Chapter 15: Society Causes Sleep Deprivation

Sleep deprivation goes far beyond our individual sleep practices. Our society has structurally locked in sleep deprivation in 4 ways.

Work Schedules Disrupt Sleep

The ethos at many companies sees sleep as an indulgence for the weak. They lionize the road warrior who fearlessly crosses time zones on tiny amounts of sleep and answers emails at 1AM. In their minds, more hours worked = more productivity.

This is short-sighted. The effects of sleep deprivation are costly to employers:

• Lost productivity per sleep-deprived worker is in the thousands of dollars a year. The author argues insufficient sleep costs 2% of GDP.
  • In a natural experiment studying workers on opposite edges of a time zone, workers who obtained an hour of extra sleep earned 5% higher wages.
• Sleep-deprived workers show bad traits:
  • Reduced work performance, creativity, motivation, social cohesion.
  • Increased risk-taking, impulsiveness, and desire to cheat.
• Leaders who sleep worse are rated worse by their team and caused less engagement in their workers. This is visible day-by-day -- poor sleep one night is immediately seen as worse performance the next day.
• Workers who sleep less rate their leaders as less charismatic, regardless of the leader’s sleep level (thus forming a multiplicative effect where sleepless leaders and workers make everyone miserable).
• Insidiously, workers don’t perceive themselves as performing worse when sleep deprived.

Another vicious cycle: people sleep less because of the amount of work they have to do, but their low sleep reduces their productivity and increases the work remaining.

Solutions for employers:

• Focus less on hours worked, but on real productivity and output.
• Let people have flexible work hours to suit personal circadian rhythms. Don’t punish night owls more than morning people.
• Add nap pods and adaptive office lighting to better suit sleep.

School Schedules Disrupt Sleep

To match parent’s schedules, primary/secondary school often begins at 8AM, sometimes 7AM. Kids who need to catch a long bus ride have to wake at 5:30AM or earlier.

Remember that children have delayed circadian rhythms. This is akin to forcibly waking adults at 3:30AM everyday. Kids these days are sleeping two hours less per night, compared to children a century ago.

Kids with lower sleep show lower motivation, academic performance, test scores, IQ, as well as greater irritability, distraction, anxiety, substance abuse, and risk of traffic accidents.

Unfortunately, kids from poorer families are less likely to be driven to school, so they need to wake up even earlier.

Many kids diagnosed with ADHD may actually have sleep disorders (the author estimates >50% are misdiagnosed). Unfortunately, they’re treated with amphetamine (Adderall), causing even worse sleep problems.

Society should push to change school schedules to better match the circadian rhythm of kids.

Medical Training Schedules Disrupt Sleep

The medical residency training system began with a cocaine-addicted surgeon (William Halsted) in New York in the 1880s. Viewing sleep as the enemy, he instituted 30-hour shifts.

Sleep-deprived residents show a greater risk of medical errors, surgical errors, misdiagnoses, and careless deaths. (Recall that after 22 hours without sleep, performance is impaired to the same level as being legally drunk.)

First-year residents are now limited to 24-hour shifts and 80-hour weeks. Later-year residents have no such restriction, since the ACGME claims the medical error studies were done only on first-year residents.

Structurally, the medical system resists change for fear of limiting training volume. Also, older doctors may fear this encourages laziness, relative to what the attending doctors had to suffer through.

Sleep Deprivation is Used for Torture

Sleep deprivation torture is recognized by many countries as unethical, but still practiced by others (like the US in Abu Ghraib).

According to the author, sleep deprivation doesn’t even work well. It reduces the quality of information (harms memory recall) and increases the risk of lying and false confessions in a desperate hope to get some sleep.