Are you getting enough sleep to stay in good health? Studies suggest that sleep loss for less than 7 hours per night may have wide-ranging effects on the cardiovascular, endocrine, immune, and nervous systems.
The Importance Of Healthy Sleep
One of the most important principles of Ayurveda is the principle of the three sub-supporting pillars of life, called Upastambha. Those three pillars are diet (Aahar), sleep (Nidra) and celibacy (Brahmacharya) or control of the sexual urges. These three pillars execute an important role in maintaining health.1
Sleep has its importance in leading a healthy life. By getting good and sufficient sleep, one can be ready for new challenges enthusiastically. A sound sleep in the night regenerates the power of the mind and body to accept new challenges, maintains health, proficiency and emotional wellbeing.2
Sleep loss or insomnia (Nidranasha) is the difficulty in initiating or maintaining sound sleep or waking up early without complete sleep with tiredness and exhaustion. The concept of “unsatisfactory sleep” was developed by the American Medicine Institute in 1979.3 According to which insomnia corresponds to the complaint of insufficient sleep almost every night or by being tired after the usual sleep time.4
Signs And Symptoms Of Insomnia (Nidranasha)
Ayurveda describes sleep loss or insomnia (Nidranasha) as a symptom, disorder and even sometimes as a complication of certain diseases. Peculiar symptoms arising during sleep loss are yawning, body aches, lethargy, headache, giddiness in the head and eyes, apathy, fatigue, indigestion and diseases produced by Vata dosha.5 Troubled sleep can lead to unpleasantness, emaciation, weakness, impotency, terminating in death.6 According to Charaka, vigil during the night causes roughness in the body. Obesity is also related with improper sleep and diet.7
Research concludes that women suffer from more sleep-related complaints than men and it is more prevalent with both the onset of menses and menopause.8
What Happens When You Don’t Sleep
There are several consequences to sleep loss which can lead to more serious problems down the road.
1. Premature Aging
Lack of sleep is one of the worst things for your skin. It isn’t called beauty sleep for nothing. Researchers found that women who were sleep deprived had twice the level of skin aging than those who slept well. This meant finer lines, uneven skin tone and slackening of the skin. In one research study, it was seen that the faces of sleep deprived individuals had more hanging eyelids, redder eyes, more swollen eyes, darker circles under the eyes, paler skin, more wrinkles and fine lines and more droopy corners of the mouth.
They looked sadder than after normal sleep. The results show that sleep deprivation affects the features relating to the eyes, mouth, and skin.9
Insomnia or sleep loss can be an overlooked culprit that triggers headaches and migraines. Migraines can be triggered by sleepless nights, and “36 to 58% of people with sleep pane wake up with nondescript morning headaches”. Studies demonstrated that short sleep group, who routinely slept six hours per night, exhibited more severe headache patterns and sleep-related headache.10
3. Inability To Learn
Researchers believe that sleep affects learning power adversely. A study conducted on young volunteers showed that there are dynamic, compensatory changes in cerebral activation during verbal learning after sleep deprivation.11 Another study showed that sleep within 30 hours of training is absolutely required for improved performance.12
4. Obesity Or Weight Gain
When a person sleeps less than seven hours a night there is a dose-response relationship between sleep loss and obesity: the shorter the sleep, the greater the obesity, as typically measured by body mass index (BMI) weight in kilograms divided by height in meters squared.
In a study of 500+ people, it was seen that by age 27, individuals with short sleep duration (less than six hours) were 7.5 times more likely to have a higher body mass index, after controlling for confounding factors such as family history, levels of physical activity, and demographic factors.13 In another study on a large population-base it was observed that those who slept 7.7 hours had the lowest BMI; those with shorter and longer sleep duration had progressively higher BMI. The study found that sleep insufficiency increased appetite. Sleep insufficiency was associated with lower levels of leptin, a hormone produced by an adipose tissue hormone that suppresses appetite, and higher levels of ghrelin, a peptide that stimulates appetite.14 Effects of sleep deprivation on the sympathetic nervous system and/or hypothalamic hormones also influence appetite and increased hunger and appetite, especially for calorie-dense foods with high carbohydrate content.15 Obesity also contributes to obstructive sleep apnea. This most likely occurs through fat deposition in airways, causing them to narrow.
