This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (171)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Psychiatry, Other  • Alert me on articles by topic

Daniel F. Kripke, MD; Lawrence Garfinkel, MA; Deborah L. Wingard, PhD; Melville R. Klauber, PhD; Matthew R. Marler, PhD

Arch Gen Psychiatry. 2002;59:131-136.

Background  Patients often complain about insufficient sleep or chronic insomnia in the belief that they need 8 hours of sleep. Treatment strategies may be guided by what sleep durations predict optimal survival and whether insomnia might signal mortality risks.

Methods  In 1982, the Cancer Prevention Study II of the American Cancer Society asked participants about their sleep duration and frequency of insomnia. Cox proportional hazards survival models were computed to determine whether sleep duration or frequency of insomnia was associated with excess mortality up to 1988, controlling simultaneously for demographics, habits, health factors, and use of various medications.

Results  Participants were more than 1.1 million men and women from 30 to 102 years of age. The best survival was found among those who slept 7 hours per night. Participants who reported sleeping 8 hours or more experienced significantly increased mortality hazard, as did those who slept 6 hours or less. The increased risk exceeded 15% for those reporting more than 8.5 hours sleep or less than 3.5 or 4.5 hours. In contrast, reports of "insomnia" were not associated with excess mortality hazard. As previously described, prescription sleeping pill use was associated with significantly increased mortality after control for reported sleep durations and insomnia.

Conclusions  Patients can be reassured that short sleep and insomnia seem associated with little risk distinct from comorbidities. Slight risks associated with 8 or more hours of sleep and sleeping pill use need further study. Causality is unproven.

From the Departments of Psychiatry (Drs Kripke and Marler) and Family and Preventive Medicine (Drs Wingard and Klauber), University of California, San Diego; and The American Cancer Society, New York, NY (Mr Garfinkel).

RELATED ARTICLE

Can Sleep Be Bad For You? Can Insomnia Be Good?
Daniel J. Buysse and Mary Ganguli
Arch Gen Psychiatry. 2002;59(2):137-138.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Sleep/Wake Patterns of Individuals With Advanced Cancer Measured by Ambulatory Polysomnography
Parker et al.
JCO 2008;26:2464-2472.
ABSTRACT | FULL TEXT  

Quantitative Genetic Analysis of Sleep in Drosophila melanogaster
Harbison and Sehgal
Genetics 2008;178:2341-2360.
ABSTRACT | FULL TEXT  

How is Your Sleep: A Neglected Topic for Health Care Screening
Sorscher
J Am Board Fam Med 2008;21:141-148.
ABSTRACT | FULL TEXT  

Sleep duration, general and abdominal obesity, and weight change among the older adult population of Spain
Lopez-Garcia et al.
Am. J. Clin. Nutr. 2008;87:310-316.
ABSTRACT | FULL TEXT  

Cross-sectional versus Prospective Associations of Sleep Duration with Changes in Relative Weight and Body Fat Distribution: The Whitehall II Study
Stranges et al.
Am J Epidemiol 2008;167:321-329.
ABSTRACT | FULL TEXT  

Association of Fewer Hours of Sleep at 6 Months Postpartum with Substantial Weight Retention at 1 Year Postpartum
Gunderson et al.
Am J Epidemiol 2008;167:178-187.
ABSTRACT | FULL TEXT  

Is Siesta More Beneficial Than Nocturnal Sleep?
Patel
Arch Intern Med 2007;167:2143-2144.
FULL TEXT  

Socioeconomic Status Predicts Objective and Subjective Sleep Quality in Aging Women
Friedman et al.
Psychosom. Med. 2007;69:682-691.
ABSTRACT | FULL TEXT  

Why Is Nondipping in Ambulatory Blood Pressure Monitoring Not Prognostic in Poor Sleepers?
Martinez and Fuchs
Hypertension 2007;50:e20-e20.
FULL TEXT  

Response to Why Is Nondipping in Ambulatory Blood Pressure Monitoring Not Prognostic in Poor Sleepers?
Verdecchia et al.
Hypertension 2007;50:e21-e21.
FULL TEXT  

RE: "OBJECTIVELY MEASURED SLEEP CHARACTERISTICS AMONG EARLY-MIDDLE-AGED ADULTS: THE CARDIA STUDY"
Hale and Do
Am J Epidemiol 2007;165:231-232.
FULL TEXT  

The link between short sleep duration and obesity: we should recommend more sleep to prevent obesity.
Taheri
Arch. Dis. Child. 2006;91:881-884.
FULL TEXT  

Effects of sleep deprivation on the development of autoimmune disease in an experimental model of systemic lupus erythematosus
Palma et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2006;291:R1527-R1532.
ABSTRACT | FULL TEXT  

Sleep disruption, oxidative stress, and aging: New insights from fruit flies
Cirelli
Proc. Natl. Acad. Sci. USA 2006;103:13901-13902.
FULL TEXT  

