Determinants of Sleep Duration and Sleep Quality: Gender Differences, Coping and Health Outcome

Sleep, that knits up the ravell'd sleeve of care. The death of each day's life, sore labour's bath Balm of hurt minds, great nature's second course. Chief nourisher in life's feast."Macbeth" by Shakespeare (1564-1616)IntroductionThe health restoring and recuperating properties of sleep seem to have been well known throughout the centuries. Loss of quality of sleep and the adverse effects of sleep deprivation seem to be associated with inferior psychological and physical health. Current studies suggest that sleeping problems and sleeprelated conditions are very common. Among some of the behavioral definitions of sleep disturbance are problems getting to or maintaining sleep, sleeping adequately but experiencing little in the way of rest and recuperation after waking, distress arising from recurring awakenings and detailed recall of frightening dreams involving personal threats, insomnia or hypersomnia complaints resulting from a reversal of the sleep-wake schedule normal for the individual's environment, or excessive daytime sleepiness and tiredness or bouts of falling asleep during the day (1).Approximately 1 in 10 patients complain of sleep-related disorders when visiting their general practitioner. Sateia (2) reviewed the literature of sleeping disorders indicating the incidence of occasional and intermittent insomnia to be around 35 percent for the general population, and the rates of chronic insomnia to be closer to 10 to 15 percent. European findings suggest the estimates of around 11 percent of the population. These numbers seem consistent across cultures. Ishigooka et al. (3) observed an average sleeping duration of 6.77 hours on weekdays, while approximately 20% revealed current sleeping problems, with 11.7% displaying insomnia that lasted over a month, in a large scale epidemiological outpatient study in Japan.There appears to be an association between the disorders in sleeping behavior and the thought patterns. Borkovec and Roemer (4) found that it was the cognitive facet of anxiety, i.e. worrisome thoughts, rather than physiological symptoms of anxiety that was associated with insomnia. His suggestion for any effective treatment was to distract the individual away from intrusive thoughts to other sensations. People with insomnia tend to experience unwanted intrusive thoughts before sleep onset and tend to attribute difficulty falling asleep to their level of cognitive arousal (5). In addition, these same people spend much of their time concerned about insomnia and are likely to experience the same sort of intrusive thoughts about not being able to sleep and about hazardous consequences of sleep deprivation there might be. This in turn contributes to the general level of anxiety and discouragement. The intrusive thoughts about sleep are shaped by dysfunctional beliefs about sleep that are characteristic in people with insomnia.OECD statistics (http://www.oecd.org/statsportal /0,3352,en_2825_293564_1_1_1_1_1,00.html) have demonstrated some cross-cultural differences in the sleeping behavior with the French sleeping the most (an average of 8.8 hours per day) followed by the US (8.6 hours per day). Norway, Sweden and Germany were the EU nations in which people slept the least. In Finland, females slept on average 7.62 hours in contrast to males with 7.39 hours on average. Short sleepers, as defined having 6 hours or less sleep per day, represented 14.5% of the sample, with more males being short sleepers (16.7 vs. 12.5% females), and about 1 in 7 (13.5%) was a long-sleeper (at least 9 hours per day). Overall, just over 1 in 5 persons reported experiencing sleeping disturbances.Hossain and Shapiro (6) claimed that difficulties falling asleep or daytime sleepiness commonly affects between 35 and 40 percent of the US adult population annually. They argue that the prevalence and burden in terms of personal and organizational health costs are significant, and sleeping ailments are often underestimated and under-treated. …