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Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society

DOI:10.5664/jcsm.4758

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PubMed

Authors:

M.Safwan Badr

Wayne State University

Gregory Belenky

Washington State University

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Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine. © 2015 Associated Professional Sleep Societies, LLC.

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591 Journal of Clinical Sleep Medicine, Vol. 11, No. 6, 2015

Sleep is essential for optimal health. The American Academy

of Sleep Medicine (A ASM) and Sleep Research Society (SRS)

developed a consensus recommendation for the amount

of sleep needed to promote optimal health in adults, using

a modi ed RAND Appropriateness Method process. The

recommendation is summarized here. A manuscript detailing

the conference proceedings and evidence supporting the  nal

recommendation statement will be published in SLEEP and

the Journal of Clinical Sleep Medicine.

Citation: Watson NF, Badr MS, Belenky G, Bliwise DL,

Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner

MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF,

Tasali E. Recommended amount of sleep for a healthy adult:

a joint consensus statement of the American Academy of

Sleep Medicine and Sleep Research Society. J Clin Sleep

Med 2015;11(6):591–592.

pii : jc- 0X231 -15

http://dx.doi.org/10.5664/jcsm.4758

CONSENSUS STATEMENT

• Adults should sleep 7 or more hours per night on a regular

basis to promote optimal health.

• Sleeping less than 7 hours per night on a regular basis

is associated with adverse health outcomes, including

weight gain and obesity, diabetes, hypertension, heart

disease and stroke, depression, and increased risk of

death. Sleeping less than 7 hours per night is also asso-

ciated with impaired immune function, increased pain,

impaired performance, increased errors, and greater

risk of accidents.

• Sleeping more than 9 hours per night on a regular

basis may be appropriate for young adults, individu-

als recovering from sleep debt, and individuals with

illnesses. For others, it is uncertain whether sleeping

more than 9 hours per night is associated with health

risk.

• People concerned they are sleeping too little or too

much should consult their healthcare provider.

Recommended Amount of Sleep for a Healthy Adult: A Joint

Consensus Statement of the American Academy of Sleep

Medicine and Sleep Research Society

Consensus Conference Panel: Nathaniel F. Watson, MD, MSc, Moderator1; M. Safwan Badr, MD2; Gregory Belenky, MD3;

Donald L. Bliwise, PhD4; Orfeu M. Buxton, PhD5; Daniel Buysse, MD6; David F. Dinges, PhD7; James Gangwisch, PhD8;

Michael A. Grandner, PhD, MSTR, CBSM7; Clete Kushida, MD, PhD9; Raman K. Malhotra, MD10; Jennifer L. Martin, PhD11;

Sanjay R. Patel, MD, MSc12; Stuart F. Quan, MD12; Esra Tasali, MD13

Non-Participating Observers: Michael Twery, PhD14,*; Janet B. Croft, PhD15,*; Elise Maher, RPSGT16,*

American Academy of Sleep Medicine Staff: Jerome A. Barrett17; Sherene M. Thomas, PhD17; Jonathan L. Heald, MA17

1University of Washington, Seattle, WA; 2Wayne State Universit y, Detroit, MI; 3Washington State University, Spokane, WA;

4Emory University, Atlanta, GA; 5Pennsylvania State University, University Park , PA; 6University of Pittsburgh, Pittsburgh, PA;

7University of Pennsylvania, Philadelphia, PA; 8Columbia University, New York, NY; 9Stanford Universit y, Stanford, CA; 10Saint

Louis University, St. Louis, MO; 11University of California, Los Angeles, Los Angeles, CA;12Harvard Medical School, Boston,

MA; 13The Universit y of Chicago, Chicago, IL; 14National Heart, Lung, Blood Institute, NIH, Bethesda, MD; 15Centers for Disease

Control and Prevention, Atlanta, GA; 16Sleep Disorders Institute, New York, NY; 17American Academy of Sleep Medicine, Darien,

IL; *attendance by these individuals does not constitute endorsement of this statement by their afﬁ liated institutions or organizations

METHODOLOGY

Healthy sleep requires adequate duration, good quality, ap-

propriate timing and regularity, and the absence of sleep dis-

turbances or disorders. Sleep duration is the most frequently

investigated sleep measure in relation to health. Furthermore,

the US Department of Health and Human Services created a

Sleep Health Objective to “increase the proportion of adults

who get suf cient sleep” in Healthy People 2020, a federal ini-

tiative to improve the nation’s health.1 Thus our recommenda-

tion focuses on this sleep parameter. A panel of 15 experts in

sleep medicine and research used a modi ed RAND Appropri-

ateness Method2 to develop a recommendation regarding the

sleep duration, or sleep duration range, that promotes optimal

health in adults aged 18 to 60 years.

