Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem
Apr 6, 2006 - 5:36:00 AM
, Reviewed by: Himanshu Tyagi
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The IOM report sheds more light on the problem of large numbers of people with unrecognized and undiagnosed sleep disorders that adversely affect health and performance. The major obstacles to people getting the care they need is the public's lack of awareness of the importance of avoiding sleep deprivation and detecting sleep disorders and the lack of recognition by primary care health professionals of the signs and symptoms of sleep disorders.
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By Dr Shivani Arora,
[RxPG] It is estimated that 50 to 70 million Americans chronically suffer from a disorder of sleep and wakefulness, hindering daily functioning and adversely affecting health and longevity. The cumulative long-term effects of sleep loss and sleep disorders have been associated with a wide range of deleterious health consequences including an increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke.
Hundreds of billions of dollars a year are spent on direct medical costs associated with doctor visits, hospital services, prescriptions, and over-the-counter medications. Almost 20 percent of all serious car crash injuries in the general population are associated with driver sleepiness, independent of alcohol effects.
Despite such huge societal consequences and costs, the Institute of Medicine (IOM) finds that the cumulative effects of sleep loss and sleep disorders are "under- recognized" and "awareness among the general public and health care professionals is low given the magnitude of the burden
The Sleep Research Society applauds the Institute of Medicine (IOM) of the National Academy of Sciences for recognizing the adverse impact of sleep disorders and sleep deprivation on public health in its report entitled "Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem" (IOM Report), which was released on April 4, 2006. The 2006 IOM Report updates and reinforces the prior recommendations of the National Commission on Sleep Disorders Research that was chaired by William C. Dement, MD, PhD. The Sleep Research Society, which was one of the sponsoring organizations for the IOM Report, strongly supports the Institute of Medicine's conclusion that additional investment is needed to address this serious unmet public health problem by Recognizing that sleep disorders and sleep deprivation are significant public health problems that have a wide range of deleterious health and safety consequences
A multi-media education program to foster increased awareness among the general public (including children, young adults, middle age adults, and older adults) and health care professionals about the physiology of healthy sleep across the lifespan, and of the importance of sleep to health, performance, learning and safety and of the tremendous societal costs associated with sleep loss and sleep disorders should be developed
Programs to promote the early diagnosis and treatment of sleep disorders should be Instituted
Surveillance and monitoring of sleep patterns in the U.S. population and of the public health burden of sleep loss and sleep disorders by the Centers for Disease Control and Prevention should be Improved
Sleep medicine should be recognised as an independent specialty of medicine that is interdisciplinary in nature but requires specialized training
More research scientists in the fields of sleep science and sleep medicine and more clinicians in the field of sleep medicine should be trained
The number of trained scientists in other disciplines who focus on sleep-related researchIntegrating the teaching of sleep science and sleep medicine into undergraduate, graduate and professional education programs should be increased
Investment in basic research in sleep science and in research in sleep medicine on the causes and treatments of inadequate sleep and sleep disorders should be increased
The sleep research community through initiatives to attract new investigators to the fields of sleep science and sleep medicine should be strengthened
Interdisciplinary sleep programs in all academic health centers should be established. The Sleep Research Society further recommends that clinical revenues generated by these programs be reinvested in sleep science and sleep medicine through these interdisciplinary sleep programs.
A national sleep science and sleep medicine research and clinical network should be created
The research agencies in the National Institutes of Health (NIH) that are responsible for supporting research in sleep science and sleep medicine should be Reinvigorated
According to NSF CEO Richard L. Gelula, "The IOM report should be read by everyone concerned about sleepiness and fatigue in our society, whether it is in the classroom, at work or on the road. The report complements what NSF has been finding in its annual Sleep in America polls - namely, that too many Americans are getting too little sleep, that sleep problems and symptoms of sleep disorders are widespread in our population, that too few people ever talk to their doctor about sleep and, importantly, that too few doctors ask their patients about sleep when assessing health. The IOM report shows there are achievable solutions to these problems, but that Americans must be re- educated about sleep, all doctors should be trained to understand the contribution of sleep to health as well as to be able to recognize and effectively respond to sleep disorders, and the nation should increase investment in sleep research to learn how to best prevent and most effectively treat sleep disorders."
The American Academy of Sleep Medicine, the National Center on Sleep Disorders Research at the NIH, the National Sleep Foundation, and the Sleep Research Society requested that the IOM conduct a study that would examine the public health significance of sleep, sleep loss, and sleep disorders, gaps in the public health system and adequacy of the current resources and infrastructures for addressing the gaps, barriers and opportunities for improving interdisciplinary research and medical education and training in the area of sleep and sleep medicine, and, develop a comprehensive plan for enhancing sleep medicine and sleep research.
