Manifestations and Prevalence

Sleep loss generally, in adults, refers to sleep of shorter duration than the average basal need of 7 to 8 hours per night. The main symptom of sleep loss is excessive daytime sleepiness, but other symptoms include depressed mood and poor memory or concentration (Dinges et al., 2005). Chronic sleep loss, while neither a formal syndrome nor a disorder, has serious consequences for health, performance, and safety, as described in Chapter 4.

Sleep loss is a highly prevalent problem that continues to worsen in frequency as individuals grow older. Recent studies find that at least 18 percent of adults report receiving insufficient sleep (Liu et al., 2000; Kapur et al., 2002; Strine and Chapman, 2005). Historically, there have been a limited number of nationally representative surveys that provide reliable data on sleep patterns in the population. The National Health Interview Survey (NHIS), run by the Centers for Disease Control and Prevention (CDC) (see Chapter 5), included the following question in the 1977, 1985, 1990 cycles: “On average how many hours of sleep do you get a night (24-hour period)?” The same question was added to the core NHIS questionnaire in 2004. Based on these data, it has been estimated that the percentage of men and women who sleep less than 6 hours has increased significantly over the last 20 years (Figure 3-1) (CDC, 2005). More than 35 years ago, adults reported sleeping 7.7 hours per night (Tune, 1968).

Adolescents also frequently report receiving insufficient sleep. Contrary to public perceptions, adolescents need as much sleep as preteens. A large survey of over 3,000 adolescents in Rhode Island found that only 15 percent reported sleeping 8.5 or more hours on school nights, and 26 percent reported sleeping 6.5 hours or less (Wolfson and Carskadon, 1998). The optimal sleep duration for adolescents, about 9 hours per night, is based on research about alertness, sleep-wake cycles, hormones, and circadian rhythms (Carskadon et al., 2004). Among adolescents, extensive television viewing and growing social, recreational, and academic demands contribute to sleep loss or sleep problems (Wolfson and Carskadon, 1998; Johnson et al., 2004).

Etiology and Risk Factors

The causes of sleep loss are multifactoral. They fall under two major, somewhat overlapping categories: lifestyle/occupational (e.g., shift work,1


The term “shift work” is defined by regular employment outside of the normal day work hours of 7:00 a.m. to 6:00 p.m.

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