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Long sleep and mortality: rationale for sleep restriction
Abstract
Epidemiologic studies have consistently shown that sleeping >8 h per night is associated with increased mortality. Indeed, the most recent American Cancer Society data of 1.1 million respondents showed that sleeping longer than 7.5 h was associated with approximately 5% of the total mortality of the sample. The excess mortality was found even after controlling for 32 potentially confounding risk factors. Although epidemiologic data cannot prove that long sleep duration causes mortality, there is sufficient evidence to warrant future testing of the hypothesis that mild sleep restriction would decrease mortality in long sleepers. Sleep restriction might resemble dietary restriction as a potential aid to survival. Sleep restriction has several potential benefits besides possible enhanced survival. Acute sleep restriction can have dramatic antidepressant effects. Also, chronic sleep restriction is perhaps the most effective treatment for primary insomnia. Conversely, spending excessive time in bed can elicit daytime lethargy and exacerbate sleep fragmentation, resulting in a vicious cycle of further time in bed and further sleep fragmentation. Sleep restriction may be most beneficial for older adults, who tend to spend excessive time in bed and have more sleep fragmentation compared with young adults.
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“Sleep duration and mortality are associated in a U-shaped fashion, where lowest risk is usually found in those who sleep between 7-8 hours, and mortality risk increasing with further deviation on either end of the range.”
From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [13]
In the citing paper
“Also, there is still a lack of clarity on the biological plausibility of the long sleep relationship, although some ideas have been proposed.37,38”
From Sleep, Health, and Society (2017) · cites this paper as [37]
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Stenholm, S., Kronholm, E., Sainio, P., Borodulin, K., Era, P. A., Fogelholm, M., Partonen, T., Porkka‐Heiskanen, T., & Koskinen, S. V. P. (2010) · The Journals of Gerontology Series A · doi:10.1093/gerona/glq017 · Cited by 108
Sleep Duration, Nap Habits, and Mortality in Older Persons
Cohen‐Mansfield, J., & Perach, R. (2012) · SLEEP · doi:10.5665/sleep.1970 · Cited by 103
Sleep, aging, and lifespan in Drosophila
Bushey, D., Hughes, K. A., Tononi, G., & Cirelli, C. (2010) · BMC Neuroscience · doi:10.1186/1471-2202-11-56 · Cited by 100
“For instance, if short sleep causes heart disease, controlling for a history of heart disease might obscure the underlying effect of sleep duration [3,13].”
Backgroundas the Sleep Disturbance Expert Panel on behalf of the Cancer Journey Advisory Group of the Canadian Partnership Against Cancer, Howell, D., Oliver, T. K., Keller-Olaman, S., Davidson, J. R., Garland, S. N., Samuels, C. H., Savard, J., Harris, C. A., Aubin, M., et al. (2013) · Supportive Care in Cancer · doi:10.1007/s00520-013-1823-6 · Cited by 100
Physical Activity and Cognition: A Mediating Role of Efficient Sleep
Wilckens, K. A., Erickson, K. I., & Wheeler, M. E. (2016) · Behavioral Sleep Medicine · doi:10.1080/15402002.2016.1253013 · Cited by 115
“…and greater sleep fragmentation that can occur with longer sleep durations (Harrison & Horne, 1996; Monk, Buysse, Begley, Billy, & Fletcher, 2009; Youngstedt & Kripke, 2004) and the greater likelihood of progressing through sleep stages that benefit the prefrontal cortex with higher sleep…”
BackgroundSleep Problems and Associated Daytime Fatigue in Community-Dwelling Older Individuals
Goldman, S. E., Ancoli‐Israel, S., Boudreau, R. M., Cauley, J. A., Hall, M. H., Stone, K. L., Rubin, S. M., Satterfield, S., Simonsick, E. M., Newman, A. B., et al. (2008) · The Journals of Gerontology Series A · doi:10.1093/gerona/63.10.1069 · Cited by 100
Ramos, A. R., Dong, C., Rundek, T., Elkind, M. S. V., Boden-Albala, B. M., Sacco, R. L., & Wright, C. B. (2014) · Journal of Sleep Research · doi:10.1111/jsr.12177 · Cited by 99
“actigraphy or polysomnography), but epidemiological studies of long sleep and adverse health outcomes are based mainly on subjective reports from questionnaires (Youngstedt and Kripke, 2004).”
