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American Thoracic Society Issues Recommendations on Healthy Sleep

The American Thoracic Society has released a policy statement with recommendations for clinicians and the general public on achieving good quality sleep and getting an adequate quantity of sleep.

“Sleep plays a vital role in human health, yet there is a lack of sufficient guidance on promoting good sleep health,” said Sutapa Mukherjee, MBBS, PhD, chair of the committee that produced the statement. “In this statement, with an eye towards improving public health, we address the importance of good quality sleep with a focus on sleep health in adults and children; the effects of work schedules on sleep; the impact of drowsy driving; and the diagnosis and treatment of obstructive sleep apnea and insomnia.”

The statement is published in the June 15 issue of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

Major conclusions and key recommendations of the statement include:

  • Good quality sleep is critical for good health and overall quality of life.
  • The amount of sleep needed by an individual varies significantly with age across the lifespan.
  • Children are not merely smaller adults with regard to sleep and differ importantly from adults, thereby requiring specific attention to sleep maturational processes.
  • Disparities exist in sleep health related in part to modifiable factors for adequate sleep quality and quantity.
  • Short sleep duration (6 hours or less per 24 hour period) is associated with adverse outcomes including mortality.
  • Long sleep duration (>9-10 hours per 24 hour period) may also be associated with adverse health outcomes.
  • The optimal sleep duration for adults for good health at a population level is 7-9 hours, although individual variability exists.
  • Drowsy driving is an important cause of fatal and non-fatal motor vehicle crashes. We recommend that all drivers (occupational and non-occupational) receive education about how to recognize the symptoms and consequences of drowsiness.
  • Adolescents may be a particularly susceptible group to drowsy driving; therefore, we recommend inclusion of sleep awareness during their driving education.
  • Occupational demands are a frequent cause of insufficient sleep and can contribute to accident risk in the workplace. We recommend better education for the general public and health care providers regarding the impact of working hours and shift work on sleep duration and quality and the association of sleepiness with workplace injuries.
  • Sleep disorders are common, cause significant morbidity and have substantial economic impact, but are treatable.
  • Many individuals with sleep disorders remain undiagnosed and untreated.
  • We recommend better education of professional transportation operators regarding obstructive sleep apnea (OSA), other sleep disorders and medications that may interfere with alertness.
  • Currently health care providers receive very little formal education on the importance of sleep to health or on the evaluation and management of common sleep disorders.
  • For children, we suggest that age-based recommendations for sleep duration be developed. These should enable the child to awaken spontaneously at the desired time through implementation of regular wake and sleep schedules.
  • For adolescents we suggest that school start times be delayed to align with physiological circadian propensity of this age group.
  • We recommend that health care providers receive a greater level of education on sleep hygiene and encourage patients to maximize their sleep time.
  • We recommend that public education programs be developed to emphasize the importance of sleep for good health.
  • We recommend better education/awareness for the general public and physicians regarding the importance of early identification of high-risk OSA groups (in children and adults) due to the profound public health implications of untreated OSA.
  • We recommend better education of physicians as to the effectiveness of cognitive behavior therapy for insomnia rather than immediate implementation of hypnotics and sedatives, and recommend structural changes to increase access to this treatment, including training of a wider range of health care providers and insurance coverage.

“These recommendations are based on a comprehensive review of the literature and the experience of a panel of clinicians and scientists with expertise in sleep health,” said Atul Malhotra, MD, president of the American Thoracic Society and a member of the team that produced the statement. “They provide an important framework for promoting healthy sleep on a wide scale, which would in turn generate a number of additional health and other benefits.”