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March 24, 1993, Vol 269, No. 12 >
ARTICLE | March 24, 1993

It's Time to Wake Up to the Importance of Sleep Disorders FREE

William C. Dement, MD, PhD; Merrill M. Mitler, PhD
[+] Author Affiliations

Reprint requests to Stanford University Sleep Disorders Center, 701 Welch Rd, Suite 2226, Palo Alto, CA 94304 (Dr Dement).


JAMA. 1993;269(12):1548-1550. doi:10.1001/jama.1993.03500120086032
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References

STUDIES indicate that as many as 80 million Americans who have serious, incapacitating sleep problems are being ignored—either because they do not report their symptoms or because physicians do not ask.1,2 Treatment of sleep complaints, such as insomnia, and sleep disorders, such as sleep apnea, are compromised by this apathy. The National Commission on Sleep Disorders Research, which was charged by a 1988 congressional mandate to evaluate the effect of sleep deprivation on American society, found that 95% of the 5 million to 10 million Americans with sleep apnea do not know they have sleep apnea and consequently face cardiovascular complications and sudden death.1 Even snoring, a phenomenon often thought of by those affected as benign, is associated with poor prognosis in individuals who are at risk for cardiovascular disease3 and also can increase risk of stroke.4 Individuals with chronic insomnia report 2.5 times as many

