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Preston Wiebe

Mrs. Gatfield

Senior Thesis

6 May 2021

Sleep Duration on Health and Mortality

Getting good sleep is the elusive goal that’s in the back of everyone’s mind. Always

overridden and procrastinated, getting the dreaded ‘8 hours’ is something commonly pushed

back day by day as more wakeful activities are deemed more important. With how busy daily life

can get in such a fast-paced society, it makes sense that more and more Americans are getting

less than optimal amounts of sleep. According to NPR, researchers from Ball State University

found that “the prevalence of inadequate sleep [...] increased from 30.9% in 2010 to 35.6% in

2018,” (Neighmond). It’s clear that American’s aren't getting any better at maintaining healthy

sleep schedules. Everyone has seen various numbers thrown around and has heard it said that

good sleep is crucial for good health, but how much weight do these claims carry? Does getting a

good amount of sleep actually have a positive effect on one’s health and lifespan? And even

scarier, does a poor amount of sleep have a negative effect on these things? The evidence is

frighteningly compelling that it does. While the science of sleep is relatively young, vast

numbers of studies repeatedly come to a strong consensus. 7-9 hours of sleep is optimal for the

average adult, and is not only strongly correlated with better physical and mental health, but

shows a positive u-shaped correlation with the risk of all-cause mortality, strongly affirming the

claim that an optimal sleep quantity is one of the most crucial factors for good health and

longevity. This means that those who get the sleep that their bodies need tend to be healthier and

live longer than their counterparts who do not get as much sleep.
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For comprehension, it’s important to understand some background knowledge on the

science of sleep and the nature of the majority of sleep studies. To start, the CDC states that “[...]

adults need 7 or more hours of sleep per night for the best health and wellbeing,” with adults

being the ages 18-60 (CDC.gov). The CDC cites two major studies in which a panel of experts

from a variety of medical fields was assembled and discussed sleep amounts for a range of age

groups. Each study took the opinions of over a dozen experts as well as countless research

sources. The first study, done by the National Sleep Foundation, found that adults ages 18-60

should get 7-9 hours of sleep for optimal health (Hirshkowitz). The second study, done by the

American Academy for Sleep Medicine, found that “adults should sleep 7 or more hours per

night on a regular basis to promote optimal health,” (Watson). It is widely accepted that the

optimal range of sleep for adults is 7-9 hours, and for the purposes of this paper, ‘optimal sleep’

will refer to these findings. On a more terminological basis, there are a handful of definitions that

are valuable to know. ‘Short sleep’ refers to sleep that is beyond the low end of this optimal

range. For almost all research studies, this means less than 7 hours of sleep for adults. ‘Long

sleep’ means the opposite, referring to more than 9 hours for most studies, but sometimes

referring to more than 10 hours of sleep. Finally, many studies on sleep and health discuss a ‘u-

shaped correlation.’ This simply refers to a correlation in the shape of a parabola where the

results in regard to one factor go down and back up along with the increase of the related factor.

In the context of medical studies, this often pertains to the effect on one aspect of health or

biological function under the increasing influence of another factor.

All of that said, the first area in which achieving optimal sleep has an affect on good

health and longevity is physical health. Optimal sleep and physical wellbeing are closely

intertwined, as sleep is the time in which the body repairs tissues and the immune system
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recovers from (and prepares for) its task of keeping one safe. It is no secret that good physical

health is the desire of nearly everyone as evidenced by the culture surrounding exercise and

dieting. Taking actions to be physically healthy is an important concept to modern society.

Unfortunately, the idea that sleep habits can have a drastic effect on one’s health is often lost

amidst the countless diets and workout routines, simply because sleeping doesn’t seem to have

much of an effect on appearance. What that says about society is a discussion for another time,

but having a strong sleep schedule is just as important to physical health as eating a good diet

and getting good exercise. According to the National Institute of Health, sleep is when the body

repairs itself and rests from the day’s activities. While someone sleeps their “body increases the

supply of blood to [the] muscles [and] performs tissue growth and repair,” (NICHD). The reason

one feels physically tired at the end of a long day or sore after a good workout is because the

tissues have been broken down and need to be restored. The best time for the body to do this is

while one is asleep and their muscles are at rest. Sleep is not only important to the body’s

recovery but is also critical to immune health, which in turn keeps the body safe from sickness

and disease. In an article published in Pflügers Archiv - European Journal of Physiology,

researchers explored the effects of sleep on immune functions by looking at immune cell activity

during sleep. The article states:

