, socialize with friends, or just relish in a little “me time” without my precious little rug rats needing something from me. Oftentimes life interferes with my desire to get more sleep—the unfortunate reality of nighttime parenting, nagging work deadlines, never-ending household responsibilities, and the occasional insomnia.

Most of us devalue rest and we feel we can “steal” from our sleep time when we are overwhelmed by other demands and priorities. I know I’m not alone!

  • Americans are getting less sleep than ever before.
  • Middle-aged Americans sleep on average one hour less than we did fifty years ago, and the number of people sleeping less than six hours per night is increasing.
  • Forty percent of Americans (60% of women) are sleep deprived and on average we get about six and a half hours of sleep per night—many of us are getting less than five.
  • It is clear that many of us are not getting enough sleep, and research is showing that our chronic sleep deprivation is causing irreversible damage to our health.

Sleep Debt

When we experience sleepiness we usually know we are overtired, yet we dismiss the connections that sleepiness has to many health problems. We typically fuel up with coffee, tea, or energy drinks and push through. And, unfortunately, the more sleep deprived we are, the less we recognize it.

Many people even pride themselves on how little sleep they need to function. But poor sleep is nothing to be proud of. Poor sleep quality and short sleep duration are associated with higher levels of inflammation and illness. Sleep should truly be one of the cornerstones of our health strategy.

The average amount of sleep that we need for optimum performance, health and safety on a daily basis is called our “sleep need” and is typically seven to nine hours per night. When we get less than our sleep need we build up what is called “sleep debt.” Sleep debt is the difference between the amount of sleep we should be getting and the amount we actually get.

As our sleep deficit grows, consequences grow more alarming. It starts with foggy thinking, daytime sleepiness, impaired attention, increased cortisol levels, weakened immune system, accelerated aging, mood instability, impaired memory, and compromised safety (like poor driving or making bad decisions). All of which have dramatic implications for our quality of life and overall health.

In the long term, the low-level inflammation caused by sleep loss actually increases the risk of obesity, diabetes, cancer, and heart disease. Sleep deprivation has been shown in research to actually shed years off one’s life.

Sleep Debt Recovery: Is it Possible?

Many of us try to make up for lost sleep on the weekends or “when we get a chance”—but is that enough? Unfortunately, getting extra sleep does not necessarily restore all systems. Sleep scientists continue to discover the complexity of sleep deprivation recovery and how sleep debt is harder to repay than initially thought.

A study from the University of Chicago concludes that it might be reasonable to recover from short-term sleep loss. They found subjects who slept only four hours nightly for six consecutive days (short-term sleep loss) developed higher blood pressure, increased cortisol levels, and produced only half the usual number of antibodies to a flu vaccine (indicating a weakened immune systems). The sleep-deprived subjects also showed signs of insulin resistance—a precursor of type 2 diabetes. All the changes were reversed when the students made up the hours of sleep they had lost. However, other short-term sleep loss studies have shown that baseline cortisol levels and attention are not easily regained with sleep recovery.

“Short-term” sleep loss isn’t the category in which most of us fit. We are chronic offenders. Get this—if we lose an hour of sleep every night for a year that adds up to a sleep deficit of two full weeks. Some researchers say if you build up more than twenty hours of sleep debt you may not be able to fully reverse the effects of sleep deprivation. Since having three kids, my sleep deficit has surely put me in bankruptcy status. No wonder I am brain dead and dangerous! And I’m quite disappointed that I’m not recovering from that anytime soon.

Although we can’t recover all functioning from high sleep deficits, we can begin to improve some functioning by tacking on an extra hour or more of rest per night. So rather than binge sleeping, it is better to increase sleep an hour or more over a long period of time. It can still take months to begin to feel rested and regain some functioning.

Even though scientists are still learning about the consequences of sleep deprivation and the effectiveness and limitations of sleep recovery, Dr. Epstein, medical director of the Harvard Sleep Health Centers, shares the following suggestions that have led him to successfully help many sleep deprived individuals:

  1. Avoid seeing sleep as an indulgence or luxury. Remember that sleep is just as important for health as diet and exercise.
  2. Settle short-term debt. If you missed 10 hours of sleep in a week, add three to four extra sleep hours on the weekend and an extra hour or two per night the following week until you have “repaid” the debt.
  3. Address a long-term debt. Plan time off or a period of time with minimal work and obligations. Go to bed as soon as you are tired and turn off the alarm clock—sleep until you naturally wake.
  4. Avoid accumulating new debt. Determine your “sleep need” and factor it into your daily schedule. Try to consistently go to bed and wake up at the same time every day (at the very least on the weekdays).

I know it’s not the best news that we can’t perfectly recover from chronic sleep deprivation. However, I hope you are inspired to start chipping away at your sleep debt and to avoid accumulating new debt. Let’s start viewing our “sleep need” as non-negotiable in our daily routines.