A Lack of Sleep can Kill you


A month ago, many of us heard about the sad demise of Ranjan Das from Bandra, Mumbai. Ranjan, just 42 years of age, was the CEO of SAP-Indian Subcontinent, the youngest CEO of an MNC in India. He was very active in sports, was a fitness freak and a marathon runner. It was common to see him run on Bandra’s Carter Road. Just after Diwali, on 21st Oct, he returned home from his gym after a workout, collapsed with a massive heart attack and died. He is survived by his wife and two very young kids.

It was certainly a wake-up call for corporate India. However, it was even more disastrous for runners amongst us. Since Ranjan was an avid marathoner (in Feb 09, he ran Chennai Marathon at the same time some of us were running Pondicherry Marathon 180 km away), the question came as to why an exceptionally active, athletic person succumb to heart attack at 42 years of age.

Was it the stress?

A couple of you called me asking about the reasons. While Ranjan had mentioned that he faced a lot of stress, that is a common element in most of our lives. We used to think that by being fit, one can conquer the bad effects of stress. So I doubted if the cause was stress.

The Real Reason
However, everyone missed out a small line in the reports that Ranjan used to make do with 4-5 hours of sleep. This is an earlier interview of Ranjan on NDTV in the program Boss Day Out: Ranjan Das of SAP India. Here he himself admits that he would love to get more sleep (and that he was not proud of his ability to manage without sleep, contrary to what others extolled).

The Evidence
Last week, I was working with a well-known cardiologist on the subject of ‘Heart Disease caused by Lack of Sleep’. While I cannot share the video nor the slides because of confidentiality reasons, I have distilled the key points below in the hope it will save some of our lives.

Some Excerpts:
· Short sleep duration (<5 or 5-6 hours) increased risk for high BP by 350% to 500% compared to those who slept longer than 6 hours per night. Paper published in 2009. As you know, high BP kills.

· Young people (25-49 years of age) are twice as likely to get high BP if they sleep less. Paper published in 2006.

· Individuals who slept less than 5 hours a night had a 3-fold increased risk of heart attacks. Paper published in 1999.

· Complete and partial lack of sleep increased the blood concentrations of High sensitivity C-Reactive Protein (hs-cRP), the strongest predictor of heart attacks. Even after getting adequate sleep later, the levels stayed high!

· Just one night of sleep loss increases very toxic substances in body such as Interleukin-6 (IL-6), Tumour Necrosis Factor-Alpha (TNF-alpha) and C-reactive protein (cRP). They increase risks of many medical conditions, including cancer, arthritis and heart disease. Paper published in 2004.

· Sleeping for <=5 hours per night leads to 39% increase in heart disease. Sleeping for <=6 hours per night leads to 18% increase in heart disease. Paper published in 2006.

Ideal Sleep
For lack of space, I cannot explain here the ideal sleep architecture. But in brief, sleep is composed of two stages: REM (Rapid Eye Movement) and non-REM. The former helps in mental consolidation while the latter helps in physical repair and rebuilding. During the night, you alternate between REM and non-REM stages 4-5 times. The earlier part of sleep is mostly non-REM. During that period, your pituitary gland releases growth hormones that repair your body. The latter part of sleep is more and more REM type.

For you to be mentally alert during the day, the latter part of sleep is more important. No wonder when you wake up with an alarm clock after 5-6 hours of sleep, you are mentally irritable throughout the day (lack of REM sleep). And if you have slept for less than 5 hours, your body is in a complete physical mess (lack of non-REM sleep), you are tired throughout the day, moving like a zombie and your immunity is way down (I’ve been there, done that L)

Finally, as long-distance runners, you need an hour of extra sleep to repair the running related damage.

In conclusion
Barring stress control, Ranjan Das did everything right: eating proper food, exercising (marathoning!), maintaining proper weight. But he missed getting proper and adequate sleep, minimum 7 hours. In my opinion, that killed him. If you are not getting enough sleep (7 hours), you are playing with fire, even if you have low stress.

I always took pride in my ability to work 50 hours at a stretch whenever the situation warranted. But I was so spooked after seeing the scientific evidence last week that since Saturday night, I ensure I do not even set the alarm clock under 7 hours. Now, that is a nice excuse to get some more sleep.

