Sleep, the bedrock of public health, is eroding. This is how experts say we can fix it

In order to address other health problems, poor sleep in America needs to be treated like a public health crisis

By Nicole Karlis

Senior Writer

Published November 11, 2023 9:00AM (EST)

Group of tired people (Getty Images/PeopleImages)
Group of tired people (Getty Images/PeopleImages)

Since giving birth to my daughter over a year ago, my brain is still frequently foggy and my memory is weak. I have a harder time recalling some somewhat significant details in my life. I’m embarrassed to say that the name of a distant relative has sat on the tip of my tongue for longer than I'd like to admit.

Then there's the time when my in-laws unscrewed the lightbulbs on my kitchen chandelier (in front of me, to dim the lights for dinner). Yet weeks later I declared to my husband: a bunch of our light bulbs are broken. Some might say this is a case of “mommy brain,” the notion that forgetfulness and memory loss accompany being a mom. While it’s true that motherhood affects the female brain (just not in the sexist way many are quick to embrace), what I’m actually suffering from is severe sleep deprivation

For over a year now, my tiny human has woken me up in the middle of the night at least once for about 90 percent of the time she’s been alive, leaving me to live in reality where a solid four or five hour stretch is considered good sleep. Complaints aside, this is nothing new for many parents of young children, and it’s not just parents of young children who are suffering from lack of sleep. The CDC estimates that one in three American adults is not getting enough sleep. A 2019 analysis in the Journal of Community Health found that sleep deprivation in working adults is on the rise. An estimated 58% of middle school students and 73% of high school students are also not getting enough sleep. 

“The CDC actually called sleep deprivation a public health epidemic, and it’s probably gotten worse since then.”

There is no exact definition of what constitutes a public health crisis or emergency. According to researchers they’re often defined "as much by their health consequences as by their causes and precipitating events.” A situation becomes an emergency, so to speak, when the health consequences “have the potential to overwhelm routine community capabilities to address them.” Isn’t sleep deprivation doing this to us in America already? 

“The CDC actually called sleep deprivation a public health epidemic, and it’s probably gotten worse since then,” Dr. Pedram Navab, a neurologist, sleep medicine specialist and author of "Sleep Reimagined: The Fast Track to a Revitalized Life," told me on the phone. Indeed, in 2014 the CDC described sleep deprivation as a "public health epidemic" that is linked to a wide range of medical issues, including obesity, diabetes, cardiovascular disease, and mental health disorders.

Nearly a decade later, sleep issues continue to persist. Nearly one in five Americans use sleep medication. "Sleep tourism,” where people are now going on vacation just to get a good night’s sleep, is another trend on the rise. Is it time for another call to action from public health officials? 

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Dr. Jocelyn Cheng, a neurologist and vice chair of the Public Safety Committee at the American Academy of Sleep Medicine, told me while there is no official definition of a public health crisis, she would describe lack of sleep in America as “a prevalent problem in which the impacts of it are under-recognized by most people.”

“I think that we're all aware that we're sleep deprived, to some extent, and that at a basic level it can affect us badly,” Cheng said. “But I don't think that people realize the sort of serious actual health implications that that has.”

In the public discourse, there is a lot of discussion about how the country faces a variety of public health issues, from the overdose crisis to climate change. But sleep experts say addressing sleep deprivation could be the first step as part of the solution to other epidemics like obesity, diabetes and mental health disorders.

For example, Navab said, when people get good sleep it produces a hormone called leptin, which tells you if you’re full or not after eating food. When people don’t get good sleep, it’s harder or nearly impossible for the body to send that signal. “So we tend to overeat, and because of that, we can gain weight, we can have diabetes and high blood pressure,” he said. “It all stems from these hormones." He added that a lack of sleep can also activate inflammation which can predispose people to a variety of health conditions as well. 

“Sleep has to come into the conversation. I think it's just as important as the other stuff.”

At the end of 2022, the CDC issued a warning that diabetes is likely to increase rapidly among people under the age of 20 within the next few decades. Specifically, it could rise nearly 700 percent by 2060, according to the modeling survey. While being physically active is usually a solution that’s promoted as a protective mechanism against type 2 diabetes, or a way to manage it, good sleep is just as important, Navab said.

“Physicians who have to treat these issues, they don't have a lot of knowledge about sleep, and so the easiest thing for them to treat diabetes and high blood pressure is by suggesting eating the right food and exercising,” Navab said. “But sleep has to come into the conversation. I think it's just as important as the other stuff.”

As I’ve previously reported, sleep trends over the last century have drastically changed in America. Before electricity, people typically went to sleep about two hours after the sun went down and then slept in two phases known as “biphasic sleep.” After the first stage of sleep that lasted between four and six hours, people woke up for an hour or two, and then went back to sleep until dawn. Today, people are getting less and less sleep in one stretch. In the 1940s, the average adult in the U.S. slept 7.9 hours. That has now dropped to 6.8. Navab said adults need at least seven hours of good sleep, and teenagers need between eight and 10. When asked what’s behind the struggle to get enough sleep, Navab said longer work hours, higher expectations by employers and screens are obviously not helping.

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Cheng said part of the problem in addressing sleep deprivation in America is that it’s difficult for doctors to change peoples’ lifestyles. Education is something that can happen, but ideally health care providers would have the time to speak to their patients and actually go over whether or not they are getting healthy sleep, she said. “Sometimes it's not just your lifestyle," Cheng said. "Sometimes there are actual underlying medical causes, like obstructive sleep apnea, which is pretty common in the population.”

From a public policy perspective, she’d like to see later start times for schools. “If we’re able to alter, for instance, school start schedules, in order for those children and adolescents to get enough sleep it will help them learn more, it will help them learn better, it will be good for their health for various reasons,” she said. Of course, that would require employers and work start times to get on board, too. Navab added a cultural shift in expectations, and having more free time, would help solve sleep deprivation in America. 

“We need to make sure that people are getting enough sleep and they have an opportunity to get sleep,” he said. “A lot of people just don't spend enough time in bed to go to sleep."

By Nicole Karlis

Nicole Karlis is a senior writer at Salon, specializing in health and science. Tweet her @nicolekarlis.

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Cdc Diabetes Health Reporting Sleep Sleep Deprivation