And so to bed: New guidelines from the National Sleep Foundation

SLEEP recommendations 2

On February 2, 2015, the National Sleep Foundation revamped its recommendations for bed rest. With the guidance of an 18-member multidisciplinary expert panel—which included Leila Kheirandish-Gozal, MD, MSc, director of clinical sleep research for the Department of Pediatrics at the University of Chicago—they published new guidelines for healthy individuals of all ages.

Leila Kheirandish-Gozal, MD, MSc

Leila Kheirandish-Gozal, MD, MSc

The 2015 review included several substantial changes. One was greater recognition of the differences between people within the various age ranges. The panel added a buffer, “may be appropriate,” to acknowledge this person-to-person variability in sleep requirements. The recommendations now define times as either recommended, may be appropriate for some individuals, or not recommended.

After an extensive literature review of 312 sleep studies, the panel revised the recommended sleep ranges for every group that includes children under the age of 18. They also added two new adult age categories. A summary of the changes includes:

  • Newborns (0-3 months ): Sleep range narrowed to 14-17 hours each day from previous recommendation of 12-18 hours
  • Infants (4-11 months): Sleep range widened two hours to 12-15 hours, from 14-15
  • Toddlers (1-2 years): Sleep range widened by one hour to 11-14 hours, from 12-14
  • Preschoolers (3-5): Sleep range widened by one hour to 10-13 hours, from 11-13
  • School age children (6-13): Sleep range widened by one hour to 9-11 hours, from 10-11
  • Teenagers (14-17): Sleep range widened by one hour to 8-10 hours, from 8.5-9.5
  • Younger adults (18-25): Sleep range is 7-9 hours (new age category)
  • Adults (26-64): Sleep range did not change and remains 7-9 hours
  • Older adults (65+): Sleep range is 7-8 hours (new age category

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The panel included six sleep experts, selected by the National Sleep Foundation, plus 12 authorities from several other medical associations including the American Neurological Association, American Academy of Pediatrics and American Physiological Society.

Their recommendations followed multiple rounds of consensus voting after a rigorous and systematic review of the world scientific literature relating sleep duration to health, performance and safety, according to Charles Czeisler, chairman of the board of the National Sleep Foundation. Research articles were sorted and ranked, based on the strength of each study. Then the panel graded every possible sleep duration, from zero to 24 hours a day, for appropriateness, on a scale of one to nine for each age group. “No effort was made,” the study authors wrote, “to eliminate disagreement.”

The panel emphasized that some individuals might sleep longer or shorter than the recommended times with no adverse effects. “However,” they cautioned, “individuals with sleep durations far outside the normal range may be engaging in volitional sleep restriction or have serious health problems. An individual who intentionally restricts sleep over a prolonged period may be compromising his or her health and well-being.”

While all agreed that consistently sleeping far less than recommended could have serious consequences, there is currently “no strong evidence that sleeping too much has detrimental health consequences, or even evidence that our bodies will allow us to sleep much beyond what is required,” noted Kristen Knutson, PhD, an assistant professor at the University of Chicago, in a message to the Associated Press.

There is laboratory evidence that short sleep durations—four to five hours a night—have negative physiological and neurobehavioral consequences. “We need similar laboratory and intervention studies to determine whether long sleep durations (if they can be obtained) result in physiological changes that could lead to disease before we make any recommendations against sleep extension,” Knutson added.

“For parents,” Gozal said, “the best indicator that their children are sleeping as much as they need is that they wake up on their own rather than be awakened. Another thing to remember is that for everyone, healthy sleep means healthy lives. Sleep well and be well.”

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