Unfortunately, Ranjan Das is not alone when it comes to missing sleep. Many of us are doing exactly the same, perhaps out of ignorance.

I would like to thank Madhur Kotharay for contributing this article. I think this is an area that many entrepreneurs tend to neglect far too often, myself included.

13 Comments A Lack of Sleep can Kill you

  1. max

    thanks, i was always proud i could deal with 4/5 hours sleep each night, but after reading your article i am just giving up half of my next coffee and will try to sleep more tonite.
    Plus, i will avoid taking flights 7am and going to sleep at 1am the same morning…… (which happens quite frequently)

  2. Omar

    Thats really ironic. Its now 8:30 am, and i slept at 5:00am. I was researching about side effects of sleep lacking. And it turns out that you are writing about it. I am very exhausted!

  3. Usman Sheikh

    I used to do that quite a lot. It doesn’t effect you as much in the short term as it does in the medium term. Your immune system becomes weaker and you are more susceptible of falling sick. Would high encourage you to get at least 6 hours as a minimum to operate efficiently!

  4. nsr

    thank you – stumbled on this on a break at 12.33 am- i will turn in instead of lurching onwards through the night fuelled by coffees, sweets and biscuits – aside from my wacked out sleep patterns – we all would benefit from way reduced poor snacking at night.

    here’s to all of us getting more than 6+ hours regularly of sleep, thanks for the post.

  5. Bart W

    Good article – it would be good to see the actual references to journals, instead of ‘Paper published in 1999′, etc. It makes the argument more convincing.

  6. opyate

    Thanks for the article!
    Could you please post links to those research papers? (if Ben Goldacre’s advice is anything to go by)

  7. Sharif Olorin

    Good post. This is entirely accurate, but I’d like to point out that lack of sleep is just one risk factor for cardiovascular problems. Like working out on amphetamine, running marathons with significantly elevated BP is a Bad Idea.

    A highly simplified view: cardiovascular stress is cumulative, and below some unknown threshold you’re probably fine. It’s possible to cut out all the major risk factors for CV problems, but most people don’t and live relatively healthy lives. Balance is key – strenuous exercise is one cardiac stressor, lack of sleep is another. One or the other is usually okay, but combining them is asking for trouble.

  8. Amokrane

    Interesting. My father is a cardiologist as well, and he always insisted that I sleep normal hours, which I can’t do unfortunately now. But it’s definitely, a lifestyle that I would like to adopt. Work normal hours, eat normal hours and sleep normal hours.

    Also, I think sleeping 7 hours doesn’t mean everything. Sleeping from 4 AM to 11 AM, is not as good than sleeping from 11 PM to 6 AM for instance.

  9. Dan D

    Can you please cite your sources? Simply saying paper x was published in year y isn’t enough. Please post links to PubMed.

  10. originalgeek

    Sleep apnea, though admittedly rarer in slim individuals, can also increase the risk of high blood pressure. It’s not just the length of time you sleep, but also the ability to achieve deep sleep (my pulmonary specialist referred to it as Phase 3 and 4). Deep sleep is essential for the repairing processes of sleep to engage. Sleep apnea will deprive a person of the ability to achieve deep sleep because when you stop breathing, your body usually spurts out a little adrenaline to wake you up so you can start breathing again. This can keep an apnea sufferer hovering in Phase 1 & 2.

    Note sleep apnea is commonly attributed to obesity, however, people with a naturally long soft palette or uvula, a small airway, or even intense allergies can be susceptible. If you feel weary even after sleeping 6-8 hours per night, go get the sleep study done. Dealing with my sleep apnea has greatly improved my thinking, my attitude, and my blood pressure. Sleeping with the CPAP machine is a little uncomfortable, but the benefits greatly outweigh the discomfort. Overall though, it is the most significant decision I have made in terms of changing the quality of my life. If you have apnea and are treating it, bear in mind, the results won’t be greatly apparent for 2-3 months, perhaps longer, so stick with it.

  11. Winnie

    Wow Usman, great article. As you know I struggled with chronic insomnia, ever since I’ve been in SF I’ve been sleeping like a baby. No more migraine issues, now my mind feels really clear.

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