Sleep also plays a key role in energy metabolism. Importantly, a study demonstrated physiological and behavioral mechanisms by which insufficient sleep may contribute to overweight and obesity.16
5. Poor Vision
Lack of sleep is one of the leading causes of eye spasms which results in vision loss. Sleep deprivation hinders the proper performance of many essential tasks and in extreme situations (machine operation or vehicle driving). If you are awake for a longer period then you are likely to experience visual errors or hallucinations such as tunnel vision, double vision, and dimness.17
6. Heart Disease / Cardiovascular Morbidity
Sleep loss and sleep complaints are associated with heart attacks (myocardial infarction) and perhaps stroke, according to several large epidemiological studies.18 Several potential mechanisms could explain the link between sleep loss and cardiovascular events, including increased blood pressure, sympathetic hyperactivity or impaired glucose tolerance.
Experimental data shows that acute sleep loss (3.6 hours sleep) for one night results in increased blood pressure in healthy young males. This is evidence of the association between sleep loss and cardiovascular disease.19,
7. Slow Reaction Time
A study conducted on male college student athletes showed that sleep deprivation adversely affects cognitive function such as reaction time.
Reaction time is severely impeded when one doesn’t get enough sleep. Researchers did two tests that require quick decision-making, in which some were allowed to sleep between tests, while others were not. Those who slept did better the second time and those who had not did worse so their reactions slowed down.21
8. Diabetes And Impaired Glucose Tolerance
Impaired glucose tolerance, which is a precursor to diabetes, is manifested by glucose levels rising higher than normal and for a longer period after an intravenous dose of glucose. In the Sleep Heart Health Study, which is a community-based cohort, adults (middle-aged and older) who reported five hours of sleep or less were 2.5 times were more likely to have diabetes, compared with those who slept 7 to 8 hours per night.22 Those reporting six hours per night were about 1.7 times more likely to have diabetes.
Both groups were also more likely to display impaired glucose tolerance. Adjustment for waist girth, a measure of obesity, did not alter the significance of the findings, suggesting that the diabetes effect was independent of obesity.
Prolonged sleep deprivation suppresses immune system function which results in the breakdown of host defenses against indigenous and pathogenic microorganisms.23 The Study showed that even a modest disturbance of sleep produces a reduction of natural immune responses and T cell cytokine production.24
10. Economic Risk-Taking
The results of a study suggest that a night of total sleep deprivation affects the neural mechanisms underlying economic preferences independent of its effects on vigilant attention.
“A single night of sleep deprivation evoked a strategy shift during risky decision making such that healthy human volunteers moved from defending against losses to seeking increased gains”, researchers concluded.25
11. Excessive Urination
Excessive urination at night (called nocturia) is a common symptom of sleep loss. A study conducted in children, confirmed the importance of sleep in the normal circadian regulation of urine output. It demonstrated a significant increase in urine production during sleep deprivation in healthy children aged 8–12 years.26 Nocturia may be linked to bedwetting in children and in adults.27
Attention tasks appear to be particularly sensitive to sleep loss. Adequate sleep is necessary if you want to stay alert and attentive. Otherwise, you enter an unstable state that fluctuates within seconds and that cannot be characterized as either fully awake or asleep, and your ability to pay attention is also diminished.28,29
Poor or inadequate sleep can cause irritability and stress, while healthy sleep can enhance well-being. A study investigated the relationship between sleep loss and emotional reactivity in medical residents. It was seen that sleep loss amplifies the negative emotive effects of disruptive events while reducing the positive effects of goal-enhancing events.30
14. Memory Problems
Sleep disruptions in the elderly can lead to structural changes in the brain that are associated with impaired long-term memory. Sleep-related memory deficits have been observed in the general adult population as well. As early as 1924, researchers noticed that people who slept more forgot less.31,32
15. Car Accidents