Sleep and the circadian system are strong regulators of immunological processes. The

basis of this influence is a bidirectional communication between the central nervous and

immune system which is mediated by shared signals [...] and direct innervations of the

immune system by the autonomic nervous system. Many immune functions display

prominent rhythms in synchrony with the regular 24-h sleep–wake cycle, reflecting the

synergistic actions of sleep and the circadian system on these parameters. (Besedovsky)
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As stated, there is a strong connection between the circadian rhythm and the immune system.

Immune cells and hormones pertinent to the immune system are active when the body is at rest

and work in close correlation with the body’s central nervous system under the influence of the

circadian rhythm. The researchers concluded that “Prolonged sleep curtailment and the

accompanying stress response invoke a persistent unspecific production of pro-inflammatory

cytokines [...] and also produce immunodeficiency, which both have detrimental effects on

health,” (Besedovsky). This shows that when the closely intertwined rhythm of the immune

system and circadian rhythm is disrupted, the immune system cannot properly keep up with its

task of keeping the body safe, thus exposing an individual to potential sickness or disease. When

this happens, individuals are at a much higher risk of developing the many common health

problems that plague adults and the elderly. The National Institute of Health states that “sleep

deficiency is linked to many chronic health problems, including heart disease, kidney disease,

high blood pressure, diabetes, stroke, obesity, and depression,” (NHLBI). Problems such as these

are at the pinnacle of importance to physical health. While such health conditions have many

factors, one may be able to reduce the risk of developing one and keep themselves far more

physically healthy simply by working to get optimal sleep on a consistent basis. When this is

done, the body is far more equipped to defend itself against illness and prevent such issues from

forming.

As can be seen, sleep does more than just help one to feel physically refreshed; it allows

the body to repair and allows the immune system to work properly. By getting the optimal

amount of sleep, the body is allowed the best amount of time to repair damaged tissues and keep

immunity strong, both key parts of physical health. When sleep is neglected for too long, the

body will be physically fatigued and weak to sickness or disease. While these factors are too fine
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and complex to track perfectly down to health events and the outcome of one’s life, it is obvious

that living in a state of physical fatigue and immune weakness is detrimental to physical health in

both the short term and the long.

Physical health is not the only aspect of one’s well-being that is affected by getting the

right amount of sleep. Mental health is strongly affected by sleep as well. According to Dr.

Alexander J. Scott, a researcher at Sheffield University, the relationship between mental health

and sleep goes hand in hand. Dr. Scott wrote an article setting up the protocol for a meta-analysis

of studies on sleep and mental health. He writes, “traditionally, sleep problems have been viewed

as a consequence of mental health problems. Although this is not contested, evidence also

suggests that problems sleeping can contribute to the formation of new mental health problems

and to the maintenance of existing ones,” (Scott). The relationship between mental health and

sleep is complex and seems to be bidirectional, with mental health affecting sleep as well as

sleep affecting mental health. This relationship is intricate and research is still young, but

evidence suggests that problems with sleep can not only be a symptom of underlying mental

health issues, but that trouble sleeping can actually lead to mental health issues on its own.

According to Medical News Today, a systematic review of studies pertaining to insomnia and

mental health found that “insomnia preceded the development of not only depression but also

bipolar disorder and anxiety disorders” (Kingsland). This may mean that insomnia is an early

symptom of such mental disorders, but may also mean that insomnia has the potential to lead to

such things as well. This complex relationship can become a downward cycle of mental health

issues and sleep problems. Because of this, if one struggles with a mental health disorder and has

difficulty sleeping because of it, it can be hard to prescribe good sleep as a treatment for the

symptoms.
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All of that said, there is strong evidence of a positive influence of good sleep on one’s

mental health. Whether one is being treated for a mental illness or not, good sleep should always

be a top priority for staying mentally healthy. An article by Harvard Medical School writes,

