Over the past 15 to 20 years, the fields of sleep medicine and chronobiology have gone through a metamorphosis made possible by exponential increases in knowledge related to sleep and circadian rhythm disorders, their diagnosis and treatment. New medical devices, pharmaceuticals and other interventions have been developed that have the potential not only to improve sleep but also the quality of life of afflicted individuals and to dramatically reduce mortality and morbidity from medical conditions associated with sleep deficiency and sleep disorders, such as cardiovascular disease and diabetes. Even the motor vehicle crash risk of drivers with obstructive sleep apnea is reduced with continuous positive airway pressure treatment.1
Nevertheless, the number of Americans having problems with their sleep is not declining. In 2006, the Institute of Medicine estimated that 50-70 million Americans were afflicted by a disorder of sleep and wakefulness. Sleep disorders result in not only negative personal impacts on health and wellness but also substantial adverse economic consequences for society as a whole.2 Furthermore, most Americans are sleeping less. Thirty percent of US workers report nightly sleep durations of ≤ 6 hours,3 in contrast to 50 years ago when only 3% of the population reported such short sleep duration.4 The reason for the vast reduction in sleep is multifactorial including: societal pressures such as working long hours; competing priorities (e.g., working multiple jobs and/or childcare); widespread use/abuse of caffeine and other stimulants; artificial lighting, internet and video game use, round-the-clock television channels, and, more generally, societal and individual attitudes towards sleep; and the perceived need to use electronic devices (e.g., smart phones, tablets) to remain “connected” 24/7.
Why do we have this paradox of increased scientific knowledge regarding the importance of sleep and people sleeping fewer hours? Although the importance of sleep may not be appreciated by some individuals, the lack of public awareness is likely not the primary explanation. This supposition is supported by results from an informal survey conducted at a recent business conference of several thousand persons attended by one of the authors. It showed the vast majority of the attendees realized adequate sleep was important for their health and well-being. Nevertheless, large numbers still reported sleeping less than 7 hours per night suggesting that knowledge is not being translated into practice.
What can be done to change behavior such that it is more in line with the current knowledge of sleep health? Certainly making easily accessible information available over the internet and other venues is helpful.5 However, we contend that it is time for a national movement to imbue sleep health into the public consciousness and make it part of our social fabric. Similar revolutionary movements have changed public attitudes towards smoking, and have led to more stringent laws and penalties against drunk driving. To be successful, the movement will need to engage multiple stakeholders. Entities such as professional societies (e.g., American Academy of Sleep Medicine, Sleep Research Society), and academic institutions will be needed to demonstrate leadership and energize their memberships. The real strength of the movement, however, may come from corporate America. It has been proposed that sleep health is a business issue as well as a healthcare issue.6,7 Presenteeism, accidents, poor judgment and absenteeism due to poor sleep health all have direct impacts on corporate productivity. Furthermore, when poor sleep health leads to chronic sleep disorders, corporate healthcare costs increase due the rising incidence of the comorbidities of sleep disorders.
Millions of Americans are employed by large corporations. For example, a major corporation such as Walmart employs 1.4 million people or 1% of the working population of the United States.8 If major corporations could be recruited to join the movement and institute sleep health friendly policies, they would be improving the health of their employees as well as their own economic “bottom line.” A simple first step for corporations would be to add sleep health to their existing wellness programs. Healthy sleep educational classes could be provided. In the same way that many corporations have weight loss or smoking cessation challenges or events, innovative healthy sleep competitions could be developed and implemented. Vulnerable individuals at high risk for sleep disorders could be identified by simple screening questionnaires and referred for further evaluation and treatment, if required.9 Finally, sleep-friendly corporate policies discouraging late night texts and emails could be instituted. These trailblazing corporations would be demonstrating leadership that would result in adoption of similar policies by other employers, eventually resulting in a “snowball” effect that could engage all Americans.
The science of sleep and circadian biology has demonstrated that sufficient, high quality sleep is indeed the third pillar of health along with nutrition and exercise. The time is ripe for a movement to translate this knowledge into action.
Dr. Quan is the Editor-in-Chief of the Journal of Clinical Sleep Medicine. Dr. Barger has consulted for Alertness Solutions.
Barger L; Quan SF. A movement to promote healthy sleep: the case for corporate involvement. J Clin Sleep Med 2013;9(8):739-740.
Tregear S, Reston J, Schoelles K, Phillips B, authors. Continuous positive airway pressure reduces risk of motor vehicle crash among drivers with obstructive sleep apnea: systematic review and meta-analysis. Sleep. 2010;33:1373–80. [PubMed Central][PubMed]
Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. 2006. Washington, DC: National Academies Press.
Luckhaupt SE, author. Short Sleep Duration Among Workers – United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61:281–5. [PubMed]
Czeisler CA, author. Perspective: casting light on sleep deficiency. Nature. 2013;497:S13. [PubMed]
Quan SF, Anderson JL, Hodge GK, authors. Use of a supplementary internet based education program improves sleep literacy in college psychology students. J Clin Sleep Med. 2013;9:155–60. [PubMed Central][PubMed]
Huffington Arianna, author. Getting Naps Ahead of the Competition. http://blogs.hbr.org/cs/2013/06/getting_naps_ahead_of_the_comp.html.
Kirby Julia, author. Change the World and Get to Bed by 10:00. http://blogs.hbr.org/hbr/hbreditors/2013/05/change_the_world_and_get_to_be.html.
Blodget Henry, author. Walmart Employs 1% Of America. Should It Be Forced To Pay Its Employees More? http://www.businessinsider.com/walmart-employees-pay.
Rajaratnam SM, Barger LK, Lockley SW, Shea SA, Wang W, Landrigan CP, O'Brien CS, Qadri S, Sullivan JP, Cade BE, Epstein LJ, White DP, Czeisler CA, authors; Harvard Work Hours, Health and Safety Group. Sleep disorders, health, and safety in police officers. JAMA. 2011;306:2567–78. [PubMed]