Although the amount of sleep varies from person to person, as adults, an average of 7 to 9 hours of sleep is needed to function at our best. Sometimes, we may get sufficient hours of sleep but may still experience sleep deprivation if the quality of our sleep is poor. For example, suppose you have an underlying sleep problem like sleep apnea, your breathing is interrupted while sleeping, and you may wake up feeling exhausted despite sleeping the appropriate number of hours. Consulting a sleep doctor or sleep specialist can help diagnose and treat such conditions.

There are multiple proposed theories about why humans need sleep, including energy conservation, body restoration and rejuvenation, information processing, and learning. The benefits of restful sleep are vast and include:

• Attention, memory consolidation, and executive function

• Physical health and development, metabolic and immune function

• Emotional health

• Personal and public safety

“You don’t need kindergarten to know that a resident working a 36-hour shift is in no condition to make any kind of judgment call—forget about life and death.”

This was a comment made by Sidney Zion following his daughter Libby’s death in 1984.

Libby was a freshman in New York with a history of depression who was admitted to the hospital for observation and hydration due to having flu-like symptoms for a few days. The cause of her illness was not clear. She was cared for by two well-meaning resident physicians that night who had been working for several hours without sleep. She received medication for agitation, and within a few hours of receiving the medication, she became less agitated, had a very high fever, suffered a cardiac arrest, and died. Her death was found to be due to an adverse reaction to the medication she was given. Her grieving parents, Zion Libby and his wife Elsa, hired a lawyer to investigate the cause of her death. They found that medical trainees worked as long as 36-hour shifts with little to no sleep while caring for patients.

Motivated by this grief, a civil case was filed, leading to changes in the rules regarding duty hours for physicians. Due to the Zion family’s persistence, the medical body instituted these work-hour limitations responsible for medical education accreditation. The recommendation was for an 80-hour limit on trainees' work hours and limiting continuous duty hours to 24 hours.

While the consequences of sleep deprivation may not always lead to fatal endings, lack of sleep can lead to impaired judgment and poor decision-making. In this blog, I discuss the impact of sleep deprivation on our decision-making skills and how to optimize sleep for better executive function.

How does sleep affect our performance? Sleep deprivation can lead to decreased function and performance in several areas. Researchers have shown the impact in:

• Decreased vigilance and awareness: This is due to brief lapses in wakefulness, also known as microsleeps, which can cause errors and omissions.

• Decreased ability to perform basic skills

• Depressed mood

• Impaired executive function

• Decreased empathy

• Poor judgment

• Increased risk-taking behaviors

The most problematic issue is that most sleep-deprived people are often unaware of their impaired function. Sleep-deprived people who are moody, exhausted, and stressed often take these emotions home to their loved ones. Unfortunately, chronic sleep deprivation can also lead to risks of other severe mental conditions like anxiety, depression, and increased risk of suicidality.

Impaired decision-making associated with sleep deprivation can result in a craving for high-calorie sugary foods, increasing the risk of obesity and conditions like Type 2 diabetes and other diseases.

Sleep and Executive Function

Executive function is a set of skills that include our long and short-term memory, self-control, and flexible thinking. We use these skills daily to make critical decisions, learn, work, and live in our society as meaningful contributors. The ability to plan, anticipate, judge, and reason are essential elements in decision-making.

The central region of our brain responsible for decision-making is called the prefrontal cortex, located in the frontal lobe. This (frontal lobe) coordinates other activities such as problem-solving, thinking, planning, organizing, and even movements. It is also responsible for many aspects of our personality and emotional makeup.

Several experimental studies show that sleep deprivation, either shortened sleep or poor-quality sleep, causes impaired performance on our frontal lobe functions, including alertness, attention, decision making, and cognitive processing. Some researchers have studied this impact using specialized brain imaging techniques.

How does sleep deprivation affect our decision-making? While sleep deprivation is common in our society, its effect on cognition is only beginning to be understood. Sleep deprivation has been linked to inattention and memory problems. Missing sleep makes it hard for our brains to make new memories and, as a result, to recall information. During sleep, our brains undergo a process called memory consolidation, storing new memories for long-term retrieval. Sleep deprivation is associated with an increased risk of errors and poor decision-making, which has been studied extensively in health care organizations. Residents that are sleep-deprived are more likely to:

• Make more serious medical errors.

• Have attention failures at work

• Double their risk of car crashes on the way home after a 24-hour shift

• Suffer a needle stick injury

• Experience a decrease in academic performance

When supporting our children to help improve their sleep, we must also scrutinize our own sleep habits and ensure we are getting restful sleep to combat the effects of sleep deprivation. Consulting a sleep clinic or sleep medicine specialist can provide valuable guidance and support.

How do we optimize our sleep to make better decisions? Realize the importance of sleep in all ranges of our biological functions, from our memory, creativity, and problem-solving skills, to mental, emotional, and physical health.

Be intentional about prioritizing sleep. This will require setting boundaries around sleep to ensure you are getting enough of it. As busy moms and professionals, we must learn to say “no” to certain obligations and not feel guilty about our decisions. Review your to-do list and identify tasks you can eliminate or delegate. Set your priorities so you don’t end up sacrificing your sleep over work, TV shows, or socializing.

Learn to create restful sleep habits: Healthy sleep habits can be adopted using CREATE.

• C - Consistent sleep time and wake time: We should have a fixed sleep time and wake time. Try not to deviate too far from this, even on the weekends (not more than 1 to 2 hours later). Inconsistent sleep times and wake times affect your body’s ability to anticipate sleep.

• R - Routine: Have a set bedtime routine. Routines are habits or rituals conducted around bedtime. These should be short, sweet, and should move you in the direction of the bedroom. With routines, we reinforce our minds that it is bedtime. Example activities are a warm bath, reading, journaling, and practicing mindfulness.

• E - Environment: Your sleep environment should be pleasantly cool, dark, and noise-free. One of the biggest signals to your circadian rhythm is light exposure. Keeping your room dark helps to signal your brain to produce a sleep hormone called melatonin. You can get blackout curtains if needed or use eye masks. Some people like to have a fan or noise machine going, which is alright as long as it is calming and does not disrupt your sleep.

• T – Tackle technology: While not all technology is bad for sleep, we need to limit technology or other electronic devices that can negatively impact sleep. These devices release blue light that decreases melatonin production and makes it harder to fall asleep.

• E - Eliminate: We need to eliminate caffeine, alcohol, and heavy meals at bedtime, as these can disrupt our sleep quality.

Talk to your doctor. If you have any underlying sleep problem, like sleep apnea, this can affect your sleep quality significantly. Speak to your physician if you are concerned about a sleep or medical disorder. Your doctor can also help you create a plan to help you improve your sleep. A sleep study might be recommended to understand your sleep patterns better.

As busy professionals, we make more than 3,500 decisions daily, and these may range from what we would like for breakfast to decisions that impact our teams, clients, and our world. Given the association between good sleep and high-quality decisions, I hope you are encouraged to prioritize sleep to improve your world.

What shift will you make in your sleep today to improve your decision-making? I would love to know.

Interested in additional sleep support? Learn more about Sleep Coaching and our Private Practice The Restful Sleep Place.