Insufficient Sleep Syndrome

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If you’ve ever been engrossed in a series on Netflix, you’ve probably encountered that moment when you know you should go to bed, but the auto-play feature induces you to watch another episode instead of turning in for the night.

While this type of decision may seem innocuous at the time, if it becomes habitual, it can contribute to a condition known as Insufficient Sleep Syndrome (ISS).

Lack of sleep is a growing problem and one that affects people of all ages. Even though research constantly reveals in greater depth the intricacies of why we sleep and its importance for overall health, more and more people are failing to get the recommended amounts of nightly rest.

Sleep insufficiency can pose serious consequences for individuals and society as a whole. It can happen for many reasons, many of which are physical disorders that can create major barriers to sleep. Poor sleep can also arise because of individual behavior, and that’s exactly what happens with Insufficient Sleep Syndrome.

In this condition, a person’s choices about how they use their time cause them to not dedicate enough time to sleep. Regularly sacrificing sleep in this way creates a chronic problem of ISS, which causes excessive daytime sleepiness (EDS) and other negative effects from lack of sleep.

This guide goes into detail about Insufficient Sleep Syndrome and explains what it is, how it comes about, how it is diagnosed, and how it can be effectively treated.

What is Insufficient Sleep Syndrome?

Insufficient Sleep Syndrome, also referred to as Behaviorally-Induced Insufficient Sleep Syndrome, happens when a person does not get consistent sleep because of voluntary choices. Even though this sleep loss occurs because of personal decisions, it is not intentional, and many people with this condition may not immediately realize that their sleep is insufficient.

ISS is not especially common, affecting only a small percentage of people who see a specialist about sleeping problems. It can affect people of any age but has been found to occur most often in people in their 30s, and it tends to impact more men than women.

How is Insufficient Sleep Syndrome Different From Insufficient Sleep?

As a general term, insufficient sleep refers to a lack of quantity and/or quality of sleep. This means that a person’s total sleep hours are lacking or that their sleep is fragmented or disrupted in some way. Insufficient sleep can occur over a short period of time, even just one night, or over an extended timeframe.

Insufficient Sleep Syndrome is distinct in two ways. First, it becomes prolonged, representing a pattern of poor sleep over time. Second, ISS is specific to behaviorally induced sleep loss while the broader concept of insufficient sleep can occur for many reasons. These two differences help explain why in the past this condition has been referred to as “chronic insufficient sleep” and “voluntary sleep curtailment.”

Formal systems for classifying sleep disorders began recognizing this condition starting in 1979, and the most up-to-date versions — the 11th Revision of the International Classification of Diseases (ICD-11) and the Third Edition of the American Academy of Sleep Medicine (AASM) International Classification of Sleep Disorders (ICSD-3) — continue to identify Insufficient Sleep Syndrome as a sleep disorder. They both identify this as a hypersomnolence disorder, meaning that it is associated with excessive daytime sleepiness.


What Causes Insufficient Sleep Syndrome?

Insufficient Sleep Syndrome is caused by behavioral choices that curtail sleep on a chronic basis. One of the most frequent causes is a person’s work schedule. This could mean working extended hours, working a night shift, or having changing shifts that lead to reduced time devoted to sleep. Family responsibilities like caregiving can also take away from sleeping hours, such as the significant percentage of people who have loved ones with Alzheimer’s dementia and report serious sleeping problems.

Social activities and personal entertainment can also induce a person to sleep less. For example, a person may decide to stay awake to go to a party or watch a TV series. Because they are consciously choosing to participate in other activities, many people with Insufficient Sleep Syndrome don’t realize or don’t acknowledge that this involves a tradeoff with time for sleep.

It should be noted that these causes are referred to as voluntary, but there are times in life when they may not feel exactly that way. To mention just a few examples,

  • A person who is struggling to make ends meet may not feel that they have much choice but to accept long work hours or a shift-work schedule.
  • Students who feel pressure to get excellent grades and be involved in extracurricular activities may believe that they need to keep studying rather than sleep.
  • A person involved in competition, ranging from athletics to academic debate, may feel compelled to train or practice rather than sleep.
  • A person with major family obligations may feel as though they have little alternative for handling those duties, limiting their ability to redirect their time to sleep.

For this reason, it is important to clarify that in most cases Insufficient Sleep Syndrome arises from choices that are broadly classified as voluntary, but the sleep loss itself is normally unintentional. And unfortunately, this sleep loss usually detracts from the ability to achieve other goals in terms of productivity, academic achievement, and athletic performance.


What Are the Symptoms of Insufficient Sleep Syndrome?

The main symptom of Insufficient Sleep Syndrome is excessive daytime sleepiness. This can manifest in the form of drowsiness and a tendency to nod off during normal waking hours. It can also include reduced attention and cognitive function, impaired decision-making, and physical fatigue.

People with ISS may not always realize that their sleep hours are curtailed; however, in some cases, particularly when a person is actively choosing to participate in social events, work longer hours, or engage in other types of entertainment, they may be more aware of the nature of this sleep disorder.