REFERENCES

1 +
Dement WC. Progress report: where are we now and where are we going? the National Commission on Sleep Disorders Research. Presented at the fifth annual meeting of the Association of Professional Sleep Societies; June 16, 1991; Toronto, Ontario.
2 +
Mellinger GD, Balter MB, Uhlenhuth EH.  Insomnia and its treatment: prevalence and correlates. Arch Gen Psychiatry . 1985;;42:225-232.
3 +
Zaninelli A, Fariello R, Boni E, Corda L, Alicandri C, Grassi V.  Snoring and risk of cardiovascular disease. Int J Cardiol . 1991;;32:347-352.
4 +
Palomaki H, Partinen M, Erkinjuntti T, Kaste M.  Snoring, sleep apnea syndrome, and stroke. Neurology . 1992;;42( (suppl 6) ):75-81.
5 +
The Gallup Organization. Sleep in America . Los Angeles, Calif: National Sleep Foundation; 1991;:1-30.
6 +
Seppälä T, Partinen M, Penttilä A, Aspholm R, Tiainen E, Kaukianen A.  Sudden death and sleeping history among Finnish men. J Intern Med . 1991;;229:23-28.
7 +
Ford DE, Kamerow DB.  Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention? JAMA . 1989;;262:1479-1484.
8 +
Mitler MM, Carskadon MA, Czeisler CA, et al.  Catastrophes, sleep and public policy: consensus report. Sleep . 1988;;11:100-109.
9 +
US Congress, Office of Technology Assessment. Biological Rhythms: Implications for the Worker . Washington, DC: Office of Technology Assessment; 1991;. Publication OTA-BA-463.
10 +
Jacques CHM, Lynch JC, Samkoff JS.  The effects of sleep loss on cognitive performance of resident physicians. J Fam Pract . 1990;;30:223-229.
11 +
Johnson LC, Spinweber CL.  Good and poor sleepers differ in navy performance. Mil Med . 1983;;148:727-731.
12 +
National Transportation Safety Board. Head-End Collision of Consolidated Rail Corporation Freight Trains UBT-506 and YV-61 Near Thompsontown, Pennsylvania, January 14, 1988 . Washington, DC: National Transportation Safety Board; 1988;. Railroad accident report.
13 +
National Transportation Safety Board. Safety Study: Fatigue, Alcohol, Other Drugs, and Medical Factors in Fatal-to-the-Driver Heavy Truck Crashes . Washington, DC: National Transportation Safety Board; February 5, 1990;:1.
14 +
National Safety Council. Accident Facts, 1991 Edition . Chicago, Ill: National Safety Council; 1991;.
15 +
Carskadon MA.  Patterns of sleep and sleepiness in adolescents. Pediatrician . 1990;;17:5-12.
16 +
Pollak CP, Perlick D.  Sleep problems and institutionalization of the elderly. J Geriatr Psychiatry Neurol. 1991;;4:204-210.
17 +
Coleman RM, Dement WC.  Falling asleep at work: a problem for continuing operations. Sleep Res . 1986;;15:265.
18 +
Lauber JK, Kayten PK.  Sleepiness, circadian dysrhythmia, and fatigue in transportation system accidents. Sleep . 1988;;11:503-512.
19 +
Report of the Presidential Commission on the Space Shuttle Challenger Accident . Washington, DC: National Aeronautics and Space Administration; 1986;;2:appendix G.
20 +
Koller M.  Health risks related to shift work: an example of time contingent effects on long-term stress. Int Arch Occup Environ Health . 1983;;53:59-75.
21 +
Knutsson A, Akerstedt T, Orth-Gomer K.  Increased risk of ischaemic heart disease in shift workers. Lancet . 1986;;2:89-92.
22 +
Akerstedt T.  Sleepiness as a consequence of shift work. Sleep . 1988;;11:17-34.
23 +
US Congress, Office of Technology Assessment. Gearing Up for Safety: Motor Carrier Safety in a Competitive Environment . Washington, DC: Office of Technology Assessment; 1988;. Publication OTA-SET-382.
24 +
Aldrich MS.  Automobile accidents in patients with sleep disorders. Sleep . 1989;; 12:487-494.
25 +
National Highway Traffic Safety Administration. Transportation-Related Sleep Research . Washington, DC: US Dept of Transportation; February 6, 1989.
26 +
Bartels EC, Kusakcioglu O.  Narcolepsy: a possible cause of automobile accidents. Lahey Clin Found Bull . 1965;;14:21-26.
27 +
Moore-Ede M, Campbell S, Baker T.  Falling asleep behind the wheel: research priorities to improve driver alertness and highway safety.  In: Proceedings of the Federal Highway Administration Symposium on Truck and Bus Driver Fatigue . November 29-30, 1988;; Washington, DC.
28 +
Dement WC, Carskadon MA, Richardson G.  Excessive daytime sleepiness in sleep apnea syndrome.  In: Guilleminault C, Dement W, eds. Sleep Apnea Syndromes . New York, NY: Alan R Liss Inc; 1978;:23-46.
29 +
 Driver asleep at the wheel, a bus crashes, injuring 23. New York Times . (April 11) , 1992. Metropolitan.
30 +
Schemo DJ.  School copes with shock after crash. New York Times . (April 13) , 1992;. Metropolitan.
31 +
Roehrs T, Zwyghuizen-Doorenbos A, Timms V, Zorick F, Roth T.  Sleep extension, enhanced alertness and the sedating effects of ethanol. Pharmacol Biochem Behav . 1989;;34:321-324.
32 +
Lumley M, Roehrs T, Asker D, Zorick F, Roth T.  Ethanol and caffeine effects on daytime sleepiness/alertness. Sleep . 1987;;10:306-312.
33 +
Gillin JC, Byerley WF.  The diagnosis and management of insomnia. N Engl J Med . 1990;;322:239-248.
34 +
Kales A, Kales JD. Evaluation and Treatment of Insomnia . New York, NY: Oxford University Press; 1984;.
35 +
Aldrich CK, Aldrich MS, Aldrich TK, Aldrich RF.  Asleep at the wheel. Postgrad Med J . 1986;;80:233-239.
36 +
Manheimer DI, Davidson ST, Baiter MB, Mellinger GD, Cisin IH, Parry HJ.  Popular attitudes and beliefs about tranquilizers. Am J Psychiatry . 1973;;130:1246-1253.
37 +
Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . Philadelphia, Pa: WB Saunders Co; 1989;.
38 +
Diagnostic Classification Steering Committee. International Classification of Sleep Disorders: Diagnostic and Coding Manual . Rochester, Minn: American Sleep Disorders Association; 1990;.
39 +
Gillin JC.  Relief from situational insomnia: pharmacologic and other options. Postgrad Med . 1992;;92:157-170.
40 +
