Sleep Deprivation: A

Public Health Crisis

Implications for Public Health and Policy

Katherine E. deS, BSN, RNC-OB

Community Health Survey

For this community health survey, five community
healthcare experts were interviewed. The following
questions were discussed:
1. What would you consider the top three health problems
in your community?

2. What current legislation do you see in place to address

these issues? To what degree do you consider these
interventions effective?
3. What additional community health interventions or
legislation would you like to see to address these issues?

Dr. Obosa Osawe, MD

Affiliations:

Vassar Brothers Medical Center,

Poughkeepsie, NY

Health-Quest Medical Practice,

Department of Obstetrics and
Gynecology

Top 3 Community Health

Problems:
Rise in rate of sexually
transmitted diseases
Teen pregnancies
Patients late to seek care
due to lack of insurance

Current sexual practices counseling is somewhat effective and

contraception is very effective when accessed. However, there are a lack
of affordable long-term contraceptive options, especially for younger
women. Often the more effective long-term contraceptives, such as
IUDs, are not covered by insurance (O. Osawe, personal
communication, October 2, 2012).

Erika Clayton, RNC

Affiliations:
Vassar Brothers Medical Center,
Poughkeepsie, NY, Assistant
Nurse Manager
Community Mental Health
Nurse

Top 3 Community Health

Problems:
Lack of resources available for
mental health patients

Lack of caregivers who speak

different languages
Lack of collaborative care
between medical physicians and
psychiatrists

There are currently no effective interventions or public policies to address

the special needs of psychiatric patients who come in for inpatient medical
treatment. The psychiatric care of these patients is often left to MDs and
RNs who feel ill-equipped to handle the special needs of these patients
(E. Clayton, personal communication, September 30, 2012).

Michele Cussano, RN, EMT

Affiliations:
Vassar Brothers Medical Center,
Poughkeepsie, NY
Registered Nurse, Continuing
Education Associate Instructor

Pleasant Valley Fire District,

EMT

Top 3 Community Health

Problems:
Lead
Obesity

Heart Disease

American Heart Association,

Community BLS Educator

The current programs to combat obesity and heart disease are ineffective
because they primarily deal with issues only after problems arise. They
dont address underlying socioeconomic issues of why people become
obese in the first place. There needs to be more heart screening and
education, as well as healthful habit programs that are free to the public.
As for lead, the current testing at 1 and 3 years is insufficient because we
are still seeing children with lead poisoning who have passed the age
where they are still putting unknown object in their mouths. There needs
to be more screening for homes, water supplies, schools and food sources,
and further testing at age 5 (M. Cussano, personal communication,
October 5, 2012).

Vassar Hospital Maternal Child

Health Department
Denise Markou, RN
Top 3 Health Concerns:
Lyme Disease
Obesity

Heart Disease
There are no preventative Lyme Disease
prevention programs in place in our area,
and the implications of this disease can be
more serious than people realize. For
obesity, some places in the area are offering
healthier choices on menus (schools,
hospital cafeteria) which is great, but often
these items are offered alongside, fried,
unhealthy foods which are cheaper. I dont
know how to effectively legislate for
healthier food choices without taking away
personal rights (D. Markou, personal
communication, October 5th, 2012).

Melissa Piciotta, RN
Top 3 Health Concerns:
Sleep deprivation and
stress
Medication costs for
seniors
Teen drug use &
addiction
Federal Medicare laws help many seniors to a certain
extent, but healthcare costs are still too expensive for
many elderly people. I would like to see the elderly receive
the same benefits as Medicaid recipients. Most have
worked all of their lives unlike many Medicaid recipients
who often times get access to better and cheaper
healthcare. (Regarding teen drug use) There used to be
programs in schools such as DARE to educate kids about
drugs and addiction, but due to budget restraints so many
schools have had to cut programs (M. Pisciotta, personal
communication, October 5, 2012).

Unmet Community Health

Concern:

[Untitled photograph of a student sleeping]. Retrieved October 10, 2012 from: URL
http://www.sleepdisordersguide.com/blog/sleep-deprivation/does-your-teen-sleeps-till-pastnoon-or-stay-awake-all-night/

Sleep Deprivation

What does Healthy People 2012

say about sleep deprivation?
According to the Center for
Disease Control and
prevention, poor sleep health
is a common problem with 25
percent of U.S. adults
reporting insufficient sleep or
rest at least 15 out of every
30 days (2008). Healthy
People 2020 states the public
health burden of chronic sleep
loss and sleep disorders,
coupled with low awareness of
poor sleep health among the
general population, health
care professionals, and
policymakers, necessitates a
well-coordinated strategy to
improve sleep-related health
(United States Department of
Health and Human Services,
Healthy People 2020, 2011).