Drowsy driving accounts for thousands of crashes, injuries and fatalities each year, according to the National Highway Traffic Safety Administration. Pilots, truck drivers, medical residents, and others required to stay awake for long periods of time show an increased risk of crashes or near misses due to sleep deprivation.33
16. Less Effective Vaccines
Lack of sleep weakens the effectivity of vaccines. Vaccines help in developing immunity by creating antibodies against a specific virus. When you don’t sleep, your immune system is compromised, and this doesn’t work well. In one study, 19 people were vaccinated against Hepatitis A. Ten of them got eight hours of sleep the following night, while the rest pulled an all-nighter. Four weeks later, those who had slept normally had levels of Hepatitis A antibodies almost twice as high as those who had been kept awake.34
Another study also found that sleep has a supportive influence in the very early stage of an adaptive immune response to a viral antigen. It was concluded that “sleep should be considered an essential factor contributing to the success of vaccination.”35
17. Impaired Speech
In sleep loss conditions, speech becomes slurred and you may sound like you had too much drunk. One study kept volunteers awake for 36 hours. They showed a tendency to use word repetitions and clichés. They spoke monotonously, slowly, and indistinctly, and they were not able to properly express and verbalize their thoughts.36
Lack of sleep increases your risk of catching a cold. When a group of 153 people were exposed to a common cold, it was seen that those who had less than seven hours of sleep in the two weeks prior were almost 3 times more likely to get sick than those who had 8 or more hours of sleep.
How well you sleep is also a factor in susceptibility to cold. Those who spent 92% of their time in bed actually asleep were 5.5 times more likely to catch a cold than those who had been peacefully slumbering 98-100% of the time they were in bed.37
19. Gastrointestinal Problems
Regular sleep loss is a reason for the development of both Chrone’s disease and inflammatory bowel syndrome, which affects an estimated 10-15% of people in the U.S. Patients with Crohn’s disease are twice as likely to experience a relapse when they weren’t getting enough sleep.38
20. Depleted Sex Drive
Lack of sleep kills a person’s sex drive. Testosterone is an important component of sexual drive and desire in both women and men. Sleep loss reduces testosterone levels in males. Low sex steroid hormone concentrations have been associated with sexual dysfunction.39 Sleeping increases testosterone levels, while being awake decreases them. In a study conducted on women between the ages of 45-50, sleep deprivation and disturbed sleep was found associated with reduced libido and sexual dysfunction.40 Erectile dysfunction and overall sexual dysfunction were highly prevalent in males with suspected sleep apnea.41
21. Lower Pain Endurance
Lack of sleep often makes pain worse. One study found that when subjects were kept awake all night, their pain threshold, the amount of painful stimulus that they were able to endure was lower.42
22. Sloppiness Or Lack Of Organization
Lack of sleep can make your work sloppy. One study found that one sleepless night contributed to a 20-32% increase in the number of errors made by surgeons.43 People playing sports that require precision – shooting, sailing, cycling, etc. – also make more mistakes when they’ve been awake for extended periods of time.44
Disrupted circadian rhythm and reduced immunity are direct results of sleep deprivation. Preliminary research seems to indicate that people who don’t get enough sleep are at increased risk for developing certain kinds of cancer, most notably colon and breast cancers.45,46,47 Short sleep duration and poor sleep also been linked to higher levels of β-Amyloid, a biomarker for Alzheimer’s Disease.48
24. Genetic Disruption
Poor sleep disrupts normal genetic activity. Researchers found that after sleeping less than six hours per night for one week, 700 genes were not behaving normally, including some that help govern immune and stress responses. Just one week of less-than- ideal sleep is enough to make some of your genetic activity go haywire.49
25. Unhappiness, Depression, Anxiety And Alcohol Use
Even a small levels of sleep deprivation over time can chip away at your happiness and pave a way to depression, anxiety condition. In a classic study led by Nobel Prize-winning psychologist Daniel Kahneman, a group of 909 working women kept detailed logs of their moods and day-to- day activities.
