Insufficient sleep: Evaluation and management
- Kiran Maski, MD
Kiran Maski, MD
- Instructor, Harvard Medical School
- Clinician in Sleep and Neurology, Boston Children's Hospital
A sufficient amount of sleep is essential for optimal physical health, immune function, mental health, and cognition. Consensus recommendations of the American Academy of Sleep Medicine and Sleep Research Society specify that adults aged 18 to 60 years should sleep seven or more hours per night on a regular basis for optimal sleep health . Similarly, the National Sleep Foundation consensus report specifies that seven to nine hours is recommended for adults aged 18 to 64 years and seven to eight hours is recommended for those 65 years of age and older (figure 1) . Infants, children, and teenagers require substantially more sleep than adults.
Insufficient sleep is a public health problem: nearly 30 percent of adults in the United States report sleeping six or fewer hours per day, and rates are even higher among younger adults, racial and ethnic minorities, and patients with low socioeconomic status. In observational studies, short sleep duration has been associated with a variety of adverse health outcomes, including cardiovascular disease, obesity, and all-cause mortality. (See "Insufficient sleep: Definition, epidemiology, and adverse outcomes", section on 'Epidemiology'.)
Formal diagnostic criteria for insufficient sleep syndrome (table 1) specify that a lack of adequate habitual sleep results in daytime sleepiness; associated symptoms may include irritability, decreased concentration, attention deficits, reduced vigilance, distractibility, poor motivation, fatigue, malaise, lack of energy, restlessness, and incoordination . These and other adverse effects of insufficient sleep are reviewed separately. (See "Insufficient sleep: Definition, epidemiology, and adverse outcomes".)
Insufficient sleep is only one of many causes of daytime sleepiness. This topic reviews the evaluation and management of insufficient sleep in otherwise healthy adults. An approach to the evaluation of excessive daytime sleepiness is presented separately. (See "Approach to the patient with excessive daytime sleepiness".)
Insufficient sleep may go unrecognized by clinicians if patients are not asked about it as part of the routine history. In our experience, patients more commonly present with complaints of daytime fatigue, tiredness, sleepiness, drowsy driving, and cognitive difficulties rather than specific concerns about insufficient sleep.
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