Sleep Health Objectives

SH1
Evaluation for
obstructive sleep apnea
SH2
Vehicular crashes
due to drowsy driving
SH3
Sufficient sleep
among 9th to 12th graders

SH4
Sufficient sleep
among adults

Current Research Regarding

Sleep Deprivation: What does the
Research Show Us?
Impact of maternal sleep deprivation on unborn babies:
Risk factors for small for gestational age newborns <5th percentile were
sleep deprivation and shift work (Abeysena, Jayawardana, &
Seneviratne, 2009, p. 386)

[Untitled photograph of preterm infant]. Retrieved October 10, 2012 from

http://blog.lib.umn.edu/huber195/myblog/2011/11/prematurity-1.html

Current Research Continued

Impact of Sleep Deprivation from Sleep
Disordered Breathing:
Sleep Disordered Breathing is likely to contribute to
increased cases of hypertension, cardiovascular
disease, stroke, depression, and mortality (Young,
2010, p. 8).
[Untitled drawing of couple snoring]. Retrieved
October 12, 2012 from
http://www.stopobesityforlife.com/blog/tag/sleepapnea/

Impact of Sleep Deprivation on Adolescents:

Sleep deprivation reduces positive affect across an
array of positive emotions. Furthermore, sleep
deprivation increases anxiety. Early adolescents
appear to be particularly vulnerable to increased
threat appraisal under conditions of sleep deprivation,
potentially as a result of the ongoing development of
the prefrontal cortex (Talbot, McGlinchey, Kaplan,
Dahl & Harvey, 2010, p. 839).
[Untitled photograph of teenagers fighting].
Retrieved October 12, 2012 from
http://www.gamesareus.com/wpcontent/teen-violence.jpg

Current Research Continued

Impact of Sleep Deprivation on Coronary Artery
Disease:
King et al. (2008) established that
objectively measured sleep is inversely
associated with coronary artery calcification
(p. 2865).

Colten and Altevogt (2006) found:

The cumulative 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. Compared to healthy individuals,
those suffering from sleep loss and sleep
disorders are less productive, have an
increased health care utilization, and have an
increased likelihood of injury (p. 2)

[Untitled drawing of atherosclerosis]. Retrieved

October 12, 2012 from
http://www.nlm.nih.gov/medlineplus/coronaryarter
ydisease.html

Current Research Continued

Impact of Sleep Deprivation on Public Safety:
Pandi-Perumal et al. (2006) references
Connor, Whitlock, Norton, and Jackson (2001)
when stating, There is a considerable body of
evidence that sleepiness contributes to the
cause of various accidents in industries and in
transport systems. The authors reported that
17% of the traffic accidents resulting in death
or injury were sleep related (p. 864).

[Car Collision]. (March 3, 2008). Retrieved October

12, 2012 from
http://www.walnutcreekpersonalinjuryblog.com/aut
omobile-accidents/traffic-fatalities-increase-in2012/

Impact of Sleep Deprivation on Immunity:

In her 2012 study of sleep deprivations effect

on ICU patients, Ganz found that sleep
deprivation shifts immune activity toward cellmediated immunity (TH1 activity) rather than
toward humoral immunity (TH2 activity). This
shift has clinical implicationsand leads to a
potentially altered balance between cellular
and humoral immunity and compromised
immune function (p. e22).

[Untitled photograph of macrophage].

Retrieved October 12, 2012 from
http://pathmicro.med.sc.edu/ghaffar/innate
.htm

Current Research Continued

Impact of Sleep Deprivation on Chronic Diseases:

According to the CDC (2011), persons experiencing sleep
insufficiency are also more likely to suffer from chronic diseases
such as hypertension, diabetes, depression, and obesity, as well
as from cancer, increased mortality, and reduced quality of life
and productivity (para. 1).

In Summary:

Sleep deprivation is a contributory and exacerbating

factor to many of the health concerns noted in my
interviews. Though not always stated as a health
concern outright, research shows sleep deprivation has
negative implications for heart disease, obesity, diabetes,
cancer, and risky teenage behavior!