“neuroimaging and neurochemistry studies suggest that a good night's sleep helps foster both

mental and emotional resilience, while chronic sleep deprivation sets the stage for negative

thinking and emotional vulnerability,” (Harvard Health). Mental and emotional resilience are key

factors in mental health, and in their absence, people may be more vulnerable to mental illness. It

is well documented that taking steps to be emotionally and mentally resilient can help one avoid

the snares of mental illness and can even help one to overcome such things when they are

troubled by them. Even though mental health is complex and has to do with a lot more than just

sleep, taking that small step to try and achieve better sleep hygiene can have resounding effects

both in the short and long term. The brain is a complex system that science is only just beginning

to understand, but the importance of sleep to the mental and emotional functions is not entirely in

the dark. By getting optimal sleep, the brain will be kept healthier and will be less likely to

develop a mental illness in the face of stress, as well as be less likely to succumb to the mental

and emotional strain that such illnesses can put on the brain and body.

Finally, getting optimal sleep has a positive effect on one’s longevity, with evidence

showing that consistently getting enough sleep can go as far as to reduce the risk of death. It

makes sense that longevity would be affected by sleep, considering the evidence for its effect on

physical and mental health, but the evidence of a connection between nightly sleep duration and

risk of all-cause mortality is overt. In 2010, an article was published in the academic journal,

Sleep. The study was a systematic review and meta analysis of previous research studies on sleep

and mortality. The concept behind it was that there had been numerous studies done in the past,
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but that all of them were done at different times, with different populations and methods, and

ended with slightly different results. Thus, these results and experiments from around the world

needed to be researched, deemed reliable, and combined to reach a more universal conclusion

before a strong connection could be drawn. Dr. Cappuccio and his team conducted one of the

first systematic reviews and meta analyses of sleep and mortality studies. They scoured major

databases for publications, sorting out studies that researched all-cause mortality, had strong

follow-ups, and had provable mortality events as the outcome of the research. The result of the

search was 16 studies from around the world with a variety of populations. These studies were

then analyzed extensively to determine if there was a strong correlation between sleep and

mortality, consistent throughout various populations and methods of study. This is an excerpt

from the discussion of the article, going over results:

Our study shows an unambiguous and consistent pattern of increased risk of dying on

either end of the distribution of sleep duration. Pooled analyses indicate that short

sleepers (commonly < 7 h per night, often < 5 h per night) have a 12% greater risk, and

long sleepers (commonly > 8 or 9 h per night) a 30% greater risk of dying than those

sleeping 7 to 8 h per night. These results confirm the presence of a U-shaped association,

with some heterogeneity among studies, no presence of publication bias, and a high

statistical power conferred by over 1.3 million participants included with more than

110,000 events [of mortality]. (Cappuccio)

The evidence is powerful and the connection obvious. For 16 separate and independent studies to

consistently support each other in the correlation between mortality and sleep, there must be a

strong biological connection. Even with the specific nature of each study varying slightly, the

over 1.3 million cumulative participants from many populations and walks of life showed
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together that achieving the optimal range of sleep for adults has a notable effect on one’s risk of

dying. Not only do the studies agree with each other, but they put forth shockingly significant

numbers. Those achieving short sleep on a regular basis were at a 12% higher risk of dying and

those achieving long sleep had a 30% higher risk of mortality than their optimally sleeping

counterparts. The study went on to discuss the implications of these results, saying that, when

causally related, these numbers equate to “over 6.3 million attributable deaths in the UK in

people over 16 years of age and over 25 million attributable deaths in the US in people over the

age of 20 years,” (Cappuccio). These are frightening numbers. Even though the lack of sleep is

not the direct cause of mortality, the connection between the two is far too notable to be

disregarded. This proves that sleep deprivation has enough of a negative impact on health to

shorten one’s entire lifespan, likely through the effects of physical illness and vulnerability to

disease or health problems. Evidence strongly suggests that people could live longer and

healthier lives and that millions of people could be better off in the long run if they worked to

consistently get better sleep. These findings are further backed up by numerous other meta

analyses and systematic reviews from other researchers. Since Dr. Cappuccio’s study was

published, numerous other reviews and analyses have been conducted, bringing even more

research to the table as more studies have been carried out with various populations. Two

particularly notable studies were published by a team of Japanese researchers who looked at

short and long sleep individually. The team, led by Dr. Osamu Itani and Dr. Maki Jike, used a

similar method as was used in other analyses: databases were searched for appropriate studies

and the data was compiled to observe the strength of the connection between sleep and mortality.

