
Insufficient Sleep Is a Public Health Epidemic - dpflan
http://www.cdc.gov/features/dssleep/
======
Domenic_S
Having just been officially diagnosed with obstructive sleep apnea today, let
me tell you why that part of insufficient sleep is an epidemic: the system is
a _racket_. Here are the steps to get your sleep apnea solved:

1\. Go to your GP and have them refer you to a sleep specialist.

2\. Make an appointment with the sleep specialist (one major clinic here in
the Bay Area is booked out weeks in advance). Do that office visit where you
get the prescription for an overnight sleep study.

3\. Wait 2-3 more weeks for your sleep study date, where you get wired up like
you're joining the Matrix, and then told to go to sleep at 9:30pm. Riiight.

4\. Have a follow up visit at the office in step 2. Go over results. Possibly
get prescribed a CPAP machine.

5\. Find an in-network provider to buy the CPAP from, and make an appointment
with _them_. This is not an off the shelf thing, expect to spend 2-3 hours in
the office/store. Wait time: a couple days to a couple weeks.

6\. (optional, if the study from step 3 wasn't split-phase) Return for another
sleep study with your new machine so they can calibrate it.

7\. Make another follow up appointment to have the doc look at the report from
step 6 and actually perform the calibration.

Dude, WHO HAS TIME FOR THIS? Ironically, this whole process is a bit of a
nightmare.

~~~
DanBC
You missed one of the most important steps for most people with sleep apnoea:
lose some weight.

Most people with sleep apnoea are not helpless victims to an incurable
disease. Losing weight doesn't appear to be easy, but it's certainly
achievable for most overweight people.

EDIT: Here's the CDC page listing obesity as a cause for apnea
[http://www.cdc.gov/healthyweight/effects/index.html](http://www.cdc.gov/healthyweight/effects/index.html)

~~~
arrrg
Why did you deem it necessary to even mention that?

I’m quite certain that people with sleep apnoea for whom weight is a relevant
component are quite aware of that. Yours is just a pointless diversion in this
context – because what exactly is the your angle here?

Should it be hard for people with sleep apnoea to get treatment? I mean, what
are you arguing here for exactly?

~~~
DanBC
People are complaining about the length of time it takes to get treatment, and
the cost of treatment, and that treatment is a racket.

All that stuff is true. All that stuff is avoided by losing weight.

Your comment appears to be overly sensitive to a calm, non-judgemental bit of
information.

EDIT: Here's the link to the CDC page which lists overweight as a cause of
sleep apnea:
[http://www.cdc.gov/healthyweight/effects/index.html](http://www.cdc.gov/healthyweight/effects/index.html)

It's really easy for people, especially men, to hit a BMI of 30 and not
realise that they are obese. Especially in obesogenic societies where very
many people are obese, morbidly obese or even super obese. This carries a
range of health risks, most of which are helped by losing weight.

It's weird the source article doesn't mention weight, since it is caused by
lack of sleep (especially in children and young people) and causes lack of
sleep (in adults).

[http://www.cdc.gov/sleep/about_sleep/chronic_disease.htm](http://www.cdc.gov/sleep/about_sleep/chronic_disease.htm)

> Laboratory research has found that short sleep duration results in metabolic
> changes that may be linked to obesity. Epidemiologic studies conducted in
> the community have also revealed an association between short sleep duration
> and excess body weight. This association has been reported in all age
> groups—but has been particularly pronounced in children. It is believed that
> sleep in childhood and adolescence is particularly important for brain
> development and that insufficient sleep in youngsters may adversely affect
> the function of a region of the brain known as the hypothalamus, which
> regulates appetite and the expenditure of energy

~~~
NotOscarWilde
_> People are complaining about the length of time (...) All that stuff is
avoided by losing weight._

I strongly disagree on the point of time. It is important to realize how slow
actual weight loss is. By my naive googling, losing 1kg of fat per week will
require quite a lot of calorie restriction, and it is not achievable easily.
If you are say 20kg overweight, you will need at least 20 weeks to lose that
weight, likely more as nobody is perfect and stress factors here as well.