Walsh JK, Mahowald MW.  Avoiding the blanket approach to insomnia: targeted therapy for specific causes. Postgrad Med . 1991;;90:211-224.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Dement WC. Progress report: where are we now and where are we going? the National Commission on Sleep Disorders Research. Presented at the fifth annual meeting of the Association of Professional Sleep Societies; June 16, 1991; Toronto, Ontario.
2 +
Mellinger GD, Balter MB, Uhlenhuth EH.  Insomnia and its treatment: prevalence and correlates. Arch Gen Psychiatry . 1985;;42:225-232.
3 +
Zaninelli A, Fariello R, Boni E, Corda L, Alicandri C, Grassi V.  Snoring and risk of cardiovascular disease. Int J Cardiol . 1991;;32:347-352.
4 +
Palomaki H, Partinen M, Erkinjuntti T, Kaste M.  Snoring, sleep apnea syndrome, and stroke. Neurology . 1992;;42( (suppl 6) ):75-81.
5 +
The Gallup Organization. Sleep in America . Los Angeles, Calif: National Sleep Foundation; 1991;:1-30.
6 +
Seppälä T, Partinen M, Penttilä A, Aspholm R, Tiainen E, Kaukianen A.  Sudden death and sleeping history among Finnish men. J Intern Med . 1991;;229:23-28.
7 +
Ford DE, Kamerow DB.  Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention? JAMA . 1989;;262:1479-1484.
8 +
Mitler MM, Carskadon MA, Czeisler CA, et al.  Catastrophes, sleep and public policy: consensus report. Sleep . 1988;;11:100-109.
9 +
US Congress, Office of Technology Assessment. Biological Rhythms: Implications for the Worker . Washington, DC: Office of Technology Assessment; 1991;. Publication OTA-BA-463.
10 +
Jacques CHM, Lynch JC, Samkoff JS.  The effects of sleep loss on cognitive performance of resident physicians. J Fam Pract . 1990;;30:223-229.
11 +
Johnson LC, Spinweber CL.  Good and poor sleepers differ in navy performance. Mil Med . 1983;;148:727-731.
12 +
National Transportation Safety Board. Head-End Collision of Consolidated Rail Corporation Freight Trains UBT-506 and YV-61 Near Thompsontown, Pennsylvania, January 14, 1988 . Washington, DC: National Transportation Safety Board; 1988;. Railroad accident report.
13 +
National Transportation Safety Board. Safety Study: Fatigue, Alcohol, Other Drugs, and Medical Factors in Fatal-to-the-Driver Heavy Truck Crashes . Washington, DC: National Transportation Safety Board; February 5, 1990;:1.
14 +
National Safety Council. Accident Facts, 1991 Edition . Chicago, Ill: National Safety Council; 1991;.
15 +
Carskadon MA.  Patterns of sleep and sleepiness in adolescents. Pediatrician . 1990;;17:5-12.
16 +
Pollak CP, Perlick D.  Sleep problems and institutionalization of the elderly. J Geriatr Psychiatry Neurol. 1991;;4:204-210.
17 +
Coleman RM, Dement WC.  Falling asleep at work: a problem for continuing operations. Sleep Res . 1986;;15:265.
18 +
Lauber JK, Kayten PK.  Sleepiness, circadian dysrhythmia, and fatigue in transportation system accidents. Sleep . 1988;;11:503-512.
19 +
Report of the Presidential Commission on the Space Shuttle Challenger Accident . Washington, DC: National Aeronautics and Space Administration; 1986;;2:appendix G.
20 +
Koller M.  Health risks related to shift work: an example of time contingent effects on long-term stress. Int Arch Occup Environ Health . 1983;;53:59-75.
21 +
Knutsson A, Akerstedt T, Orth-Gomer K.  Increased risk of ischaemic heart disease in shift workers. Lancet . 1986;;2:89-92.
22 +
Akerstedt T.  Sleepiness as a consequence of shift work. Sleep . 1988;;11:17-34.
23 +
US Congress, Office of Technology Assessment. Gearing Up for Safety: Motor Carrier Safety in a Competitive Environment . Washington, DC: Office of Technology Assessment; 1988;. Publication OTA-SET-382.
24 +
Aldrich MS.  Automobile accidents in patients with sleep disorders. Sleep . 1989;; 12:487-494.
25 +
National Highway Traffic Safety Administration. Transportation-Related Sleep Research . Washington, DC: US Dept of Transportation; February 6, 1989.
26 +
Bartels EC, Kusakcioglu O.  Narcolepsy: a possible cause of automobile accidents. Lahey Clin Found Bull . 1965;;14:21-26.
27 +
Moore-Ede M, Campbell S, Baker T.  Falling asleep behind the wheel: research priorities to improve driver alertness and highway safety.  In: Proceedings of the Federal Highway Administration Symposium on Truck and Bus Driver Fatigue . November 29-30, 1988;; Washington, DC.
28 +
Dement WC, Carskadon MA, Richardson G.  Excessive daytime sleepiness in sleep apnea syndrome.  In: Guilleminault C, Dement W, eds. Sleep Apnea Syndromes . New York, NY: Alan R Liss Inc; 1978;:23-46.
29 +
 Driver asleep at the wheel, a bus crashes, injuring 23. New York Times . (April 11) , 1992. Metropolitan.
30 +
Schemo DJ.  School copes with shock after crash. New York Times . (April 13) , 1992;. Metropolitan.
31 +
Roehrs T, Zwyghuizen-Doorenbos A, Timms V, Zorick F, Roth T.  Sleep extension, enhanced alertness and the sedating effects of ethanol. Pharmacol Biochem Behav . 1989;;34:321-324.
32 +
Lumley M, Roehrs T, Asker D, Zorick F, Roth T.  Ethanol and caffeine effects on daytime sleepiness/alertness. Sleep . 1987;;10:306-312.
33 +
Gillin JC, Byerley WF.  The diagnosis and management of insomnia. N Engl J Med . 1990;;322:239-248.
34 +
Kales A, Kales JD. Evaluation and Treatment of Insomnia . New York, NY: Oxford University Press; 1984;.
35 +
Aldrich CK, Aldrich MS, Aldrich TK, Aldrich RF.  Asleep at the wheel. Postgrad Med J . 1986;;80:233-239.
36 +
Manheimer DI, Davidson ST, Baiter MB, Mellinger GD, Cisin IH, Parry HJ.  Popular attitudes and beliefs about tranquilizers. Am J Psychiatry . 1973;;130:1246-1253.
37 +
Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . Philadelphia, Pa: WB Saunders Co; 1989;.
38 +
Diagnostic Classification Steering Committee. International Classification of Sleep Disorders: Diagnostic and Coding Manual . Rochester, Minn: American Sleep Disorders Association; 1990;.
39 +
Gillin JC.  Relief from situational insomnia: pharmacologic and other options. Postgrad Med . 1992;;92:157-170.
40 +
Walsh JK, Mahowald MW.  Avoiding the blanket approach to insomnia: targeted therapy for specific causes. Postgrad Med . 1991;;90:211-224.

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