The expert panel reviewed published scienti c evidence ad-

dressing the relationship between sleep duration and health,

using a broad set of National Library of Medicine Medi-

cal Subject Headings (MeSH) terms and no date restrictions,

which resulted in a total of 5,314 scienti c articles. The process

CONSENSUS S T AT E M E N T

592

Journal of Clinical Sleep Medicine, Vol. 11, No. 6, 2015

NF Watson, MS Badr, G Belenky et al.

was further guided by the Oxford grading system.3 The panel

focused on nine health categories with the best available evi-

dence in relation to sleep duration: general health, cardiovas-

cular health, metabolic health, mental health, immunologic

function, human performance, cancer, pain, and mortality.

Consistent with the RAND Appropriateness Method, multiple

rounds of evidence review, discussion, and voting were con-

ducted to arrive at the nal recommendation. The process to

develop this statement was conducted over a 12-month period

and concluded with a consensus meeting held in February 2015

in Chicago, Illinois.

DISCUSSION & FUTURE DIRECTIONS

Current evidence supports the general recommendation for

obtaining 7 or more hours of sleep per night on a regular basis

to promote optimal health among adults aged 18 to 60 years.

Individual variability in sleep need is inuenced by genetic,

behavioral, medical, and environmental factors. A clearer un-

derstanding of the precise biological mechanisms underlying

sleep need continues to require further scientic investigation.

This recommendation creates a foundation to raise aware-

ness and improve understanding of sleep effects on health. The

recommendation provides a basis for:

• Educating the public and healthcare providers on the im-

portance of adequate sleep duration for health.

• Encouraging individuals to obtain adequate sleep duration.

• Discussing the economic and social benets of adequate

sleep duration, thereby informing public policy.

• Promoting research on the role of sleep duration in health

and well-being.

Research that directly examines the effects of sleep dura-

tion on health may lead to revisions of this recommendation

in the future.

NOTES

This consensus statement was previously published in Vol-

ume 38, Number 6 of the journal SLEEP.4 In the interest of the

widest dissemination possible, the editors and publishers of the

journals SLEEP and Journal of Clinical Sleep Medicine have

agreed to allow for its dual publication.

REFERENCES

1. US Department of Health and Human Ser vices. Sleep Health Objectives.

March 6, 2015. Available from: https://www.healthypeople.gov/2020/topics-

objectives/topic/sleep-health/objectives.

2. Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness

Method User’s Manual. Santa Monica, CA: RAND, 2001.

3. OCEBM Levels of Evidence Working Group. The Ox ford Levels of Evidence

2. [cited February 9, 2015]. Available from: http://www.cebm.net/wp-content/

uploads/2014/06/CEBM-Levels-of-Evidence-2.1.pdf.

4. Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a

healthy adult: a joint consensus statement of the American Academy of Sleep

Medicine and Sleep Research Society. Sleep 2015;38:843 –4.

SUBMISSION & CORRESPONDENCE INFORMATION

Submitted for publication April, 2015

Accepted for publication April, 2015

Address correspondence to: Nathaniel F. Watson, MD, MSc; 2510 N. Frontage Road,

Darien, IL 60561; Tel: (630) 737-9700; Fax: (630) 737-9790; Email: research@

aasmnet.org.

DISCLOSURE STATEMENT

Funding for this project was provided by the American Academy of Sleep Medi-

cine and Sleep Research Society, and supported by the cooperative agreement

number 1U50DP004930 -01 from the Centers for Disease Control and Prevention

(CDC). Its contents are solely the responsibility of the authors and do not necessar-

ily represent the ofcial views of the CDC.