NSF congratulates the IOM committee on sleep medicine and research for its great effort to review the scientific evidence linking sleep to health and safety and for calling on all of those involved in healthcare - from research to delivery of patient care - to recognize and embrace how sleep contributes to health, and how untreated sleep disorders are robbing our patients of their well-being and our society of the productivity of otherwise strong and effective people. It is now up to the sleep community to create strategic partnerships and redouble its efforts to carry these findings forward and to translate them into better sleep health for patients, workers and the population at large."
The report, which was independently produced by IOM, proposes specific strategies for increasing the medical focus on sleep, awareness of sleep and sleep research. These strategies are built on the recognition that sleep-related issues span areas of medical practice and require an interdisciplinary approach. For instance, sleep concerns range from pediatrics to geriatrics, from primary care to specialties such as pulmonology, cardiology, endocrinology, and psychiatry. Research investigations into the nature of sleep and the causes and consequences of sleep disorders are similarly interdisciplinary.
While the Sleep Research Society supports these initiatives recommended by the IOM panel, the Sleep Research Society believes that the IOM Report should also have been broad enough to cover additional health policy initiatives, the urgent need for which are implied but largely unaddressed in the IOM Report. Despite extensive evidence cataloged in the 461-page IOM Report, there were no recommendations calling for health policy initiatives addressing either:
drowsy driving, which the IOM Report identified as being associated with nearly 20 percent of all serious car crash injuries in the United States; or
the extended duration (30 consecutive hour) work shifts to which medical and surgical residents (who "work longer hours than virtually all other occupational groups" according to the IOM Report) are scheduled twice per week for years during their training.
After reviewing the evidence demonstrating that forced repetitive sleep deprivation of young physicians significantly increases their risk of making serious medical errors, more than doubles their risk of having a motor vehicle crash while driving home from work, and induces performance decrements comparable to legal intoxication, the IOM Report merely recommends education of resident physicians about the adverse health effects and safety hazards of sleep loss
. To do so without addressing physician work hours or drowsy driving invites the rejoinder: "Physician, heal thyself." The Sleep Research Society calls upon the IOM and organizations involved in medical education to lead in recognizing the importance of sleep to health, performance and safety by undertaking a health policy initiative related to physician work hours so that physicians -- with their ever- increasing knowledge of the importance of adequate sleep -- can lead the nation by example.
The Sleep Research Society also calls for a health policy initiative to address the issue of drowsy driving, since the National Highway Transportation Safety Administration estimates that at least 15 million drivers nationwide have nodded off or fallen asleep while driving in the past six months. That equates to more than 80,000 drivers in the nation falling asleep at the wheel every day, or about one every second throughout day and night, endangering themselves, their families, and their fellow citizens. The outcome of those fall-asleep episodes is sobering. More than half of those drowsy drivers wandered into another lane, drifted onto the shoulder, or drove across the centerline during the incident. In another 10 percent of these incidents, the driver ran off the road. In fact, an estimated 1,350,000 drivers nationwide were involved in a drowsy-driving-related crash in the past five years -- that is 30 drowsy driver crashes per hour or one every 2 minutes. Yet this nation, which spends over $300 million annually on education regarding the hazards of drinking and driving, spends about 0.1 percent of that amount on education related to drowsy driving. Education and regulation restricting driving privileges of drivers impaired by sleep loss or sleep disorders is urgently needed.
The IOM report sheds more light on the problem of large numbers of people with unrecognized and undiagnosed sleep disorders that adversely affect health and performance. The major obstacles to people getting the care they need is the public's lack of awareness of the importance of avoiding sleep deprivation and detecting sleep disorders and the lack of recognition by primary care health professionals of the signs and symptoms of sleep disorders. Sleep specialists are trained to diagnose sleep disorders and provide high quality, effective treatment. The number of sleep specialists grows by over 350 a year and the number of accredited sleep centers increases by over 200 per year. Though more are needed, the limitation to care is that not enough people are recognized as having a possible sleep disorder and sent to a specialist trained in sleep medicine. As more people are recognized with sleep disorders we need to increase the number of sleep specialists to care for them. First, we need to increase identification of people with sleep disorders. Primary care health care professionals needed to be educated about sleep loss and sleep disorders and evaluation of sleep patterns should be part of every routine evaluation. This report can help bring this about.
However, the AASM believes the IOM did not go far enough in some of its recommendations to ensure the appropriate growth and development of the fields of sleep science and sleep medicine. Currently, research and financial policy for most sleep centers and academic units are not controlled by those units but rather by other agencies and departments. In order to truly promote the development of this field, the National Centers for Sleep Disorders Research (NCSDR) and academic and private sleep centers need to be empowered as independent entities on par with other subspecialties of medicine. For NCSDR this could mean a line item budget or movement into its own division within one of the existing Institutes. For academic sleep centers this would require establishing sleep medicine divisions or departments. These steps would enhance the attractiveness of the field to new investigators and clinicians from a wide variety of other disciplines and create a career path in sleep science and sleep medicine.
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