I am stressing this point as I would like to encourage anyone who suffers from
sleep apnea to start both treatment and losing weight. Telling yourself "I
don't have to seek treatment, I'll just lose weight" may lead you into several
weeks of diminished productivity (as a PhD student with apnea, when not
getting enough sleep my scientific productivity is close to zero).

I am not claiming any of the original commenters suggest this, but still:
"I'll just suffer until I lose enough weight" is a terrible decision.

~~~
DanBC
> It is important to realize how slow actual weight loss is

That's a good point.

> I am not claiming any of the original commenters suggest this, but still:
> "I'll just suffer until I lose enough weight" is a terrible decision.

Well, yes, but treatment will change as weight changes. Why go through risky
surgery if weight loss might help? Why go through the hassle of sleep studies
and waiting for machine fitting if weightloss will help? The alternative to
weightloss is not "instant cure", there's still time delays built in.

~~~
wlesieutre
Worst case it doesn't help your sleep and only improves the other million
things that being overweight is bad for. Darn.

/working on it

------
jensen123
I'm shocked that they don't mention sitting in front of the computer or TV
before bedtime. Computer monitors and TVs have a bluish light. Blue light
down-regulates melatonin, which is the hormone that makes you sleepy.

I used to have a serious acne problem. Cutting down on meat and dairy really
helped, but I was still getting a few small pimples now and then after that.
It was only when I stopped using my computer or TV late in the evening that I
got 100% clear skin.

~~~
option_greek
Does blue light affect the skin ?

~~~
pennaMan
Yes, via melatonin

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317110/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317110/)

~~~
rogeryu
Artificial blue light does not contain UV light, and does not influence
melatonin.

~~~
jensen123
Doesn't matter whether the light is artificial or not. If the wavelength is
about 470 nm (blue), it will suppress melatonin. There's been done many
experiments/studies on this - here are a few:

[https://www.ncbi.nlm.nih.gov/pubmed/11763987](https://www.ncbi.nlm.nih.gov/pubmed/11763987)

[https://www.ncbi.nlm.nih.gov/pubmed/14962066](https://www.ncbi.nlm.nih.gov/pubmed/14962066)

[https://www.ncbi.nlm.nih.gov/pubmed/20463367](https://www.ncbi.nlm.nih.gov/pubmed/20463367)

[https://www.ncbi.nlm.nih.gov/pubmed/22850476](https://www.ncbi.nlm.nih.gov/pubmed/22850476)

[https://www.ncbi.nlm.nih.gov/pubmed/19444752](https://www.ncbi.nlm.nih.gov/pubmed/19444752)

[https://www.ncbi.nlm.nih.gov/pubmed/20652045](https://www.ncbi.nlm.nih.gov/pubmed/20652045)

------
christiangenco
If anyone here has trouble falling asleep, I have two hacks I've recently
implemented that have reduced my TTFA (time to fall asleep) from over two
hours to about 15 minutes:

1\. Don't look at a screen for an hour before going to bed.

2\. Wear a sleep mask. If you can open your eyes and see any sliver of light
or a distinguishable shape, you need something different.

The effect is complete lack of visual stimulus making it really easy to start
hallucinating (an overly strong word) which is an easy ramp into deeper sleep.
The lack of bright blue light beforehand does something something melatonin,
and you'll feel significantly more tired before bed (the lack of stimulus will
also help).

~~~
methyl
Do you think something like f-lux would help for reducing blue light and can
be replacement for not seing screen at all?

~~~
odonnellryan
Flux definitely helps me, but it is always better to just read a book an hour
before bed :)

~~~
atom-morgan
Same. It helps but there's no replacement for no screen time before bed.

~~~
odonnellryan
But...so...hard..!