What Are the Consequences of Insufficient Sleep Syndrome?

There can be significant short- and long-term impacts from Insufficient Sleep Syndrome. For individuals, the immediate effects of excessive daytime sleepiness can drag down their performance at work or school. For teens, especially, the effects can be highly problematic. A study of adolescents with ISS found that they had worse academic achievement, more impulsiveness, and more symptoms of depression. Both impulsiveness and daytime drowsiness can increase the risk of falls and other accidents, including auto accidents that can be life-threatening.

Because ISS involves chronic sleep deprivation, people with this condition cannot capitalize on the benefits of sleep, and consequently, ISS can contribute to a host of other health problems related to the cardiovascular system, immune system, metabolism, and mental health.

Collectively, this sleep loss takes a toll at the societal level as well. Sleep deprivation reduces academic achievement in our educational system and has been found to carry an enormous economic cost to productivity — a loss of ass much as $411 billion annually — as well.


How is Insufficient Sleep Syndrome Diagnosed?

As with most sleep disorders, Insufficient Sleep Syndrome has specific diagnostic criteria, and a doctor reviews these criteria in determining whether a patient has this condition. Central components of these criteria include:

  • Significant sleepiness and/or dozing off during the day
  • Total sleep time that is less than expected for a person’s age
  • Symptoms that persist for a period of at least three months
  • Symptoms that cannot be explained by another condition such as another sleep disorder, health condition, or medication

Several different examinations and tests can be employed to determine whether a person meets these diagnostic criteria. The process usually starts by the doctor reviewing a patient’s symptoms and asking questions to learn more about their severity and duration. A review of the patient’s medical history and a physical exam are often part of this initial evaluation.

To supplement this initial review, a doctor may ask for a more detailed sleep history. This usually involves keeping a sleep journal (also known as a sleep diary or sleep log) for a period of at least one week. If you share the bed with another person, they may be asked to help record information in the sleep log.

The goal of the sleep journal is to allow the doctor to see how much and when you are sleeping. By keeping this data for weeks, patterns in your sleep can become more apparent.

Another way to gather this type of information is with actigraphy. Actigraphy is the technique found in most sleep trackers and cell phone sleep-tracking apps. Most of the time, actigraphy involves wearing a device on the wrist to collect data about movement, and then that data is used as an input in an algorithm that determines your sleep and wake times.

Results from the symptom review, sleep journal, and/or actigraphy can establish that a person has chronic sleep insufficiency. The final step in the diagnostic process is then to ensure that the person’s sleep is not being affected by another condition. This can involve a detailed sleep study, such as polysomnography, which tracks breathing, eye movement, muscle activity, and more during sleep.

Polysomnography can be used during an overnight sleep study that usually happens in a specialized clinic. Doing this test can rule out the presence of other sleep disorders like obstructive sleep apnea. Polysomnography can also be employed in a Multiple Sleep Latency Test (MSLT), which happens during the day. The MSLT checks to see whether a person is able to fall asleep at regular intervals during waking hours and can indicate the presence of excessive daytime sleepiness.

Other tests, such as blood tests or imaging tests, can be used if the doctor suspects that some other pre-existing health condition is affecting a person’s sleep. Frequently, though, these kinds of tests are not needed as people with ISS find that they sleep well when they devote enough time for bed.


How is Insufficient Sleep Syndrome Treated?

Treatment for Insufficient Sleep Syndrome is normally both straightforward and highly effective. Treatment requires changing behavior to devote more time to sleep and promoting habits that foster healthy sleep.

These types of behavior changes are a core element of sleep hygiene. Sleep hygiene covers the daily routines and practices that affect sleep, and there are a number of ways to improve these to enhance nightly sleep:

  • Keeping a stable schedule for going to bed and waking up, even on weekends and vacations.
  • Avoiding exposure to blue light from mobile phones, laptops, and tablets in the hour before bed because this light can reduce the production of melatonin, a hormone that promotes sleep.
  • Eliminating or moderating consumption of caffeine, spicy food, and alcohol in the hours before bedtime.
  • Getting moderate exercise during the day, ideally with some exposure to natural light.
  • Using a consistent routine to get ready for bed including things like putting on pajamas and brushing your teeth.
  • Finding ways to relax such as meditation, stretching, deep breathing, or other techniques.

Another important aspect of sleep hygiene is the sleep environment. Creating a bedroom setting that is conducive to sleep can help people with ISS sleep better once they have adjusted their behavior to dedicate more time to sleep. Examples of methods of improving the sleep setting can include:

By placing a greater emphasis on sleep in their daily schedule, people with ISS can resolve this condition and eliminate or reduce daytime sleepiness. Making behavior changes to devote more time to sleep and improve sleep hygiene form the key parts of effective treatment for Insufficient Sleep Syndrome.

Please remember that while our guide is thorough and well-researched, it is not a replacement for medical advice. Always consult your doctor or qualified physician with any questions or concerns you have regarding medical conditions, treatments, and advice.


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