The short sleep analysis examined 153 different studies and the long sleep analysis examined 95

studies. The results found were strikingly similar to the original findings in Dr. Cappucio’s
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study, despite taking into account at least 6 times the amount of published research and using

even more recent data. The team concluded that “Short sleep was significantly associated with

the mortality outcome (RR, 1.12; 95% CI, 1.08–1.16),” (Itani), and that “Long sleep duration

was associated with greater mortality [...] with a point estimate RR of [..] 1.39,” (Jike). These

numbers convert to a 12% higher risk of mortality for short sleepers and a 39% higher risk of

mortality for long sleepers, matching Dr. Capuccio’s study with short sleep and exceeding the

risk he found for long sleep by 9%. These numbers serve to further back up the claim that sleep

duration has an effect on mortality, not only when one doesn’t get enough sleep, but when one

gets too much sleep as well.

It’s worth discussing that most sleep studies (including the studies researched by the three

meta analyses previously mentioned) use a questionnaire-based system for researching the sleep

habits of its participants. With thousands of participants who are trying to live normal lives, it

would be difficult to study their sleep patterns through the use of technologically specific sleep

studies that might be done at a sleep clinic. That said, the questionnaires are quite in depth and

done at varying intervals to ensure their validity. And the trend still stands in the end, despite the

fact that there was no guarantee about the specificness of each participant's results. This is an

instance where the large number of participants significantly helps the case. Sleep duration, as

reported by each individual participant, was shown to have a positive u-shaped correlation to

mortality in multiple instances, suggesting that one’s lifespan may be directly affected by their

average sleep duration, likely through the effects it has on their overall health and wellbeing.

As can be observed, the aspects of one’s physical health, mental health, and longevity are

all significantly linked to getting an optimal amount of sleep consistently. In adults, ages 18-60,

achieving 7-9 hours of sleep per night is important for optimal physical recovery and immune
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health, helps prevent the onset of chronic health problems, may help prevent the development of

mental illness, keeps the brain functioning properly, and can even contribute to longevity. Thus,

optimal sleep hygiene is one of the most important factors to general health and well-being. For

most people, it doesn’t take much reflection to realize that they likely don’t get the sleep they

need. This holds especially true among certain groups, such as younger generations, new parents,

and much of America’s workforce. But with how critical getting optimal sleep is, it is key to the

general health of society that everyone takes the extra steps they need in order to get the hours

that their body requires. It’s important to consider a couple of ideas when discussing this. First

off, every individual is different in their health and the amount of sleep they need. Studies that

examine sleep use general measurements that give them a good idea of how the human body

works, but each individual knows best what they need. Because of this, it is each individual’s

own responsibility to be in tune with their sleep patterns and health. While considering this,

individuals should take into account scientific consensus and medical opinions, such as the

recommended 7-9 hours, and find an amount that suits them best. Second, most research on sleep

and health (and all the research previously referenced) examines quantity of sleep. Sleep quantity

is a far easier measurement to make en masse than sleep quality, due to the costly and time

consuming methods required for examining quality of sleep, and the fact that most of said studies

use self-reporting questionnaires to gather data. Furthermore, sleep quality and its effect on your

health is a concept that is still just being understood by scientists, making it more difficult to

translate into practical applications than sleep quantity. All that said, it is generally understood

that sleep quality plays a role in sleep hygiene and general health, but for these purposes sleep

quantity was the researched and discussed factor in regards to health and well-being. Third and

finally, sleep is a complicated function of the human body and the amount of research that has
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been done is astounding. Despite the quantity of studies and articles published, the surface has

barely been scratched and work remains scattered; general consensus remains limited to basic

factors such as recommended amounts, specific functions of sleep, and its importance to health.