While differences in income up to $60,000 had little effect on happiness, a poor night’s sleep was one of two factors that could ruin the following day’s mood. The other was tight deadlines at work.50
Another study reported, a higher level of marital happiness among women with more peaceful sleep.51 Insomniacs are also twice as likely to develop depression, and preliminary research suggests that treating sleep problems may successfully treat depressive symptoms.52 Sleep loss is also associated with adverse effects on mood and behavior. Adults with chronic sleep loss report excess mental distress, depressive symptoms, anxiety, and alcohol use.53,54,55
A meta-analysis of 19 original articles found that partial sleep deprivation alters mood to an even greater extent than it does cognitive or motor functions.56 Several studies of adolescents, found that inadequate sleep is associated with higher levels of depressed mood, anxiety, behavior problems, alcohol use57,58,59 and attempted suicide.60 On the other hand, a large, 3-year longitudinal study of more than 2,200 middle school students (ages 11 to 14) found that self-reported sleep loss was associated with more depressive symptoms and lower self-esteem over time.61 The study measured sleep loss using a single question about sleep duration on school nights and measured depressive symptoms and self-esteem by the Children’s Depressive Inventory and the Self-Esteem Questionnaire, respectively.
26. Sleep Loss, Disease Mortality And Death
Sleep deprivation may cause an increased risk of death. People who consistently do not get 7-8 hours of sleep are more likely to die during a given time period .i.e. sleeping too little – or even too much – is found associated with a higher risk of dying sooner than you otherwise might.62 Sleep loss is associated with increased age-specific mortality, according to three large, population-based, prospective studies.63,64,65 Deaths in short or long sleepers were compared with those who slept 7 hours (the reference group), after adjusting for numerous health and demographic factors. Sleeping 5 hours or less increased mortality risk, from all causes, by roughly 15 percent. The largest American study showed that progressively shorter or longer sleep duration was associated with greater mortality. Other epidemiological studies suggest that sleep-loss related mortality is largely from acute heart attacks.66
1 Agnivesha, Charaka, Dridhabala, Charaka S, Edited by Dr R.K.Sharma and Vaidya Bhagwan Das Vol 1 Sutra Sthana chapter 11 verse 35 Pg No 219-220.
2 Lawrence E, Steven M. The Harvard Medical School Guide to a Good Night’s sleep. McGraw-Hill eBooks, 2007, 13.
3 American Sleep Disorders Association (ASDA). International Classification of Sleep Disorders:
Diagnostic and Coding Manual (ICSD). Diagnostic Classification Steering Committee, Thorpy Mj,
Chairman. Rochester, M1990, 19-21.
4 World Health Organization -The ICD-10 classification of mental and behavioural disorders. Clinical
descriptions and diagnostic guidelines. Geneva: World Health Organization;1992:362
5 Acharya YT. Charaka Samhita with Ayurveda Deepika Teeka of Chakrapani Dutta. Choukhambha
Sanskrit Sansthan, Varanasi, 2011.50.
6 Acharya YT. Charaka Samhita with Ayurveda Deepika Teeka of Chakrapani Dutta. Choukhambha
Sanskrit Sansthan, Varanasi, 2011, 118.
7 Agnivesha, Charaka, Dridhabala, Charaka S, Edited by Dr R.K.Sharma and Vaidya Bhagwan Das Vol 1 Sutra Sthana chapter 21 verse 50-51 page 384.
