Sleep Deprivation

Sleep deprivation is the second most prevalent sleep disorder. This disorder is characterized by people who can sleep but do not want to because they want to stay up and work, study, party etc.  Sleep deprivation is rampant among our younger people: high school, college, and late twenties and early thirties.  Many of these young people believe sleep is downright boring and will deprive themselves of the necessary time for sleep, preferring to use that time to work hard and party hard.  These hardy, trendy, up-and-coming folks often believe that sleeping 7 to 8 hours is for weak slobs or for the older, sedate crowd.

Unfortunately, these self-proclaimed "smart people" do not understand the basics of the science of sleep (see and Dr. Dement’s book The Promise of Sleep) and are actually dangerously ignorant.  A very important concept is sleep debt, which is accumulated if one does not sleep the adequate amount of time.  The higher the sleep debt, the greater the probability that the person will experience fatigue, mood disorders, social problems and performance problems at work or at school.

Sleep deprivation helps to explain such spectacular and tragic disasters as the Exxon Valdez oil spill in Alaska, the Challenger Space Shuttle explosion, the Chernobyl Nuclear Plant meltdown in the Soviet Union, and the 2006 commuter plane crash in Fayette County, Kentucky.  In each of these situations there were highly competent professionals who had performed their jobs well for years and then went through a period where unusually high work demands deprived them of much sleep.  They then committed very simple, dumb mistakes that were not caught in time, nor even suspected, and resulted in tremendous public health disasters.

Approximately 33% of fatal truck accidents result from sleep deprivation.  In fact, when truck accidents were initially studied by the federal government, the assumption was that many were caused by driving under the influence of alcohol, and thus the prediction was that accidents would cluster around midnight, when the bars would close.  However, the accidents actually clustered long after that, around 4 am, when the sleep-deprived drivers finally dozed off behind the wheel. In addition to truck accidents, 10% of fatal car accidents are due to sleep deprivation.  It has been shown that the impairment is the same whether one is drunk, is sleep-deprived (sleeping less than 4 to 6 hours), or has sleep apnea.  In many states now, statutes severely punish drivers who are involved in accidents caused by their own sleep deprivation.  The trend to pass such laws is growing throughout the country.

Sleep deprivation also leads to obesity and less control of diabetes.  People who sleep less eat more salty, fatty and sweet snacks.  Lower body weight correlates with good sleep habits, particularly in those who are middle-aged.  Sleep is intimately related to eating and exercise.  At present, this topic is undergoing very intensive research, particularly in the area of hormones (such as leptin) that help control both hunger and sleep.


Another important but less common sleep disorder that can lead to sleepiness during the day is narcolepsy. This disorder usually begins during the teenage years or in the early twenties. Tragically, it often goes undiagnosed and untreated for years or even decades, causing the patient enormous suffering.

Besides relentless daytime sleepiness, the other hallmark symptom of narcolepsy is sudden muscle weakness (cataplexy) that can affect the eyes, neck, throat, tongue, legs and arms (but without loss of consciousness), lasting minutes at a time.  Together with muscle weakness or paralysis, dreaming actually intrudes into wakefulness.  In fact, narcolepsy represents a mixing of sleep and wake states. Another frightening symptom of narcolepsy is morning paralysis, in which the patient wakes up but cannot move for several minutes. Again, this represents the paralysis of the dream state lingering too long. (See

Sudden dreaming during the day can lead the patient to describe what appear to be hallucinations, and this can lead to the erroneous diagnosis of a serious psychiatric illness.  Unfortunately, the wrong medications can then be prescribed, after which the symptoms of narcolepsy will not improve. They might even worsen.

Fortunately, modern medications can adequately manage this devastating illness.  The problem remains its timely diagnosis.  Sleep studies are necessary to diagnose narcolepsy.


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