Cozy scottish kitten sleeps under blanket on a bed at home. Top down view.

Public Health: Got Sleep?

By Jack Becker

There are certain public health commercials that generations will always remember. For some, it’s the NHTSA’s “Drive Sober or Get Pulled Over” commercials. For others, it may be a “Think. Don’t Smoke.” commercial featuring a young Robert McElhenney. Younger generations have certainly seen “The Real Cost” campaigns, which have recently tackled vaping. And a personal favorite, Nickelodeon’s “Hidden Sugar” commercial will forever be iconic.

To the visionaries that permanently cemented the fact that “glucose, sucrose, dextrose, and maltose” are “all words that rhyme with gross” in minds across the country, here’s a new challenge: sleep deprivation.

Sleep Deprivation and Public Health Effects

For an individual, not getting enough sleep for a few nights might be frustrating, inconvenient, and, of course, tiring. But when over a third of the adult American population regularly doesn’t get enough sleep, it’s a deadly public health problem.

As most people know from experience, sleep deprivation negatively impacts energy, mood, thinking speed, memory, attention span, and decision-making. Over a longer period of time, sleep deprivation has been linked to: cardiovascular disease, type 2 diabetes, obesity, immunodeficiency, hormonal abnormalities, mental health disorders, and even pain. Effects can be worse in children, with additional problems that include decreased brain development and growth issues.

The effects don’t just impact the sleep-deprived. Drowsy driving is deadly driving. While it’s difficult to determine whether drowsiness contributed to a car crash, an estimated 328,000 drowsy driving-related crashes occur every year, including 6,400 fatal ones. When people are less attentive, react slower, and have trouble making decisions (all effects of sleep deprivation), they don’t drive as safely. And when one out of 25 adults have fallen asleep at the wheel in the past 30 days, well, that doesn’t help either. If the lost lives aren’t persuasive enough, this amounts to well over $100 billion in societal costs.

For some other staggering costs, a RAND study estimated that the United States suffers economic losses between $280 billion (1.56% of GDP) and $411 billion (2.28% of GDP) per year due to insufficient sleep. To put it another way, the United States loses nearly 10 million working hours per year from sleep deprivation. Losses in productivity paired with increased mortality rates truly add up. For some high profile examples, investigators found that sleep deprivation played significant roles in: the Three Mile Island nuclear accident, the Challenger Space Shuttle explosion, the Exxon Valdez oil spill, and the Chernobyl nuclear disaster. To put it closer to home, would you want to be operated on by a doctor who is functionally drunk?

Sleep Deprivation Is Unique (In a Bad Way)

Sleep deprivation is a fairly unique public health problem. To start, it’s sometimes seen as a good thing. Advocates for personal responsibility celebrate those who avoid poor diets, smoking, alcohol, and other unhealthy habits. Yet, not getting enough sleep can be a sign of hard work. The tireless parent working two jobs on four hours of sleep to support their family is an archetype of the American Dream. And without a doubt, they deserve admiration for their sacrifice. They also deserve more sleep.

There are also plenty of misperceptions and mixed messages about sleep. Some believe that sleep deprivation is tied to creativity, but that’s not necessarily the case. Others swear that motivation and experience can combat the effects of sleep deprivation, but people often just ignore declines in their performance. For many, sleep deprivation is an accepted norm.

It doesn’t help that getting enough sleep and getting quality sleep can take some effort. With cigarettes, messaging is simple: don’t smoke. With sleep, it’s more of a process. Good sleep hygiene includes practices like maintaining a cool room temperature, exercising, eating healthy, and having a quiet room to sleep. Plus, don’t forget to avoid the following things before sleeping: electronic screens, bright lights, large meals, alcohol, caffeine, and excessive fluid intake.

Further, it’s much harder monitor sleep than to monitor things like diet or alcohol consumption. Imagine getting pulled over while driving and a police officer asking, “Did you get enough sleep last night?” It’d be tough to know what to do with, “Well, I was in bed for 7 hours, but I woke up and couldn’t fall back asleep for a bit, and I didn’t have the best quality of sleep, but I slept better than usual at least.” And while it’s easy to plan for not driving when you’re drinking, it’s harder to know what degree of tiredness requires a designated driver.

Existing Solutions Aren’t Ideal

Unsurprisingly, widespread sleep deprivation isn’t particularly easy to solve. Like many other public health problems, there are a range of causes, including obligations (like family and work), medical problems, and personal choice. Life is complicated, and so is getting enough sleep. Seven hours of sleep per night is a lot of time. And the cards seem stacked against people like shift workers, caregivers, those with certain medical conditions, and many others. But, with all of the detrimental effects of sleep deprivation, avoiding it needs to be a priority.

Yet, existing solutions often fall short. One of the most popular answers to sleep deprivation, caffeine, is certainly not a solution or substitute for sleep. As psychologist Kimberly Fenn, who runs the Sleep and Learning Lab at Michigan State University, explained, “Caffeine may improve the ability to stay awake and attend to a task, but it doesn’t do much to prevent the sort of procedural errors that can cause things like medical mistakes and car accidents.” And while caffeine can make you feel more awake when you’re severely sleep-deprived, you can still have brief losses of consciousness called “micro sleeps.” Micro sleeps can last 4–5 seconds, translating to up to 475 feet of unconscious driving at 65mph. There’s no shortcut to sleep.

Other solutions get closer to the root cause of the problem. An entire workplace nap pod industry has emerged for companies to encourage employees to get more sleep. However, this can send mixed signals when it’s unclear whether the goal is for employees to get more sleep, or just to work longer hours. The sleep-tech wearables industry has also exploded. Wearables can be great to give people more data about their sleep, and they can even encourage getting more sleep. However, they’re still a consumer product with limited reach and persuasiveness.

Advertising as a Solution

Public health officials are intimately familiar with the power of advertising. Critics have derided advertisements for cigarettes, alcohol, and unhealthy food, particularly for their effects on children. With their developing brains, kids are especially vulnerable to influence by advertisements. And advertisers sometimes use this to their advantage through practices like using well-known characters or celebrities in their commercials. Parents are well aware of their kids’ “pester power” and how advertisements can influence it. Why not channel that influence toward healthy habits?

Imagine a Got Milk? campaign for sleep featuring characters and celebrities galore. Tom Brady (who gets 9 hours of sleep per night) is probably better at reaching kids than the Centers for Disease Control and Prevention (no offense to the CDC), especially if the kids know that sleep is vital for athletic performance. Combining endorsements with education and catchy slogans could at least get the ball rolling.

Behavioral change is incredibly difficult. It’s way more difficult than getting people to buy fancy pajamas, white noise machines, or weighted blankets. So it’s important to start forming good habits early. If kids know why sleep is important (not just that they need it “because their parents said so”), it can be a lifelong lesson.

Of course, starting early does not just apply to children. Reaching new drivers is vital, since 50% of drowsy driving crashes involve drivers under age 25. While cartoon endorsements may be less persuasive to teenagers, there are plenty of other ways to reach them. For example, advertising that the CDC recommends later start times for schools would be a great way to get high schoolers campaigning for the importance of sleep.

We need the brilliant minds behind our nation’s best public health commercials on the issue of sleep deprivation. But only after a good night of sleep.

Jack Becker

Jack is a graduate of Harvard Law School and a former student fellow at the Petrie-Flom Center. He thanks you for reading this and hopes you have a great day!

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