8 Thomas Roth, Insomnia: Definition, Prevalence, Etiology, and Consequences,J Clin Sleep Med. 2007 Aug 15; 3(5 Suppl): S7–S10. PMCID: PMC1978319
9 Sundelin T Cues of fatigue: effects of sleep deprivation on facial appearance. Sleep. 2013 Sep 1;36(9):1355-60. doi: 10.5665/sleep.2964.Pub Med
10 Dodick DW ,Clinical, anatomical, and physiologic relationship between sleep and headache,Headache. 2003 Mar;43(3):282-92PubMed. Kelman LHeadache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache. 2005 Jul-Aug;45(7):904-10. Pub Med
11 Sean P. A. Drummond Altered brain response to verbal learning following sleep deprivation International weekly Journal of Science Nature 403, 655-657 (10 February 2000)| doi:10.1038/35001068; Received 27 September 1999; Accepted 12 November 1999.
12 Robert Stickgold et al Visual discrimination learning requires sleep after training Nature Neuroscience 3, 1237 – 1238 (2000) doi:10.1038/81756
13 Hasler G, Buysse DJ, Klaghofer R, Gamma A, Ajdacic V, Eich D, Rossler W, Angst J. The association between short sleep duration and obesity in young adults: A 13-year prospective study. Sleep. 2004;27(4):661–666. [PubMed] 14 Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced
leptin, elevated ghrelin, and increased body mass index. Public Library of Science Medicine. 2004;1(3):210–217. [PMC free article] [PubMed] 15 Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Annals of Internal Medicine. 2004;141(11):846–850.[PubMed] 16 Rachel R. Markwald et al,Impact of insufficient sleep on total daily energy expenditure, food intake, and weight gain, vol. 110 no. 14 5695–5700, doi: 10.1073/pnas.1216951110
17 Orzeł-Gryglewska J,Consequences of sleep deprivation. Int J Occup Med Environ Health. 2010;23(1):95-114. doi: 10.2478/v10001-010- 0004-9.
18 Schwartz SW, Cornoni-Huntley J, Cole SR, Hays JC, Blazer DG, Schocken DD. Are sleep complaints an independent risk factor for myocardial infarction? Annals of Epidemiology. 1998;8(6):384–392
19 Tochikubo O, Ikeda A, Miyajima E, Ishii M. Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hypertension. 1996;27(6):1318–1324.[PubMed] 20 Meier-Ewert HK, Ridker PM, Rifai N, Regan MM, Price NJ, Dinges DF, Mullington JM. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. Journal of the American College of Cardiologists. 2004;43(4):678–683. [PubMed] 21 Morteza Taheri, PhD, The Effect of Sleep Deprivation on Choice Reaction Time and Anaerobic Power of College Student Athletes, Asian J Sports Med. 2012 Mar; 3(1): 15–20.PMCID: PMC3307962
22 Gottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S, Baldwin CM, Nieto FJ. Association of sleep time with diabetes mellitus and impaired glucose tolerance. Archives of Internal Medicine. 2005;165(8):863–867. [PubMed] 23 C. A. Everson, Sustained sleep deprivation impairs host defense American Journal of Physiology – Regulatory, Integrative and Comparative Physiology Published 1 November 1993 Vol. 265 no. 5, R1148-R1154
24 M Irwin, Partial night sleep deprivation reduces natural killer and cellular immune responses in humans, April 1996,The FASEB Journal vol. 10 no. 5 643-653.
