Are sleep problems linked to our use of communications technology? Do a majority of Americans suffer from the effects of sleep deprivation? Results of a survey released today by the National Sleep Foundation suggest that we could be tweeting, texting, video-gaming, and watching our way to sleep problems. A majority of survey respondents said they experienced problems sleeping, with 63 percent saying that they didn't get enough sleep on weekdays. Almost all survey respondents -- 95 percent -- said they used a computer, television, cell phone, or video game during the hour before they went to bed.
But before you turn off the computer and hang up your cell phone, read on: The survey methods were deeply flawed.
The NSF released the results of their poll the morning of Monday, March 7. On cue, news outlets major and minor rolled out the headlines called for by the press release: Washington Post blogger Hayley Tsukayama: "Does your connected life make you lose sleep?" Scientific American: "Electronic Gadgets Before Bed Can Hinder Sleep;" TechEye: "Technology Kills Our Sleep;" Newsday: "Not Getting Enough Sleep? Turn off the Technology."
Only MedPage Today offered a well-wrought critique of the survey: "Survey Shows Sleep Deficits, but Methods Questioned." Thank you, MedPage Today, for reminding us that health journalists need to ask questions, too.
The Problem with Opt-In Online Surveys
Why the scathing critique from MedPage today? It's all about the methods used in the NSF survey. The NSF researchers asked more than 1500 Americans ages 13 to 64 about their before-bedtime routines and their sleeping habits. About half of the people who participated in the study were interviewed over the phone, while the other half filled out a web-based questionnaire -- that is, an opt-in online survey.
Opt-in online surveys generally offer incentives to participants, who agree to complete online questionnaires. In exchange, they receive points redeemable for cash and gifts. But such surveys are notoriously unreliable. Last April, the American Association of Public Opinion Researchers (AAPOR) issued a report about such surveys, warning that these surveys should not be used to represent broader public opinion.
The survey technique could explain a large discrepancy between the NSF survey results and sleep data reported by the Centers for Disease Control and Prevention (CDC) in the March 4 issue of Morbidity and Mortality Report. In reporting data from two large national health surveys, the CDC researchers said that about 35 percent of respondents said they slept fewer than seven hours per 24 hour period or per night. That's a huge leap from the 63 percent that told NSF researchers they are not getting enough sleep during the week.
And in this case, the bias is obvious. If you interview people about communications technology over the internet, you're more likely to get responses from people who are heavy users of communications technology. So it's no surprise that when asked about use of communications technology during the hour before bed, 60 percent of NSF survey respondents said they used a computer or other technology device.
The Effects of Sleep Deprivation
Whether 63 percent or 35 percent of Americans have trouble sleeping, however, one thing is clear -- sleeplessness is a problem for Americans. According to the CDC's Sleep and Sleep Disorders resources, people who do not get enough sleep may be more likely to develop chronic diseases and conditions including diabetes, heart and blood vessel disease, obesity, and depression. In addition, chronic sleep deprivation may make these conditions worse. In a vicious cycle, people with sleep disorders are more likely to engage in risky health behaviors such as smoking, physical inactivity, and heavy drinking – all of which also increase the risk of chronic disease.
Drowsy driving creates dangers on America's highways and roads, as well. According to conservative estimates from The National Highway Traffic Safety Administration, at least 100,000 police-reported crashes are the direct result of driver fatigue each year. These crashes lead to an estimated:
- 1,550 deaths,
- 71,000 injuries, and
- $12.5 billion in monetary losses
Sleeplessness has also been linked to injuries and deaths in the workplace. People who are sleep-deprived are more likely to make mistakes made while operating heavy machinery or fall asleep while caring for a child, lifeguarding, or working in other jobs that demand constant vigilance.