How is the Issue of Sleep Deprivation

Being Handled by Our Community?
The truth is, the concept of sleep deprivation as a public health problem
is a relatively new concept. In fact, it was never a part of Healthy
People 2010 and is new for Healthy People 2020 (US Department of
Health, 2010).

Sleep is not routinely discussed at visits with physicians, nor are the
implications of sleep deprivation taught in schools.
There is no support network for new parents suffering from sleep
deprivation, and many new mothers present at their physicians offices
with complaints of postpartum depression.
Community hospital-based sleep centers, such as the Sleep Center at
St. Francis Hospital in Poughkeepsie, NY offer comprehensive
assessment and recommendations for sleep disorders.

Implications for the Healthcare

Community
With the correlation between sleep deprivation, obesity, and
chronic disease established by researchers such as King et
al. (2008) and Colten & Altevogt (2006), it is in the best
interest of the healthcare community to educate the public
about the health impact of too little sleep.
Questions regarding sleeping habits should be part of
routine physicals, and screening for sleeping disorders
should be done routinely.
Failing to encourage the population to get sufficient,
adequate rest increases the rate of chronic diseases that
tax the healthcare system and cause financial strain.

Recommendations for Addressing

Sleep Deprivation in the Community
In hospitals such as Vassar Brothers Medical Center, Poughkeepsie, NY,
quiet hours have been instituted to reduce the amount of disturbance
patients encounter during sleeping hours. Patients are also given the
option to opt-out of hourly nurse rounding in order to gain a more
restful sleep and promote healing. These policies should be continued
and promoted.
Questions regarding sleep health should be part of yearly physical
exams. Physicians and Nurse Practitioners should be educated
regarding the implications of sleep deprivation and how to best help
patients who present with sleep disturbances.
Programs in school should be instituted that educate students on the
importance of sleep and teach time-management skills in order to
decrease the amount of sleep time lost due to time mismanagement.
Prenatal classes should work to educate expectant mothers on the
physiologic damage of sleep deprivation, and ways to best manage the
emotional and physical duress encountered in the months postpartum.

What is the Role of the Advanced

Practice Nurse?
Community Education
Advanced practices nurses will be pivotal
in creating programs to increase public
awareness of the consequences of sleep
deprivation. According to Pandi-Perumal
(2006), There is a need for social
awareness programs to educate the
general population about the potential
consequences of various sleep disorders
such as narcolepsy, sleep apnea, shiftwork-related sleepiness, sleep loss, and
excessive somnolence (p. 870).
Information on the impact of such public
health issues should be made available to
the healthcare sectors and should become
a regular part of their training initiatives
(Pandi-Perumal, 2006, p. 870).

[Image of Nurse Practitioner]. Retrieved October 12, 2012 from

http://www.pedsurology.com/elements/images/shutterstock_405
9385_nurse_practice_sm.jpg

What is the Role of the Advanced

Practice Nurse?
More Community Education
Increase public awareness of sleep disordered breathing and increase access to weight loss
programs for those who suffer from SDB associated with excess weight. Young (2009)
concluded that The burden of SDB reflected by the large number of persons with this disorder
multiplied by the cost of adverse consequences that can be attributed to SDB is likely to be
staggering. The burden could be decreased by preventing SDB through risk factor reduction,
with weight loss as the most likely candidate (p. 8).

What is the Role of the Advanced

Practice Nurse?
Guiding In-Hospital
Practices that Promote
Better Sleep
Advanced practice nurses can work to
guide hospital policies that promote sleep
and healing, thereby increasing their
immune functioning (Ganz, 2012) and
lessening hospital stays and costs. Ganz
(2012) suggests that:
Nurses have the authority and
responsibility to provide and
support patients optimal
sleep, even if the
interventions include
decreasing the amount of
nursing activities at night or
suggesting the use of different
medications that have less of
an impact on sleep, thereby
hopefully improving patients
immune function and overall
outcome (p. e24).

Guiding Future Research

King et al. (2008) identified that further

studies are needed to determine whether
objective sleep ties to coronary disease
event outcomes over the long term and if
this association is born out, interventional
studies will be needed to guide clinical
advice (p. 2865). Advanced practice
nurses are well equipped to participate in
research studies.

What is the Role of the Advanced

Practice Nurse?
Guiding Public Policy

Guiding Future Research

Advanced practice nurses can advocate

for legislation to include sleep deprivation
education in schools, and advocate for
legislation to reduce the amount of
homework allowed for K-12 students,
ensuring adequate time for sleep.

