Good sleep is necessary for good physical and mental health and a good quality of life. Insufficient sleep is a pervasive and prominent problem in the modern 24-h society. A considerable body of evidence suggests that insufficient sleep causes hosts of adverse medical and mental dysfunctions. An extensive literature search was done in all the major databases for “insufficient sleep” and “public health implications” in this review. Globally, insufficient sleep is prevalent across various age groups, considered to be a public health epidemic that is often unrecognized, under-reported, and that has rather high economic costs. This paper addresses a brief overview on insufficient sleep, causes, and consequences, and how it adds to the existing burden of diseases. Insufficient sleep leads to the derailment of body systems, leading to increased incidences of cardiovascular morbidity, increased chances of diabetes mellitus, obesity, derailment of cognitive functions, vehicular accidents, and increased accidents at workplaces. The increased usage of smart phones and electronic devices is worsening the epidemic. Adolescents with insufficient sleep are likely to be overweight and may suffer from depressive symptoms. The paper concludes by emphasizing sleep quality assessments as an important early risk indicator, thereby reducing the incidence of a wide spectrum of morbidities.Insufficient sleep is associated with a range of negative health and social outcomes, including an adverse performance at school and in the labor market. Reduced sleep duration has been linked to 7 of the 15 leading causes of death in the U.S., including cardiovascular disease, malignant neoplasm, cerebrovascular disease, accidents, diabetes, septicemia, and hypertension [1]. The evidence suggests that the link between inadequate sleep and negative outcomes is more direct, whereas the link between excessive sleep and negative outcomes seems to be more indirect (i.e., excessive sleep is driven by underlying chronic health conditions and not vice versa). Hence, the impact of insufficient sleep appears tAn extensive literature search was done, and relevant articles were identified through online searches of electronic databases (i.e., the PubMed, Medline, PsycINFO, Web of Science, Scopus, and Global Health databases). Relevant keywords relating to “insufficient sleep”, in combination with (and/or) public health impact were searched, around 3626 articles were screened for duplication and relevance to fit the inclusion criteria, and finally 111 articles with full texts were included in this review, as shown in the flow chart below (Figure 1). Articles on cardiometabolic disorders, mental health, accidents and trauma, sleep apnoea, obesity, adolescents, meta-analysis, randomized control trials, longitudinal studies, and cross-sectional studies were included (that reflected the public health impacts of insufficient sleep). Additional publications were identified from references cited in the original articles. The major findings were classified into different categories and are presented in the tables, figures, and narrative description below.A recent study of the prevalence of sleep disorders investigated over 20,000 patients in the Netherlands who were aged 12 years old or older. The study found an alarming prevalence rate of 27.3%, with 21.2% of the males and 33.2% of the females reporting that they had some type of sleep disorder [4]. A national quasirandom sample study of sleep disorders in 12 provinces of the Netherlands showed a prevalence of 23.5% [5], while a similar nationally representative sample of individuals in the age group of 18–70 years also showed high prevalence rates. Polling based on a validated questionnaire of ICSD revealed that, among the total sample, 32% complained of experiencing general sleep disturbances while 43.2% said they suffered from insufficient sleep [6]. Other surveys by Hublin et al. [7] and Ursin et al. [8] found the prevalence rates for disturbed sleep to be, respectively, 20.4% and 20%. Discrepancies in the prevalence rates found by the various surveys were possibly due to the separate questionnaires that were used, differences in sampling techniques, or other possible methodological differences. Nevertheless, the findings were in concordance in showing that poor-quality sleep is a problem for a major segment of the samples that were surveyed.
Although the need for sleep among adolescents has been determined to be about 9.25 h per day [9], there are still many adolescents who obtain less sleep than they actually need [10], thus creating a chronic sleep debt. A study conducted in Norway among 1285 high school students (aged 16–19 years) showed an estimated 10.4% prevalence of behaviorally induced insufficient sleep syndrome (i.e., the condition was due to individual choices regarding bedtimes rather than being the consequence of a medical condition) [11]. Among a sample of 2738 soldiers who were surveyed about their sleep behavior and perceived feelings of sleepiness, the average reported sleep duration was found to be 5.8 ± 1.2 h, with 1959 soldiers, or 72% of the sample, reporting that they slept less than 6 h [12].
Sleep needs vary among individuals based on age, and even response to sleep restriction changes with age. According to a Centers for Disease Control and Prevention (CDC) state-based survey in 2014, only 65% of adults reported a healthy duration of sleep. In a recent survey, an estimated 83.6 million adults in the United States were reportedly sleeping <7 h in 24 h [13]. The prevalence of continuous insufficient sleep among American Indians and Alaska Natives (AI/AN) has not been formally surveyed, but anecdotal reports suggest that the figure is high in these minority groups. It has been suggested that the rates of mental disturbance that are also known to be elevated in these groups may possibly be, in part, attributable to insufficient sleep, and thus that public health and education efforts to address these problems should be undertaken [14].
Magee et al. [15], for instance, explored the determinants of sleep duration among a cohort of Australian adults aged 18 to 64 years. Using multivariate statistical analysis, the study found that short sleep durations were associated with longer working hours, lower education levels, being single rather than married, being a current cigarette smoker, or with showing high levels of alcohol consumption, obesity, or depression or anxiety, as shown in Figure 2 below. Krueger and Friedman [16] found that factors such as low levels of education and cardiovascular disease were associated with both short and long sleep (e.g., more than nine hours). Short sleep was associated with being in an older age group, being a frequent smoker or consumer of alcohol, being overweight or obese, as well as with having young children. A study from Finland by Kronholm et al. [17] reported that gender, as well as marital status, occupation, and physical activity, were major drivers of short sleep duration. According to the study, men were more likely to be short sleepers than women. A study of the effects of workplace-related factors found that job stress factors such as quantitative workload and interpersonal conflict led to short sleep duration among male Japanese manufacturing workers [18]. Psychosocial factors such as tension or anxiety and depressive symptoms have also been associated with reduced sleep. In addition, organizational factors related to discrimination, work-life balance, high work demands, and job insecurity were associated with an increased prevalence of sleep problems [19,20].o be the more salient issue in our society and, because of its broad-ranging effects, represents a major public health concern. In this review, we note some of the more serious consequences of insufficient sleep, and additionally consider how these might be best addressed by changes in individual behavior, actions by employers, and by public policy measures
