Sleep Deprivation a National Crisis: Take These Two Self-Screening Sleep Tests

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If every citizen in the United States placed a higher priority on sleep, there would be a significant drop in mortalities and the development of diseases and illnesses. A substantial contributor to the high level of sleep-related issues is the lack of awareness of the importance of sleep. It’s imperative that we identify those with sleep disorders prior to the development of disease or illness or before sleep deprivation results in accident-related fatalities. Proactively screening everyone is the first step and sleep medicine provides the tools for an initial self-screening of sleep-related issues.

According to the Centers for Disease Control and Prevention (CDC), one out of three Americans achieves less than 7 hours of sleep a night due to medical conditions, medication, sleep disorders, or simply choosing not to sleep. It’s critical to identify the root cause of sleep deprivation for immediate treatment before developing health problems. Here I will provide two self-evaluations used by all sleep providers that you can take now to determine if you have a sleep-related problem requiring treatment from a provider. 

In a new recommendation published in the June issue of SLEEP, the American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) recommend that adults obtain seven or more hours of sleep per night to avoid the health risks of chronic inadequate sleep

AASM (2015)

Constantly feeling tired throughout the day is not normal. Even though this may seem normal because a large majority of the U.S. lives this way, hundreds of conditions could cause fatigue that is not sleep-related, according to the Cleveland Clinic, a non-profit academic medical center, some conditions that impact sleep are infections, colds, flu, autoimmune disorders, hormonal imbalances, heart and lung issues vitamin deficiencies. And, of course, anxiety and depression can influence fatigue as well. HDr. J.F. Pagel, with the Rocky Mountain Sleep Disorders Center in Pueblo, CO, explains that the most common cause of daytime sleepiness is sleep deprivation, OSA, and sedating medications. 

The recent 2021 collection of sleep data published on the  Sleep Advisor website demonstrates sleep deficiency’s level of impact on our nation.  

• 50-70 million people in the U.S suffer from one or more sleep disorder
• 48% of people in the U.S. report snoring
• Lack of sleep costs the U.S. $411 billion annually
• 35% of adults do not get enough sleep
• Over 100,000 deaths are a result of medical provider error due to lack of sleep
• 5% of the nation’s obesity is due to lack of sleep
• 37% of people reported falling asleep at work
• 30% of the adult U.S. population suffers from insomnia
• 25 million U.S. adults suffer from obstructive sleep apnea
• 10 million people in the U.S. remain undiagnosed for obstructive sleep apnea
• 9 million Americans take sleep aids
• The frequency of sleep aid use is associated with higher mortality rates

The only way to reduce this impact demonstrated in these numbers is for each of us to improve our awareness of sleep hygiene and the ability to self-screen for sleep disorders. The Epworth Sleepiness Scale is one of these self-screening tests that anyone can take. 

Epworth Sleepiness Scale (ESS) 

One of the most used sleep screening tools for sleep disorders is the Epworth Sleepiness Scale (ESS), developed by Dr. Murray Johns. According to Dr. John’s website, he first developed this scale in 1988 to assess the level of daytime sleepiness in his patients. Dr. Johns named the scale after the Epworth Sleep Center in Melbourne, Australia. Below is an example of the Epworth Sleepiness Scale, and you can take it right now and determine if you have a sleep problem. 

In taking the ESS, you will rate your chance of dozing while engaged in the activities highlighted in the example below. The higher the score, the higher level of daytime sleepiness. A score of 11 or higher demonstrates a sleep disorder, and you should discuss your sleep with a provider.  However, the first thing you should do is improve your sleep hygiene. Many times the fatigue is related to poor sleeping habits. Click here to learn more about improving sleep hygiene. 

Self-Diagnosing Obstructive Sleep Apnea (OSA)

As you saw in the statistics above, there are 10 million people in the U.S. who with undiagnosed Obstructive Sleep Apnea (OSA). The Sleep Foundation describes OSA as a respiratory disorder with a partial or complete collapse of the upper airway. This obstruction and the body’s sense to fight for air causes the body to respond with the fight or flight response, causing you to awaken several times throughout the night. This interrupts the body from achieving the right amount of sleep during each sleep stage, preventing the body from obtaining the repair and restoration that must happen when you sleep. 

The most widely used diagnostic tool for OSA is the STOP-BANG. Many medical providers use this tool as an initial screening in diagnosing OSA. A 2012 study published in the British Journal of Anesthesia found that the STOP-BANG has a high probability of identifying those with OSA and is effective in identifying those with unrecognized OSA. STOP-BANG is an acronym for Snoring, Tired, Observed breathing issues, blood Pressure- Body mass index, Age, Neck size, and Gender.

The STOP-BANG questionnaire can be found at The Official STOP-Bang Questionnaire Website (stopbang.ca).

The STOP-BANG asks you the following questions:

• Do you Snore Loudly (loud enough to be heard through closed doors, or your bed-partner elbows you for snoring at night)?
• Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving or talking to someone)?
• Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?
• Do you have or are being treated for High Blood Pressure?
• Body Mass Index more than 35 kg/m2? (inputting your height and weight into their calculator will provide your BMI)
• Age older than 50?
• Is neck size large? (Measured around Adam’s apple)
• Gender = Male?

You will be scored between 0-8. If your score is 0-2, you are a low risk for OSA, 3-4 is an intermediate risk, 5-8 is high risk. 

There are a variety of sleep-related disorders other than OSA. Here are a few with their definitions as defined by the Sleep Medicine’s International Classification of Sleep Disorders, Third Edtion ICSD-3

• Insomnia is a consistent difficulty falling asleep, staying asleep, and not achieving the minimum required duration during each sleep stage. 
• Narcolepsy disrupts the sleep-wake process, causing excessive daytime sleepiness as the brain cannot regulate the circadian rhythm correctly. 
• Restless Leg Syndrome (RLS) is the desire to move one’s legs, feeling restless, uncomfortable, twitchy, making it difficult to fall asleep.
• Parsomnias is abnormal behavior during sleep or the onset of sleep, such as walking, confused arousal, night terrors, and unusual sexual behavior. 
• REM Sleep Behavior Disorder prevents atonia, which is the temporary muscular paralysis that occurs during REM, preventing one from acting out their dreams. Those with this disorder can harm a bed partner during sleep.
• Periodic Limb Movement Disorder (PLMD) results in uncontrollable twitches and movements of the legs, primarily and sometimes the arms. 

If the ESS and STOP-BANG indicate a sleep problem, you need to see a medical provider to address the issues as soon as possible. Achieving at least 7 hours of sleep a night is imperative to prevent future illness and achieve longevity.  A large majority of people obtain less than 7 hours of sleep a night and do not perceive a decrease in their quality of life. However, for some, the impact of sleep deprivation will not be noticed until they reach an older age, by then it’s too late. Click here to learn how to improve your sleep hygiene.

About Post Author

Chris Pierce

chris.pierce23@gmail.com

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