King et al. (2008) identified that further

studies are needed to determine whether
objective sleep ties to coronary disease
event outcomes over the long term and if
this association is born out, interventional
studies will be needed to guide clinical
advice (p. 2865). Advanced practice
nurses are well equipped to participate in
research studies.

Theoretical Basis
Social Cognitive Theory: The core determinants include
knowledge of health risks and benefits of different health
practices, perceived self-efficacy that one can exercise control
over ones health habits, outcome expectations about the
expected costs and benefits for different health habits, the
health goals people set for themselves and the concrete plans
and strategies for realizing them, and the perceived facilitators
and social and structural impediments to the changes they
seek (Bandura, 2004, p. 144).

By increasing the communitys knowledge of sleep deprivation

and its health risks, and empowering people with knowledge of
how to change their own sleep circumstances, the goal of my
interventions is to decrease the chronic health conditions
exacerbated by sleep deprivation, and to decrease the number
of injuries resulting from motor vehicle accidents caused by
sleep deprived drivers.

References:
Abeysena, C., Jayawardana, P., & Seneviratne, R. (2009). Maternal sleep deprivation is a risk factor for gestation age: a cohort
study. Australian & New Zealand Journal of Obstetrics & Gynaecology, 49(4), 382-387. doi: 10.111/j.1479-828x.2009.01010.x.
Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143-164.
[Car Collision]. (March 3, 2008). Retrieved October 12, 2012 from http://www.walnutcreekpersonalinjuryblog.com/automobileaccidents/traffic-fatalities-increase-in-2012/
Centers for Disease Control and Prevention. (2011). Insufficient sleep is a public health epidemic. Retrieved from
http://www.cdc.gov/features/dssleep/
Centers for Disease Control and Prevention, Epidemiology Program Office. Perceived insufficient rest or sleep among adults:
United States, 2008. MMWR. 2009 Oct 30;58(42):1175-9.
Colten, H.R., & Altevogt, B.M. (Eds.). (2006). Institute of Medicine. Sleep disorders and sleep deprivation: an unmet public
health problem. Washington, DC: The National Academies Press.

King, C., Knutson, K., Rathouz, P., Sidney, S., Liu, K., Lauderdale, D. (2008). Short sleep duration and incident coronary artery
calcification. JAMA: Journal Of The American Medical Association, 300(24), 2859-2866. doi:10.1001/jama.2008.867.
Pandi-Perumal, S.R., Verster, J.C., Kayumov, L., Lowe, A.D., Santana, M.G., Pires, M.L., Tufik, S., & Mello, M.T. (2006). Sleep
disorders, sleepiness and traffic safety: a public health menace. Brazilian Journal of Medical and Biological Research, 39(7),
863-871. doi: 10.1590/S0100-879X2006000700003.
Talbot, L., McGlinchey, E., Kaplan, K., Dahl, R., & Harvey, A. (2010). Sleep deprivation in adolescents and adults: changes in
affect. Emotion, 10(6), 831-841. doi: 10.1037/a0020138.

[Untitled drawing of atherosclerosis]. Retrieved October 12, 2012 from

http://www.nlm.nih.gov/medlineplus/coronaryarterydisease.html
[Untitled drawing of couple snoring]. Retrieved October 12, 2012 from http://www.stopobesityforlife.com/blog/tag/sleepapnea/
[Untitled photograph of macrophage]. Retrieved October 12, 2012 from http://pathmicro.med.sc.edu/ghaffar/innate.htm

References:
[Untitled photograph of preterm infant]. Retrieved October 10, 2012 from
http://blog.lib.umn.edu/huber195/myblog/2011/11/prematurity-1.html
[Untitled photograph of student sleeping]. Retrieved October 10, 2012 from: URL
http://www.sleepdisordersguide.com/blog/sleep-deprivation/does-your-teen-sleeps-till-past-noon-or-stay-awake-all-night/
[Untitled photograph of teenagers fighting]. Retrieved October 12, 2012 from http://www.gamesareus.com/wp-content/teenviolence.jpg
U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. (2010) Healthy People
2020. Washington, DC. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=38.
Young, T. (2010). Rationale, design and findings from the Wisconsin Sleep Cohort Study: toward understanding the total
societal burden of sleep disordered breathing. Journal of Clinical Sleep Medicine, 4(1), 37-46. doi:
10.1016/j.jsmc.2008.11.003.