BackgroundJung, K.-I., Song, C.-H., Ancoli‐Israel, S., & Barrett-Connor, E. L. (2012) · Sleep Medicine · doi:10.1016/j.sleep.2012.06.004 · Cited by 97
“Other possible explanations why long sleep duration predicts increased mortality have been suggested [29]; a long time awake in bed is associated with increased sleep fragmentation, which may cause poor health [29].”
BackgroundNicholson, K., Rodrigues, R., Anderson, K. K., Wilk, P., Guaiana, G., & Stranges, S. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.07.002 · Cited by 99
Prevalence of sleep duration among Saudi adults
Ahmed, A. E., Al-Jahdali, F., Alalwan, A., Abuabat, F., Salih, S. B., Al-Harbi, A., Baharoon, S. A., Khan, M., Ali, Y. Z., & Al-Jahdali, H. H. (2017) · Saudi Medical Journal · doi:10.15537/smj.2017.3.17101 · Cited by 97
SLEEP AND METABOLIC CONTROL: WAKING TO A PROBLEM?
Trenell, M. I., Marshall, N. S., & Rogers, N. L. (2006) · Clinical and Experimental Pharmacology and Physiology · doi:10.1111/j.1440-1681.2007.04541.x · Cited by 94
“Collectively, these studies expose a U-shaped relationship between sleep duration and all cause mortality, suggesting that there may be an optimal sleep duration for healthy living.(24) More specific studies have examined the relationship between sleep duration and metabolic/cardiovascular complications (Table 1).”
BackgroundChen, H., Su, T., & Chou, P. (2013) · SLEEP · doi:10.5665/sleep.2884 · Cited by 91
Association between Sleep Duration and the Mini-Mental Score: The Northern Manhattan Study
Ramos, A. R., Dong, C., Elkind, M. S. V., Boden-Albala, B. M., Sacco, R. L., Rundek, T., & Wright, C. B. (2013) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.2834 · Cited by 91
Night eating syndrome: implications for severe obesity
Cleator, J., Abbott, J., Judd, P. A., Sutton, C., & Wilding, J. P. H. (2012) · Nutrition and Diabetes · doi:10.1038/nutd.2012.16 · Cited by 95
Age-related changes in sleep in inbred mice are genotype dependent
Hasan, S., Dauvilliers, Y., Mongrain, V., Franken, P., & Tafti, M. (2012) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2010.05.010 · Cited by 92
Duration of sleep and breast cancer risk in a large population‐based case–control study
McElroy, J. A., Newcomb, P. A., Titus-Ernstoff, L. T., Trentham‐Dietz, A., Hampton, J. M., & Egan, K. M. (2006) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2006.00523.x · Cited by 92
“As reviewed by Youngstedt and Kripke (2004), the association of sleep with overall mortality has generally been attributed to general poor health or depression in persons with longer sleep durations rather than indicating a direct biological influence of sleep time on health.”
BackgroundStenholm, S., Kronholm, E., Bandinelli, S., Guralnik, J. M., & Ferrucci, L. (2011) · Sleep · doi:10.5665/sleep.1402 · Cited by 88
“Sleep/rest behavior was categorized as following: (1) TST 7-8 h and TIB 7-8 h (true mid-range sleepers; reference group); (2) TST ≤ 6 h and TIB ≤ 8 h (true short sleepers); (3) D ow naded rom http/academ ic.”
BackgroundMethodKakinami, L., O’Loughlin, E. K., Brunet, J., Dugas, E. N., Constantin, E., Sabiston, C. M., & O’Loughlin, J. L. (2016) · Sleep Health · doi:10.1016/j.sleh.2016.11.001 · Cited by 95
“Problems with sleep quality or sleep quantity are associated with lower self-rated health, obesity, poorer mental health,(13) and mortality.(14)”
BackgroundNicotine dependence and sleep quality in young adults
Dugas, E. N., Sylvestre, M., O’Loughlin, E. K., Brunet, J., Kakinami, L., Constantin, E., & O’Loughlin, J. L. (2016) · Addictive Behaviors · doi:10.1016/j.addbeh.2016.10.020 · Cited by 92
Chen, L.-J., Hamer, M., Lai, Y.-J., Huang, B.-H., Ku, P.-W., & Stamatakis, E. (2022) · Journal of Sport and Health Science · doi:10.1016/j.jshs.2021.03.001 · Cited by 82
Current lifestyle factors that increase risk of T2DM in China
Zhang, N., Du, S., & S, G. (2017) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2017.41 · Cited by 82
Knowlden, A. P., Sharma, M., & Bernard, A. L. (2012) · The Journal of Primary Prevention · doi:10.1007/s10935-012-0263-2 · Cited by 82
Sleep duration and risk of all-cause mortality: a systematic review and meta-analysis
García‐Perdomo, H. A., Zapata-Copete, J. A., & Cerón, C. A. R. (2018) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796018000379 · Cited by 79
Sleep disturbances in caregivers of patients with advanced cancer: A systematic review.
