The public health consequences of sleep loss, night work, and sleep disorders are far from benign. Some of the most devastating human and environmental health disasters have been partially attributed to sleep loss and night shift work-related performance failures, including the tragedy at the Bhopal, India, chemical plant; the nuclear reactor meltdowns at Three Mile Island and Chernobyl; as well as the grounding of the Star Princess cruise ship and the Exxon Valdez oil tanker (NCSDS, 1994; NTSB, 1997; Moss and Sills, 1981; United States Senate Committee on Energy and National Resources, 1986; USNRC, 1987; Dinges et al., 1989). Each of these incidents not only cost millions of dollars to clean up, but also had a significant impact on the environment and the health of local communities.

Less visible consequences of sleep conditions take a toll on nearly every key indicator of public health: mortality, morbidity, performance, accidents and injuries, functioning and quality of life, family well-being, and health care utilization. This chapter begins with an overview of the consequences of sleep loss and sleep disorders on an individual’s performance, safety, and quality of life. Drawing on the available body of evidence, the chapter then describes the economic impact of sleep loss and sleep disorders.


Nearly all types of sleep problems are associated with performance deficits in occupational, educational, and other settings. The deficits include attention, vigilance, and other measures of cognition, including memory and complex decision making. This section addresses sleep loss and then turns to sleep-disordered breathing and other sleep disorders.

Sleep Loss Affects Cognitive Performance

Sleep loss had been largely dismissed as the cause of poor cognitive performance by early, yet poorly designed, research. The prevailing view until the 1990s was that people adapted to chronic sleep loss without adverse cognitive effects (Dinges et al., 2005). More recent research has revealed sleep loss-induced neurobehavioral effects, which often go unrecognized by the affected individuals. The neurobehavioral impact extends from simple measures of cognition (i.e., attention and reaction time) to far more complex errors in judgment and decision making, such as medical errors, discussed below and in Box 4-1. Performance effects of sleep loss include the following:

  • Involuntary microsleeps occur.

  • Attention to intensive performance is unstable, with increased errors of omission and commission.

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