All that to say, there are many aspects of sleep that must be further researched that are quite

pertinent to the specific discussion of sleep and its effect on health and longevity. Many

questions still need answered, such as: does missing out on sleep early in life mean one is

permanently deprived of sleep? Can one catch up on sleep for better health and longevity in the

future? Can correcting sleep hygiene actually be a treatment for generally poor mental or

physical health? And what does one do if they cannot seem to get their sleep hygiene right?

Questions such as these are important to the topic and cannot be neglected. In the meantime, as

researchers continue to study sleep and its effect on health, it is important for one to do what they

can to keep themselves healthy in the present. As with all aspects of health, it’s never too late to

take a step for the better and work to create better healthy habits. And whenever one is in doubt

about any aspect of their health, there are always experts to consult who are glad to help you be a

healthier version of yourself, including in the field of sleep medicine.

All in all, understanding the effects of sleep on health and longevity is important on both

an individual and societal basis. To the individual, understanding sleep and how it affects them is

just as important as other aspects of health such as nutrition and exercise. While it’s not always

on the forefront of everyone’s mind, sleep plays a big role in keeping one healthy and is closely

intertwined with just about every aspect of health. As one strives to better themself, sleep should

not be neglected or lost in the day to day activities that may seem to take precedence. As difficult

as it may be, it’s important to set a big enough piece of time aside to get the sleep that the body

needs to function properly. This is not only important to individual health but to the success of
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society in general. A world where the vast majority of people do not get enough sleep on a

nightly basis is a world where people are less healthy, more fatigued, and far less productive.

The interconnectedness of the world has the detrimental side effect of being fast-paced and

attention-grabbing. Being pulled in multiple different directions has many effects on the brain

and body, but germanely, being constantly busy means people have more obligations and less

time in their day. While not much can be done to shift the tide of society, it is crucial that

individuals take it upon themselves to be healthy in every way that they can, and be a stronger

contributor to the world because of it. This moves beyond sleep and to all aspects of mental and

physical health. When the individual works to be a better version of themselves, the world

benefits just a little bit. And when multiple individuals work together to better themselves, the

influence can grow and soon have a larger effect on the world as a whole. Though going to bed

at a better time tonight may not seem like it will have a great impact on the world, it could be a

little change that makes a big difference in the long run.

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Works Cited

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of Physiology, vol. 463, no. 1, 2011, pp. 121–137., doi:10.1007/s00424-011-1044-0.

Cappuccio, Francesco P., et al. “Sleep Duration and All-Cause Mortality: A Systematic Review

and Meta-Analysis of Prospective Studies.” Sleep, vol. 33, no. 5, May 2010, pp. 585–

592., doi:10.1093/sleep/33.5.585.

CDC.gov. “CDC - Data and Statistics - Sleep and Sleep Disorders.” Centers for Disease Control

and Prevention, Centers for Disease Control and Prevention, 2 May 2017,

www.cdc.gov/sleep/data_statistics.html.

Harvard Health. “Sleep and Mental Health.” Harvard Health, Harvard Health Publishing, 18

Mar. 2019, www.health.harvard.edu/newsletter_article/sleep-and-mental-health.

Hirshkowitz, Max, et al. “National Sleep Foundation’s Sleep Time Duration Recommendations:

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doi:10.1016/j.sleh.2014.12.010.

Itani, Osamu, et al. “Short Sleep Duration and Health Outcomes: a Systematic Review,

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doi:10.1016/j.sleep.2016.08.006.

Jike, Maki, et al. “Long Sleep Duration and Health Outcomes: A Systematic Review,

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Kingsland, James. “Mental Health: What Role Does Sleep Play?” Medical News Today,

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and-mental-health#Two-way-link-to-mental-health.
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Neighmond, Patti. “Working Americans Are Getting Less Sleep, Especially Those Who Save

Our Lives.” NPR, NPR, 28 Oct. 2019, www.npr.org/sections/health-

shots/2019/10/28/773622789/working-americans-are-getting-less-sleep-especially-those-

who-save-our-lives.

NHLBI. “Sleep Deprivation and Deficiency.” National Heart Lung and Blood Institute, U.S.

Department of Health and Human Services, www.nhlbi.nih.gov/health-topics/sleep-

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NICHD. “What Happens during Sleep?” Eunice Kennedy Shriver National Institute of Child

Health and Human Development, U.S. Department of Health and Human Services, 29

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