Maltby, K. F., Sanderson, C. R., Lobb, E. A., & Phillips, J. L. (2017) · Palliative & Supportive Care · doi:10.1017/s1478951516001024 · Cited by 76
Long and Short Sleep Duration and Physical Frailty in Community-Dwelling Older Adults
Nakakubo, S., Makizako, H., Doi, T., Tsutsumimoto, K., Hotta, R., Lee, S., Lee, S., Bae, S., Makino, K., Suzuki, T., et al. (2018) · The journal of nutrition health & aging · doi:10.1007/s12603-018-1116-3 · Cited by 76
Long Sleep Duration is Associated With Serum Cholesterol in the Elderly: The Rotterdam Study
van den Berg, J. F., Miedema, H., Tulen, J. H. M., Neven, A. K., Albert Hofman, D., Witteman, J. C. M., & Tiemeier, H. W. (2008) · Psychosomatic Medicine · doi:10.1097/psy.0b013e318186e656 · Cited by 75
Matthews, K. A., Zheng, H., Matthews, K. A., Kravitz, H. M., Sowers, M., Bromberger, J. T., Buysse, D. J., Owens, J. F., Sanders, M., & Hall, M. (2010) · SLEEP · doi:10.1093/sleep/33.12.1649 · Cited by 77
“Median (IQR) age (years) 52 (3) 52 (4) 52 (3) 53 (3) 0.”
Napping, Nighttime Sleep, and Cardiovascular Risk Factors in Mid-Life Adults
Owens, J. F., Buysse, D. J., Hall, M. H., Kamarck, T. W., Lee, L., Strollo, P. J., Reís, S. E., & Matthews, K. A. (2010) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27873 · Cited by 74
Yang, X., Chen, H., Li, S., Pan, L., & Jia, C. (2015) · Heart Lung and Circulation · doi:10.1016/j.hlc.2015.08.005 · Cited by 76
Sleep Characteristics of Self-Reported Long Sleepers
for the Osteoporotic Fractures in Men (MrOS) Research Group, Patel, S. R., Blackwell, T., Ancoli-Israel, S., & Stone, K. L. (2012) · SLEEP · doi:10.5665/sleep.1822 · Cited by 71
“Variables estimated from actigraphy included: (1) total sleep time (TST): the hours per night spent sleeping while in bed after “lights off”; (2) time in bed (TIB): the time from “lights off” to the time the participant got out of bed; (3) total nap time (TNT): the minutes scored as sleeping between the last time out…”
Method
Metadata
- Authors
- Youngstedt, S. D., & Kripke, D. F.
- Affiliations
- University of South Carolina (US)
- University of California San Diego (US)
- Corresponding author
- Youngstedt, Shawn D.
- ORCID
- Kripke, Daniel F.
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2004-06
- Volume
- 8
- Issue
- 3
- Pages
- 159-174
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2081485580
- Cited by
- 324
- References
- 105
- Citations by year
- 2026: 4 · 2025: 15 · 2024: 12 · 2023: 9 · 2022: 15 · 2021: 8 · 2020: 21 · 2019: 17 · 2018: 17 · 2017: 23 · 2016: 19 · 2015: 13 · 2014: 13 · 2013: 21 · 2012: 17
- FWCI
- 13.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Scholar Commons (University of South Carolina) (submittedVersion)
- Funders
- National Institutes of Health
- National Institute on Aging (R01AG012364, AG-12364)
- National Heart, Lung, and Blood Institute (HL-71560, R01HL071560)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- long sleep, mortality, sleep restriction, excessive sleep, time in bed, sleep fragmentation, insomnia treatment, dietary restriction, older adults
- MeSH terms
- Aging, Antidepressive Agents, Circadian Rhythm, Humans, Sleep Wake Disorders, Time Factors, Polysomnography
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