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deprivation makes us dangerously less healthy. About 60% of
men who suﬀer a heart attack also have a sleep disorder. Adults
who have trouble falling asleep are involved in a third more fatal
car accidents than those who do not have trouble. And those
with symptoms of insomnia are nearly three times more likely
to die from a fatal injury. Sleep deprivation also makes us more
susceptible to garden-variety illnesses, like the common cold.
Sleep deprivation has a major impact on our ability to regulate our weight. In a Mayo Clinic study, sleep-restricted subjects
gained more weight than their well-rested counterparts over the
course of the week, consuming an average of 560 extra calories
a day. People who get 6 hours of sleep a night are nearly 25%
more likely to be overweight than those who get more than that.
Getting <4 hours of sleep per night increases the likelihood of
being overweight by nearly 75%. In other words, cutting back
on sleep is a fantastic way to gain weight.
And sleep deprivation plays havoc with our skin. In a Swedish
study, untrained participants were asked to look at sleep-deprived
and well-rested people. Participants judged those in the sleepdeprived group as "less healthy, more tired, and less attractive."
The skin was analyzed and photographed after they slept for
8 hours and then again after sleeping 6 hours for 5 nights in a
row. Fine lines and wrinkles increased by 45%, blemishes went
up by nearly 15%, and redness increased by nearly 10%. In other
words, we wear our lack of sleep on our faces.
Good sleep is also a key to mental health. Sleep aﬀects our
mental health every bit as profoundly as it does our physical
health. Sleep deprivation has a strong connection with practically every mental health disorder, especially depression and
anxiety. One study showed that sleep-deprived people were
7 times more likely to experience feelings of helplessness and
5 times more likely to feel lonely than controls. Sleep deprivation takes a toll on our mental abilities. Our cognitive performance is reduced greatly, memory capacity is reduced, and
social competence is reduced. In just 2 weeks of getting 6 hours
of sleep per night, the performance drop-oﬀ is the same as going 24 hours without sleep. For those getting just 4 hours, the
impairment is equivalent to going 48 hours without sleep. The
side eﬀects of not getting enough sleep include having diﬃculty
concentrating, losing interest in hobbies and leisure activities,
falling asleep at inappropriate times throughout the day, losing our temper or behaving inappropriately with children or
partners, and behaving inappropriately at work.
In terms of driving while drowsy, one study found that after
being awake from 17 to 19 hours, we can experience levels of
cognitive impairment equal to having a blood alcohol level of
0.5% (just under the legal limit in many US states). And, if we
are awake just a few hours more, we are up to the equivalent
of 0.1%-legally drunk. There is of course a roadside test for
drunk driving; there is no equivalent test for sleep-deprived
driving. Awareness of the impact of sleep deprivation on driving is important. Nearly 60% of train operators, 50% of pilots,
44% of truck drivers, and 29% of bus and taxi drivers admit
that they never or rarely get a good night's sleep on work nights.
So why do we tolerate, much less venerate and applaud,
sleep deprivation? In much of our culture, especially in the
April 2017

workplace, going without sleep is considered a badge of honor.
Yet since the eﬀects of sleepiness are largely the same as those
of being drunk, when we get behind the wheel of a car without
enough sleep, we are engaging in behavior that is dangerous
to both ourselves and others. Sleepiness-related motor vehicle
crashes have a fatality rate and injury severity level similar to
those of alcohol-related crashes. Drowsy drivers are involved
in 330,000 accidents each year, 6400 of which result in death.
Sleep experts have a name for the phenomenon of nodding
oﬀ: "microsleep." Microsleep occurs when we unknowingly fall
asleep from a few seconds to a minute or so. It is a terrifying
phenomenon when one is behind the wheel of a car. Imagine
commuting home from work driving down the highway at
60 miles per hour. At that speed, the car is traveling 88 feet per
second. If your eyes close for only 4 seconds, your car has traveled roughly the length of a football ﬁeld before you jerk awake,
and the consequences, of course, can be deadly. And nowhere
is this truer than in the trucking industry. There are now an
estimated 2 million truckers on our highways, and accidents
involving trucks and buses are responsible for 4000 deaths and
>100,000 injuries in the US each year. More than 60% of the
drowsy drivers involved in fatal crashes were driving trucks,
and nearly half of all truckers have said in a survey that they
had fallen asleep behind the wheel in the previous year. Several
states are considering measures that would make driving while
sleep deprived a criminal oﬀense.
Airlines have stricter standards, with rules mandating speciﬁc
rest periods for commercial pilots between ﬂights and dictating
how many hours they are allowed to ﬂy in a given period of
time. One pilot of a Boeing 747 said in the PBS documentary
Sleep Alert, "It is not unusual for me to fall asleep in the cockpit,
wake up 20 minutes later and ﬁnd the other two crew members
totally asleep." Luggage screeners deteriorate rapidly when they
are sleep deprived. Air traﬃc controllers averaged only 5.8 hours
sleep per night, which dropped to 3.25 hours per night when
they worked overnight shifts. Of the controllers who made safety
errors on the job, 56% attributed the mistake to fatigue. Train
accidents from sleep deprivation also occur.
Of course, physicians and nurses commonly are sleep deprived. Sleep-deprived health care workers show less empathy,
among other consequences. Sleep-deprived adolescents (those
getting <7 hours of sleep per night) were at a higher rate of failing and had higher dropout rates than those sleeping >7 hours
nightly. Politicians, soldiers, and law enforcement oﬃcers are
burdened considerably with sleep deprivation.
I found the book to be superb. Every page is loaded. And she
advises how to sleep better. She has never taken a sleeping pill.
BELLEVUE
David Oshinsky, who previously authored Polio: An
American Story, has produced a terriﬁc book entitled Bellevue:
Three Centuries of Medicine and Mayhem at America's Most
Storied Hospital (2). Th e information that follows comes
entirely from his 2016 book.
Bellevue started as a small inﬁrmary built in the 1660s for
soldiers overcome with "bad smells and ﬁlth," and it was replaced

Facts and ideas from anywhere

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Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings April 2017