To the Editor:
In their landmark study, Dr Kowlessar et al concluded, “Modifiable health risks are associated with higher employer costs. Targeted programs that address these risks are expected to yield substantial savings.”1 In the current financially challenging period, these researchers have provided a practical, timely, and novel idea to improve the employers' bottom line.
To the 11 Mayo-Clinic health risks Dr Kowlessar evaluated, we recommend adding one more: the growing public health problem of “chronic sleep curtailment.” Sleep deprivation is endemic in modern society. At least 15% of the US working population gets less than 5 hours sleep per night.2 Late night activities are pervasive parts of our life. We use sleep time as “safety net” time for unfinished daytime business. Naively, we extend an activity into the sleep-time, since our calendar contains nothing else scheduled there!
Sleep restriction reduces testosterone levels in young healthy men, with consequent adverse effect on mental concentration at work, vigor, libido, muscle mass, bone density, and adiposity.3 The sleep-wake cycle is regulated by melatonin, a hormone secreted only in the dark. Melatonin promotes sleep by chemically causing drowsiness and lowering the body temperature. Melatonin is a powerful antioxidant, protects DNA, and may have beneficial effects on learning and memory.4When people sleep less, they spend less time in darkness, and therefore may develop hypomelatoninemia. Most importantly, sleep loss directly contributes to the causation of all of the 11 health risks Dr Kowlessar studied, namely obesity, hypertension, diabetes mellitus, hypercholesterolemia, inadequate exercise, poor nutrition, poor emotional health, hypertriglyceridemia, poor safety practices, smoking, and alcohol abuse.5,6
Several factors deprive people of a good 7 to 8 hours sleep. One striking example is the 7 PM or later start of many athletic and entertainment events. The situation may be worse on the US east coast where some games start at 9 PM local time to catch the west coast television audiences. By the time the event ends, and one navigates the traffic, it would be past midnight for retiring to sleep. How can there be time left for adequate sleep if one has to work at 7 AM the next morning? Likewise, many college classes are held in the late evening, with students staying over past midnight in the laboratories to finish assignments. Other common causes of sleep deprivation are late night TV watching and Internet use, and widespread caffeine abuse.
Sleep is not a waste of time.6 To curb sleep deprivation, we need to make major changes in our lifestyle. For a start, sporting events should begin at 6 PM local time. West coast viewers could use TiVo-DVR (TiVo Inc, Alviso, CA) to record a Yankees home game! Academic coursework could be planned such that more use is made of the daylight hours. The American public is quite flexible in adjusting to a genuine need. For example, we readily adapt to an abrupt change from standard to daylight time and vice versa. A good night's sleep should reduce the prevalence and severity of the 11 health risks by primary prevention, and thereby improve the workers' general health and productivity. Since the vast majority of Americans are employed, the employment setting is the ideal venue, and as trusted Occupational Medicine specialists, we are the most suited professionals to bring about this sea change.
Ghan-Shyam Lohiya, MD, MS, FACOEM
Consultant, Occupational Medicine & Toxicology
Royal Medical Group
Santa Ana, Calif
Student, Riverside Community College Norco, Calif
Student, University High School
1. Kowlessar NM, Goetzel RZ, Carls GS, Tabrizi MJ, Guindon A. The relationship between 11 health risks and medical and productivity costs for a large employer. J Occup Environ Med. 2011;53:468–477.
2. National Sleep Foundation. Sleep in America Poll. Washington, DC: National Sleep Foundation; 2002. Available at: www.sleepfoundation.org/article/sleep-america-polls/2002-adult-sleep-habits
. Accessed June 06, 2011.
3. Leproult RL, Cauter EV. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011;305:2173–2174.
4. Mayo Clinic. Melatonin. Available at: http://www.mayoclinic.com/health/melatonin/ns_patient-melatonin
. Accessed June 06, 2011.
5. Kntuson KL, Spieegl K, Peneve P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Med Rev. 2007;11:163–178.
6. Chaput JP. A good night's sleep for a healthier population. Am J Prev Med. 2010;38:349.