Disclosure statements for Consensus Conference Panel members: Dr. Belenky

has received research support from United Airlines, COPA Airlines, and FHWA,

DOT. Dr. Bliwise has consulted for the New England Research Institute, Ferring

Pharmaceuticals, Georgia Institute of Technology, Vantia Therapeutics, Morehouse

School of Medicine, and Merck. Dr. Buysse has consulted for Merck, Medscape,

Purdue Pharmaceuticals, Emmi Solutions, Eisai, CME Outtters, and Otsuka and

has received research support from the NIH. Dr. Dinges has received research sup-

port from NIH, NASA, ONR and FMCSA DOT, and has consulted for Mars, Inc. He

is Editor-In- Chief of SLEEP. Dr. Grandner has consulted for Bayer and Nexalin Tech-

nologies and has received research support from Bentley Systems. Dr. Kushida has

received research support from ResMed, Jawbone, Cephalon, Aerial BioPharma,

Impax Laboratories, Inc., Zephyr Sleep Technologies, Philips-Respironics, Morphy

Smart Bed, and Nokia. Dr. Malhotra has par ticipated in speaking engagements for

Teva Pharmaceuticals. Dr. Martin has received research support from Equinox Fit-

ness. Dr. Patel has received research support from the American Sleep Medicine

Foundation. He has received a stipend for Chairing the Young Investigator Research

Forum from the American Academy of Sleep Medicine and a stipend for authorship

from the American College of Physicians. Dr. Quan has consulted for Global Corpo-

rate Challenge. Dr. Watson has received research support from the NIH and NSF. He

is President of the Amer ic an Aca demy of Sleep Me di ci ne and a member of the Board

of Directors of the American Sleep Medicine Foundation. The other Consens us Con-

ference Panel members have indicated no nancial conicts of interest.

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Article

Apr 2015

Recent epidemiological studies have documented that depression is associated with short sleep duration, which may be interpreted as a consequence of comorbid insomnia and/or that of curtailment of time in bed (TIB). However, none of the studies examined association between depression and TIB. Here, we study TIB, short sleep duration and depression in the Japanese general adult population. Cross-sectional surveys with a face-to-face interview were conducted in 2009 as part of the Nihon University Sleep and Mental Health Epidemiology Project (NUSMEP). Data from 2532 individuals were analyzed. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess the prevalence of depression with a cut-off point of 16. Sleep habits and sleep problems during the previous month, including bed time, getting up time, sleep duration, insomnia symptoms, and hypnotic medication use were evaluated. TIB was calculated from bed time and getting up time. The prevalence of depression identified with CES-D was 6.0% in total samples, 5.1% in men and 6.7% in women. Multiple logistic regression analysis revealed that both short sleep duration (<6 h) and short TIB (<6 h) were significantly associated with CES-D depression after adjusting for the confounding effects of sociodemographic variables, insomnia symptoms, and hypnotic medication use. We postulate that TIB, a modifiable sleep habit, may be an important target for improvement of sleep hygiene as a means of preventing depression.

Short and Long Sleep Durations are Both Associated with Increased Risk of Stroke: A Meta-Analysis of Observational Studies

Article

Nov 2014
Int J Stroke

Background There is uncertainty over the relationship of sleep duration on stroke risk.AimWe aimed to clarify the relationship between sleep duration and risk of stroke by using epidemiological evidence.Methods We searched MEDLINE and EMBASE to identify all studies that might be looking at the association between sleep duration and stroke, including both cohort and cross-sectional studies. Pooled hazard ratios (HRs) and odds ratios (ORs) were calculated through a random-effects model.ResultsOur study included a total of 12 cohort studies and 6 cross-sectional studies. Pooled results from the cohort studies showed that short sleep duration was associated with a higher risk for stroke [HR, 1·13; 95% confidence interval (CI) 1·02–1·25], and that long sleep duration also increases the risk of having a stroke (HR, 1·40; 95% CI, 1·16–1·64). Results from cross-sectional studies confirmed the relationship between stroke and inappropriate sleep duration, either too little sleep or too much. For short sleep duration, the OR was 1·71 (1·39–2·02); for long sleep duration, the OR was 2·12 (1·51–2·73).Conclusion Both short and long sleep durations have a significant association with higher risk of stroke.

Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society

Abstract

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