25 Vinod Venkatraman, Sleep Deprivation Biases the Neural Mechanisms Underlying Economic Preferences, Journal of Neuroscience 9 March 2011, 31 (10) 3712-3718; DOI: https://doi.org/10.1523/JNEUROSCI.4407-10.2011
26 B. Mahler,Sleep deprivation induces excess diuresis and natriuresis in healthy children American
Journal of Physiology – Renal Physiology Published 3 January 2012 Vol. 302 no. 2, F236-F243 DOI: 10.1152/ajprenal.00283.2011
27 Konstantinos Kamperis, Excess diuresis and natriuresis during acute sleep deprivation in healthy adults, American Journal of Physiology – Renal Physiology Published 3 August 2010 Vol. 299 no. 2, F404-F411 DOI: 10.1152/ajprenal.00126.2010
28 Doran SM, Sustained attention performance during sleep deprivation: evidence of state instability. Arch Ital Biol. 2001 Apr;139(3):253-67.PubMed
29 Namni Goe, Neurocognitive Consequences of Sleep Deprivation, PMCID: PMC3564638,NIHMSID: NIHMS354519 Published online 2009 Sep 9. doi: 10.1055/s-0029- 1237117
30 Zohar D,The effects of sleep loss on medical residents' emotional reactions to work events: a cognitive-energy model. Sleep. 2005 Jan;28(1):47-54.PubMed
31 Robbert Havekes, The impact of sleep deprivation on neuronal and glial signalling pathways important for memory and synaptic plasticity Cell Signal. 2012 Jun; 24(6): 1251–1260.doi: 10.1016/j.cellsig.2012.02.010PMCID: PMC3622220 NIHMSID: NIHMS360143
32 Bryce A Mander ,Prefrontal atrophy, disrupted NREM slow waves and impaired hippocampal dependent memory in aging Nature Neuroscience 16, 357–364 (2013) doi:10.1038/nn.3324
33 Namni Goel, Ph.D, Neurocognitive Consequences of Sleep Deprivation Semin Neurol. 2009 Sep; 29(4): 320–339.Published online 2009 Sep 9. doi: 10.1055/s-0029- 1237117 PMCID: PMC3564638 NIHMSID: NIHMS354519
34 Lange T ,Sleep after vaccination boosts immunological memory J Immunol. 2011 Jul 1;187(1):283- 90. doi: 10.4049/jimmunol.1100015. Epub 2011 Jun 1.
35 Christian Benedict ,Acute sleep deprivation has no lasting effects on the human antibody titer response following a novel influenza A H1N1 virus vaccination BMC Immunology201213:1 https://doi.org/10.1186/1471-2172- 13-1© Benedict et al; licensee BioMed Central Ltd. 2012
36 Orzeł-Gryglewska J, Consequences of sleep deprivation Int J Occup Med Environ Health. 2010;23(1):95-114. doi: 10.2478/v10001-010- 0004-9
37 Cohen S Sleep habits and susceptibility to the common cold. Arch Intern Med. 2009 Jan 12;169(1):62-7. doi: 10.1001/archinternmed.2008.505.
38 Tauseef Ali, Sleep, immunity and inflammation in gastrointestinal disorders, World J Gastroenterol. 2013 Dec 28; 19(48): 9231–9239.Published online 2013 Dec 28. doi: 10.3748/wjg.v19.i48.9231 PMCID: PMC3882397
39 Monica L.Andersen ,The association of testosterone, sleep, and sexual function in men and women SCIENCE DIRECT,Brain ResearchVolume 1416, 6 October 2011, Pages 80-104
40 Night sweats, sleep disturbance, and depression associated with diminished libido in late menopausal transition and early postmenopause: baseline data from the Herbal Alternatives for Menopause Trial (HALT) Am J Obstet Gynecol. 2007 Jun;196(6):593.e1-7; discussion 593.e7.
41 Budweiser S ,Sleep apnea is an independent correlate of erectile and sexual dysfunction. J Sex Med. 2009 Nov;6(11):3147-57. doi: 10.1111/j.1743-6109.2009.01372.x. Epub 2009 Jun 29
42 Onen SH et al,The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects. J Sleep Res. 2001 Mar;10(1):35-42. pub med
43 NJ Taffinder ,Effect of sleep deprivation on surgeons' dexterity on laparoscopy simulator The Lancet Volume 352, No. 9135, p1191, 10 October 1998
44 Thomas Reilli, Altered sleep–wake cycles and physical performance in athletes Science Direct Physiology & Behaviour Volume 90, Issues 2–3, 28 February 2007, Pages 274-284
45 Filipski E ,Disruption of circadian coordination accelerates malignant growth in mice. Pathol Biol (Paris). 2003 Jun;51 (4):216-9.Pub Med
46 Cheryl L ,Short duration of sleep increases risk of colorectal adenoma Wiley Online Library Cancer, Volume 117, Issue 4, 15 February 2011 Pages 841–847
47 Reed VA ,Shift work, light at night, and the risk of breast cancer.AAOHN J. 2011 Jan;59(1):37-45; quiz 46. doi: 10.3928/08910162-20101216- 01. Epub 2010 Dec 23.