------
mschuster91
I miss "Job-caused sleep deprivation" aka "what happens when you have to work
2 jobs+care for a child" to pay rent.

~~~
orthecreedence
It's like you people have never heard of bootstraps. When _I_ was down on my
luck, I worked hard and created _my own opportunities_. Now I sleep 10 hours a
night.

I never got help from anyone but myself and _my huge trust fund_.

~~~
Matumio
Not everyone can do that. Some people also have to actually plant the corn for
your food, fix the plumbing, etc. Imagine them all creating their own
opportunities instead. Thanks to industrialization and automation it surely
would be possible for them to work half their current hours and get more sleep
(with more people required to work in those kind of jobs), but somehow this
isn't what's happening.

------
chatmasta
I've always thought of sleep from a libertarian perspective. For the most
part, it's your choice how much you sleep. Yeah, some people have trouble
sleeping... but that's largely a result of individual choices. Factors like
lack of exercise, too much caffeine, and poor diet all collude to reduce
quality of sleep. In that sense, insufficient sleep is a public health
epidemic in the same way as obesity. Lots of people are affected by it, but
it's still avoidable with proper preparation and habits.

Everybody knows you should get 8-9 hours of sleep per night, and most people
are at least vaguely familiar with studies that say lack of sleep can reduce
life expectancy. Yet people still choose to sleep less than the optimal
amount. That's a _choice._ There is a tradeoff of time now, vs time at age
70+. If time now is more valuable, then it could be rational to sacrifice time
at 70+ by sleeping less now. People make this choice every day, subconsciously
or not.

Of course, the choice of how much sleep to get is often not an easy one. We
have to go to school or work. We have obligations. Perhaps the easiest win
from a public health perspective would be changing the start time of public
high schools. Why are we forcing kids to wake up at 6am to go to school?
That's just stupid, and flies in the face of all sorts of research.

~~~
buckbova
> Everybody knows you should get 8-9 hours of sleep per night

I'm with you on health choices and quality of sleep, but I've never needed
more than 6-7 hours in the rack.

> The National Institutes of Health suggests that school-age children need at
> least 10 hours of sleep daily, teens need 9-105 hours, and adults need 7-8
> hours.

According to the article 7-8 for adults is normal.

~~~
0xffff2
>teens need 9-105 hours

Sounds about right...

~~~
cheepin
I don't know, 9 seems a bit on the low end. From watching relatives grow up,
the teenage years seems to be where bad sleep habits start in many cases.

------
joshsharp
It's not a huge sample set to draw from but the average amount of sleep across
all of our Exist[1] users is 6:56 (as tracked by a device like a Fitbit,
Jawbone UP, etc). So not quite as bad as in the article, but not quite enough
either.

[1]: [https://exist.io](https://exist.io)

~~~
jay-saint
Do you think think that your user base is a little more health aware than the
average population? I would expect that someone using your site is going to be
more self aware, affluent and health conscious than the average that the CDC
is polling. For example, how many single hispanic mothers or black senior
citizens use exist.io?

~~~
joshsharp
Though I can't back it up with data, I'm sure you're correct! Plus I suspect
most of our small user base is early adopters who of course tend to be
younger, affluent, etc.

------
bitJericho
Very important to get your sleep. I recommend no caffeine 4 hours before bed.
It seems like everytime I can't fall asleep its because I accidentally drank
caffeine. I sleep 6 to 10 hours weirdly enough. It seems to depend largely on
the previous nights sleep and the physical exertion I've done in the day.

~~~
rimantas
Not everybody is the same. Caffeine has zero effect on my sleep: I often drink
a cup of coffee before going to bed. Or have a can of Red Bull (I drink it for
the taste, not for some energising properties which have no effect on me).

~~~
rbinv
Just because you're not aware of it doesn't mean that it's not affecting you.

