Along with other factors necessary to sustain human life, including food, oxygen, and water, sleep is a biological requirement and an important contributor to overall health.

On average, sleep occupies 20% to 40%, or 5 to 10 hours, of a person’s day.1 Sleep is so essential that many people ask their health care professionals what amount of sleep is adequate. The 2019 Pharmacy Times® OTC Guide® reported that pharmacists make 925,105 recommendations monthly for patients who require sleep aids.2

HOW MUCH IS ENOUGH?
Understanding sleep’s importance requires knowledge of the downstream effects of either insufficient duration or poor quality of sleep. Healthy sleep involves various factors, including an absence of sleep disorders, adequate duration, good quality, proper timing, and regularity.3 The American Academy of Sleep Medicine recommends that adults get at least 7 hours of sleep nightly to promote optimal health.3 The table1,4,5 provides tips for obtaining this recommended amount.

The CDC reports that adults categorized as short sleepers—those accruing fewer than 7 hours of sleep per 24-hour period—were more likely to report chronic health conditions than those who obtained adequate sleep.4 These conditions include cardiovascular disease, depression, diabetes, and hypertension.3 Investigators hypothesize that short duration and fragmented sleep interfere with the body’s restorative process that usually occurs during sleep.4,6 The lack of or interference with this process may lead to dysregulation of various body functions and, down the line, chronic conditions.

EFFECTS ON DIET
Because of sleep’s impact on appetite-regulating hormones, its effects extend to the ability to maintain a healthy diet. Researchers report that sleep alters levels of ghrelin and leptin, which regulate hunger and satiety, respectively.4 Sleep deprivation increases ghrelin, contributing to overeating behaviors and triggering greater neuronal activation to food stimuli, increasing the likelihood of eating foods that are high in fat and sugar.4



HORMONE DYSREGULATION
Lack of sleep also leads to dysregulation of the release of hormones, including cortisol.4 A study reported that chronic sleep deprivation in healthy volunteers led to increased appetite, blood pressure, and evening cortisol levels.7 The presence of too much cortisol may suppress the body’s proinflammatory responses and compromise immune defenses, weakening the immune system.7 Findings have shown that sleep-deprived patients have increased susceptibility to infectious illnesses, including upper respiratory
tract infections.8

CONTRIBUTIONS TO OVERALL HEALTH
Sleep deprivation can lead to cardiovascular disease, diabetes, inflammation, lower mortality, and weight gain.1,4,8 Insufficient sleep is also associated with cardiovascular disease, as it raises risks of hypertension, hypercholesteremia, atherosclerosis, acute myocardial infarction, and heart failure.1,4



In addition, short sleep duration impairs neurocognitive function. As sleep time decreases, attentional lapses increase in a dose-dependent manner. A night of minimal rest can affect executive function, processing speed, and working memory the next day. Investigators note that sleep is critical to maintaining alertness, sustaining attention, and thinking clearly.6,8 Patients who are sleep deficient experience delayed reaction times and increased lapses in attention.8 Some may use caffeine to mitigate these issues, but caffeine has no effect on executive function.

Investigators have found that insufficient sleep may contribute to atypical, impulsive behavior and that chronically sleep-restricted patients exhibit more risk-taking behaviors and manifest deficiencies in reasoning, arriving at conclusions before evaluating an entire problem.8

ENCOURAGING BETTER REST
Sleep is a necessity, and any lack of or shortened duration of sleep may impair numerous bodily functions. Pharmacists can counsel patients who have trouble sleeping or report inadequate sleep. The figure2 displays common OTC pharmacist-recommended medications and their accompanying frequencies, as reported in the OTC Guide®. These should be used only short term. Refer patients who still have trouble sleeping to their prescribers.


REFERENCES
  1. Grandner MA. Sleep, health, and society. Sleep Med Clin. 2017;12(1):1-22. doi:10.1016/j.jsmc.2016.10.012.
  2. Pharmacist recommendations—sleep aids. OTC Guide®. otcguide.net/recommendations/sleep-aids. Published 2019. Accessed December 2, 2019.
  3. Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38(6):843-844. doi: 10.5665/sleep.4716.
  4. Frank S, Gonzalez K, Lee-Ang L, Young MC, Tamez M, Mattei J. Diet and sleep physiology: public health and clinical implications. Front Neurol. 2017;8:393. doi: 10.3389/fneur.2017.00393.
  5. Are you getting enough sleep? cdc.gov/features/sleep/index.html. CDC website. Updated March 18, 2019. Accessed December 2, 2019.
  6. Worley SL. The extraordinary importance of sleep: the detrimental effects of inadequate sleep on health and public safety drive an explosion of sleep research. P T. 2018;43(12):758-763.
  7. McEwen BS. Sleep deprivation as a neurobiologic and physiologic stressor: allostasis and allostatic load. Metabolism. 2006;55(10 suppl 2):S20-S23. doi: 10.1016/j.metabol.2006.07.008.
  8. Chattu VK, Manzar MD, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The global problem of insufficient sleep and its serious public health implications. Healthcare (Basel). 2018;7(1):pii:E1. doi: 10.3390/healthcare7010001.