Signs of Sleep Deprivation
How do you know if you're sleep deprived? Sleep researchers agree that the average adult needs 7 to 9 hours of sleep each night. If you're sleeping less than seven hours a night, there's a good chance that you not getting enough sleep to function well, and you may be increasing your risk of health problems or injuries. If you experience any of the following symptoms, it's time to address your sleeping problems.
|Symptoms of Sleep Deprivation|
Getting Better Sleep
So what’s a connected nation to do? "If you're having problems sleeping at night, or if you're feeling too sleepy the next day, take a look at your bedtime habits," says Allison Harvey, PhD, behavioral sleep expert at the University of California Berkeley. "Create a relaxing wind-down routine and turn down the lights. Make your bedroom a sanctuary from the worries of your day."
While the NSF experts may not be the best at survey techniques, they are experts at helping people to get better sleep. Here are their suggestions for restful nights:
- Set and stick to a sleep schedule. Go to bed and wake up at the same times each day.
- Expose yourself to bright light in the morning and avoid it at night. Exposure to bright morning light energizes us and prepares us for a productive day. Alternatively, dim your lights when it's close to bedtime.
- Exercise regularly. Exercise in the morning can help you get the light exposure you need to set your biological clock. Avoid vigorous exercise close to bedtime if you are having problems sleeping.
- Establish a relaxing bedtime routine. Allow enough time to wind down and relax before going to bed.
- Create a cool, comfortable sleeping environment that is free of distractions. If you're finding that entertainment or work-related communications are creating anxiety, remove these distractions from your bedroom. Treat your bed as your sanctuary from the stresses of the day. If you find yourself still lying awake after 20 minutes or so, get up and do something relaxing in dim light until you are sleepy.
- Keep a "worry book" next to your bed. If you wake up because of worries, write them down with an action plan, and forget about them until morning.
- Avoid caffeinated beverages, chocolate and tobacco at night.
- Avoid large meals and beverages right before bedtime.
- Avoid “nightcaps.” Drinking alcohol before bed can rob you of deep sleep and can cause you to wake up too early.
- Avoid medicines that delay or disrupt your sleep. If you have trouble sleeping, ask your doctor or pharmacist if your medications might be contributing to your sleep problem.
- Avoid late-afternoon or evening naps, unless you work nights. If you must nap, keep it under 45 minutes and before 3:00 pm.
Centers for Disease Control and Prevention. Sleep and Sleep Disorders. Reviewed January 27, 2011. Retrieved March 4, 2011 from http://www.cdc.gov/sleep/index.htm
Smith, Melinda and Segal, Robert. "How Much Sleep Do You Need?" Available at http://www.helpguide.org/life/sleeping.htm
McKnight-Eily L, et al "Unhealthy sleep-related behaviors -- 12 states, 2009" (2011). Morbidity and Mortality Weekly Report. 60: 233-238. Retrieved March 4, 2011 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a2.htm
National Highway Traffic Safety Administration and National Center on Sleep Disorders Research. Drowsy driving and automobile crashes. Washington, DC: National Highway Traffic Safety Administration. Available at http://www.nhtsa.gov/people/injury/drowsy_driving1/drowsy.html#ncsdr/nhtsa. Accessed March 4, 2011.
National Sleep Foundation. (2011, Mar 7). Annual Sleep in America Poll Explores Connections with Communications Technology Use and Sleep. Press Release. Available at http://www.sleepfoundation.org/article/press-release/annual-sleep-americ...
National Sleep Foundation. (2011, Mar 7). 2011 Sleep in America Poll: Communications Technology in the Bedroom. Summary of Findings. Available at http://www.sleepfoundation.org/sites/default/files/sleepinamericapoll/SIAP_2011_Summary_of_Findings.pdf
Wheaton A, et al "Effect of short sleep duration on daily activities -- United States, 2005-2008." (2011). Morbidity and Mortality Weekly Report. 60: 239-242. Retrieved March 4, 2011 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a3.htm?s_cid=mm6008a3_e&source=govdelivery
Photo by Ed Yourdon