Sleep duration and health in young adults.
Steptoe et al.
Arch Intern Med 2006;166:1689-1692.
ABSTRACT | FULL TEXT  

Sleep duration and body mass index in a rural population.
Kohatsu et al.
Arch Intern Med 2006;166:1701-1705.
ABSTRACT | FULL TEXT  

Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation.
Irwin et al.
Arch Intern Med 2006;166:1756-1762.
ABSTRACT | FULL TEXT  

Impaired Performance in Commercial Drivers: Role of Sleep Apnea and Short Sleep Duration
Pack et al.
Am. J. Respir. Crit. Care Med. 2006;174:446-454.
ABSTRACT | FULL TEXT  

Objectively Measured Sleep Characteristics among Early-Middle-Aged Adults: The CARDIA Study
Lauderdale et al.
Am J Epidemiol 2006;164:5-16.
ABSTRACT | FULL TEXT  

Invited Commentary: How Much Do We Really Sleep?
Quan
Am J Epidemiol 2006;164:17-18.
FULL TEXT  

Sleep Quality and Its Correlates in the First Year of Dialysis
Unruh et al.
CJASN 2006;1:802-810.
ABSTRACT | FULL TEXT  

Socioeconomic position and sleep quantity in UK adults.
Adams
J. Epidemiol. Community Health 2006;60:267-269.
ABSTRACT | FULL TEXT  

Explaining social inequalities in health by sleep: the Japanese civil servants study
Sekine et al.
J Public Health (Oxf) 2006;28:63-70.
ABSTRACT | FULL TEXT  

Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes
Spiegel et al.
J. Appl. Physiol. 2005;99:2008-2019.
ABSTRACT | FULL TEXT  

Timing and Consolidation of Human Sleep, Wakefulness, and Performance by a Symphony of Oscillators
Dijk and von Schantz
J Biol Rhythms 2005;20:279-290.
ABSTRACT  

In Reply
Benca
Psychiatr. Serv. 2005;56:752-753.
FULL TEXT  

Association of Sleep Time With Diabetes Mellitus and Impaired Glucose Tolerance
Gottlieb et al.
Arch Intern Med 2005;165:863-867.
ABSTRACT | FULL TEXT  

Brief Communication: Sleep Curtailment in Healthy Young Men Is Associated with Decreased Leptin Levels, Elevated Ghrelin Levels, and Increased Hunger and Appetite
Spiegel et al.
ANN INTERN MED 2004;141:846-850.
ABSTRACT | FULL TEXT  

Leptin Levels Are Dependent on Sleep Duration: Relationships with Sympathovagal Balance, Carbohydrate Regulation, Cortisol, and Thyrotropin
Spiegel et al.
J. Clin. Endocrinol. Metab. 2004;89:5762-5771.
ABSTRACT | FULL TEXT  

Microarousals During Sleep Are Associated With Increased Levels of Lipids, Cortisol, and Blood Pressure
Ekstedt et al.
Psychosom. Med. 2004;66:925-931.
ABSTRACT | FULL TEXT  

Incidence of Diabetes in Middle-Aged Men Is Related to Sleep Disturbances
Nilsson et al.
Diabetes Care 2004;27:2464-2469.
ABSTRACT | FULL TEXT  

Naps and Circadian Rhythms in Postmenopausal Women
Yoon et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2004;59:M844-M848.
ABSTRACT | FULL TEXT  

Reductions in circulating anabolic hormones induced by sustained sleep deprivation in rats
Everson and Crowley
Am. J. Physiol. Endocrinol. Metab. 2004;286:E1060-E1070.
ABSTRACT | FULL TEXT  

Self-reported Sleep Complaints With Long and Short Sleep: A Nationally Representative Sample
Grandner and Kripke
Psychosom. Med. 2004;66:239-241.
ABSTRACT | FULL TEXT  

Effect of sleep loss on C-Reactive protein, an inflammatory marker of cardiovascular risk
Meier-Ewert et al.
J Am Coll Cardiol 2004;43:678-683.
ABSTRACT | FULL TEXT  

A Prospective Study of Self-Reported Sleep Duration and Incident Diabetes in Women
Ayas et al.
Diabetes Care 2003;26:380-384.
ABSTRACT | FULL TEXT  

A Longer Biological Night in Long Sleepers Than in Short Sleepers
Aeschbach et al.
J. Clin. Endocrinol. Metab. 2003;88:26-30.
ABSTRACT | FULL TEXT  

OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02)
Evid. Based Nurs. 2003;6:e1-1.
FULL TEXT  

Other articles noted
Evid. Based Ment. Health 2002;5:104-104.
FULL TEXT  

To Sleep, Perchance to Live
JWatch Psychiatry 2002;2002:3-3.
FULL TEXT  

Can Sleep Be Bad For You? Can Insomnia Be Good?
Buysse and Ganguli
Arch Gen Psychiatry 2002;59:137-138.
FULL TEXT