48 Adam P. Spira, Self-reported Sleep and β-Amyloid Deposition in Community-Dwelling Older Adults JAMA Neurol. 2013;70(12):1537-1543. doi:10.1001/jamaneurol.2013.4258
49 Carla S. Möller-Levet Effects of insufficient sleep on circadian rhythmicity and expression
amplitude of the human blood transcriptome vol. 110 no. 12 , E1132–E1141, doi: 10.1073/pnas.1217154110
50 Daniel Kahneman, A Survey Method for Characterizing Daily Life Experience: The Day Reconstruction Method, Science 03 Dec 2004: Vol. 306, Issue 5702, pp. 1776-1780 DOI: 10.1126/science.1103572
51 Wendy M. Troxel ,Marital Happiness and Sleep Disturbances in a Multi-Ethnic Sample of Middle Aged Women Behav Sleep Med. 2009; 7(1): 2–19.doi: 10.1080/15402000802577736 PMCID: PMC2654623 NIHMSID: NIHMS94684
52 Baglioni C ,Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies J Affect Disord. 2011 Dec;135(1-3):10- 9. doi: 10.1016/j.jad.2011.01.011. Epub 2011 Feb 5
53 Baldwin DC Jr, Daugherty SR. Sleep deprivation and fatigue in residency training: Results of a national survey of first- and second-year residents. Sleep. 2004;27(2):217–223. [PubMed] 54 Strine TW, Chapman DP. Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Medicine. 2005;6(1):23–27. [PubMed] 55 Hasler G, Buysse DJ, Gamma A, Ajdacic V, Eich D, Rossler W, Angst J. Excessive daytime sleepiness in young adults: A 20-year prospective community study. Journal of Clinical Psychiatry. 2005;66(4):521–529. [PubMed] 56 Pilcher JJ, Huffcutt AI. Effects of sleep deprivation on performance: A meta-analysis. Sleep. 1996;19(4):318–326. [PubMed] 57 Carskadon MA. Patterns of sleep and sleepiness in adolescents. Pediatrician. 1990;17(1):5–12. [PubMed] 58 Morrison DN, McGee R, Stanton WR. Sleep problems in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry. 1992;31(1):94–99. [PubMed] 59 Wolfson AR, Carskadon MA. Sleep schedules and daytime functioning in adolescents. Child Development. 1998;69(4):875–887. [PubMed] 60 Liu X. Sleep and adolescent suicidal behavior. Sleep. 2004;27(7):1351–1358. [PubMed] 61 Fredriksen K, Rhodes J, Reddy R, Way N. Sleepless in Chicago: Tracking the effects of adolescent sleep loss during the middle school years. Child Development. 2004;75(1):84–95.[PubMed] 62 Grandner MA ,Mortality associated with short sleep duration: The evidence, the possible mechanisms, and the future. Sleep Med Rev. 2010 Jun;14(3):191-203. doi: 10.1016/j.smrv.2009.07.006. Epub 2009 Nov 25.
63 Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Archives in General Psychiatry. 2002;59(2):131–136. [PubMed] 64 Tamakoshi A, Ohno Y. JACC Study Group. Self-reported sleep duration as a predictor of all-cause mortality: Results from the JACC study, Japan. Sleep. 2004;27(1):51–54. [PubMed] 65 Patel SR, Ayas NT, Malhotra MR, White DP, Schernhammer ES, Speizer FE, Stampfer MJ, Hu FB. A prospective study of sleep duration and mortality risk in women. Sleep. 2004;27(3):440–444. [PubMed] 66 Ayas NT, White DP, Manson JE, Stampfer MJ, Speizer FE, Malhotra A, Hu FB. A prospective study of sleep duration and coronary heart disease in women. Archives of Internal Medicine. 2003;163(2):205–209. [PubMed]