~~~
chrisan
People often refer to having a cup of coffee to "wake up" or stay awake/alert.
I'm sure physiologically caffeine is doing _something_ but I am in the same
boat as him, I can drink caffeine and it never keeps me awake.

Back in Lan Party days pounding red bull after red bull I was still easily the
first one to bed by far (which is never a good thing to be asleep around a
bunch of wired up young immature males late at night...)

~~~
david-given
I don't feel like I've woken up properly in the morning until I've had a cup
of coffee.

...of course, sometimes I will get up early, do some stuff around the house,
drive to the shops, drive back to the house, put everything away, cycle to
work, and I _still_ won't feel like I've woken up properly until I've drunk my
coffee and read my email.

For me, it's all about the ritual of drinking the coffee rather than the
caffeine content. I'm quite sure that if someone were to replace it with decaf
and not tell me, it'd work just as well.

Everyone's different.

------
doczoidberg
sometimes I feel like an alien when I say that I need 8-9 hours sleep to feel
awake the whole day. 6h seems to be normal nowadays.

Can I train to sleep (a little bit) less?

~~~
rwallace
No, but you can train to remember that eight hours is normal; it's the people
who think six hours is normal - or rather, the ideology they've bought into -
that's alien.

------
afarrell
As someone who went to a university where "sleep is for the weak" was a slogan
among undergrads, I want to go back in time and throw chalk at anyone who says
that.

~~~
weavie
"I'll sleep when I'm dead."

------
znt
There is this IndieGogo project for a mini sleep apnea mask, if anyone is
interested: [https://www.indiegogo.com/projects/airing-the-first-
hoseless...](https://www.indiegogo.com/projects/airing-the-first-hoseless-
maskless-micro-cpap)

------
rm_-rf_slash
I would be interested in hearing the opinion of startup employees who were not
a part of the early team (yardstick: <1% equity/options) and what their
company's attitudes are about proper sleep and work-life balance.

------
gavreh
ep·i·dem·ic ˌepəˈdemik/ noun 1\. a widespread occurrence of an INFECTIOUS
DISEASE in a community at a particular time.

~~~
tertius
Did you just Google this and forget to click down arrow for "more
definitions"?

That should lead you to something like this: "a sudden, widespread occurrence
of a particular undesirable phenomenon."

Also look up Epidemiology, which studies all manner of health based topics,
sleep being one of them.

------
Gnarl
When disease - like sleep disruption - spreads rapidly across a large area
with no apparent vector, look for a common change in environment. For example,
ambient RF has increased to 1000000000000000000 times natural background
levels over short period. Who is John Snow?

~~~
maxerickson
Social organization and interaction are an obvious vector that has changed
over time.

~~~
Gnarl
to anywhere near the power of 10^18?

~~~
maxerickson
I was disputing your claim that there is "no apparent vector". Which is why I
labeled changes to society an obvious vector.

If your proposed RF interference model has a factor of ~10^-19 in it, then a
competing social interaction model that has a factor of 1 in it would have a
much stronger effect, even if social interaction has only changed to the power
of 10^0.1.

So the point there is that the magnitude of the change in the environment is
not sufficient information to do a comparison, you also need some sort of
explanatory model.

~~~
Gnarl
so how do you propose to measure this "social interaction" model? And are you
really, seriously, running the "no mechanism" claim about RF induced
bioeffects?

~~~
Gnarl
@maverickson: this just in:
[https://www.ncbi.nlm.nih.gov/pubmed/26151230](https://www.ncbi.nlm.nih.gov/pubmed/26151230)

~~~
maxerickson
I guess you misunderstand what I mean by an explanatory model.

It would be something like:

    
    
      sleep deprivation=(x*RF intensity)+A Constant.
    

Without x, we have no idea how relevant the 10^18 is to the problem.

So I'm not demanding a theory demonstrating that RF can influence biology,
just pointing out that the magnitude of the change in RF is insufficient
information to draw a conclusion from.

