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ROI: Sleep and Effective Decision-Making by Robert Dollinger, MD

Sure, the boardroom and the corner office play key roles in effective decision-making. But another room has significant impact: the bedroom.

A good night's sleep allows the mind to do effective strategic thinking and formulate workable plans, recent research finds. Because there is power in a well-rested body and mind, you can sleep your way to the top - but you can't cut corners.

Government estimates show as many as 70 million Americans suffer from sleep deprivation. Multiple research studies cite lack of sleep as a cause of: 

• decreased physical energy
• lowered stress and anger thresholds
• loss in basic cognitive functions important to decision-making

Lack of sleep compromises our ability to be alert, pay attention and stay vigilant and negatively affects risk-taking behaviors.

In fact, sleep deprivation and extreme fatigue have played a role in some of the world's worst accidents, including the 2003 crash of the Staten Island Ferry that killed eleven people. Sleep deprivation ultimately resulted in the fatal dawn decision to launch the Space Shuttle Challenger, by impeding focus on details and effective communication. The Chernobyl nuclear reactor meltdown, the Exxon Valdez oil spill and the nuclear accident at Three Mile Island in Pennsylvania have also been blamed on human error resulting from a severe lack of sleep.

From leaders of Fortune 500 companies to doctors, from scientists to students, from entrepreneurs to engineers, sleep is a must - especially in today's e-mail, social networking, and cell phone driven world of constant communication and stimuli. The proper amount of sleep produces a significant return on investment. How much is enough?

The American Academy of Sleep Medicine estimates that most adults need about seven to eight hours of sleep each night to feel well rested. While the majority of Americans report that's the amount they get, some say they sleep as few as five hours, and other as many as 10 hours.

Effective leaders require a substantial amount of energy to be optimally productive in the workplace and need sufficient sleep, in both quantity and quality, to have the energy and alertness necessary to make the right decisions.

Both the quantity and the quality of sleep are important. Interrupted sleep results in a deficiency of certain sleep stages such as the deep slow-wave sleep or rapid eye movement (REM) sleep. Despite getting the right amount of sleep, interrupted REM sleep always results in sleep deprivation.

Sleep deprivation reduces cerebral metabolism within the pre-frontal cortex, the brain region most responsible for higher-order cognitive processes including judgment and decision-making. This vulnerability becomes more pronounced with increased age and has a negative impact on executive functions such as planning, sequencing, organizing, concept formation, and conflict resolution.i

Losing just one night's sleep results in riskier decisions, impairs flexible thinking and causes a decrease in corrective decisions normally made in response to mistakes.ii In spite of concerted efforts to stay awake by working on interesting projects, sleep deprivation impairs decision-making involving the unexpected, hampers ignoring competing distractions, and reduces effective communication.

Studies have shown that sleep loss for 24 to 36 hours impairs other types of executive functions such as supervisory ability, problem solving, and the ability to learn from past experiences.

The minimal amount of sleep required for optimal decision-making varies but most research indicates that four hours of sleep per night is the absolute minimum for adequate performance, particularly when critical decisions need to be made. The effects of sleep deprivation on performance cannot readily be reversed by consumption of caffeine or physical exercise.iii

Sleep deprivation may also be especially dangerous for those who must make quick decisions such as military personnel and emergency physicians. Researchers at the University of Texas at Austin found a link between sleep deprivation and information-integration, a process that relies heavily on instantaneous, "gut-feeling" decisions.

According to a study on U.S. military cadets, sleep-deprived individuals may put themselves and others at risk when they need to make split-second decisions. The results published in the journal SLEEP showed that moderate sleep deprivation can cause an overall immediate loss of information-integration thought processes.iv

Sleep deprivation is costing American businesses and employers an enormous amount of time and money. The National Institutes of Health estimates that sleep deprivation costs employers $16 billion in healthcare expenses and $50 billion in productivity each year.

At FIU's Center for Leadership, the importance of sleep is addressed to help build awareness of optimal performance levels for leaders. In leadership workshops and other vehicles, participants learn important information about the potential correlation between sleep and success and realize that just as an athlete trains the body, eats well and rests in order to achieve the finish line so, too, should effective leaders.

Leaders are encouraged to seek help with sleeping disorders or try to train the body's rhythms to get the proper quantity and quality of sleep to be the most effective for their organizations, their families and communities.

Dr. Robert "Bob" Dollinger is Assistant Professor of Internal Medicine and Assistant Dean for Student Affairs at the College of Medicine, Florida International University (FIU). Dr. Dollinger also sits on the Academic Board of Advisors to the FIU Center for Leadership and serves as an instructor for the center's Executive Leadership Development Programs.

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i Killgore WD, Balkin TJ, Wesensten NJ. Impaired decision making following 49 h of sleep deprivation. J Sleep Res. 2006 Mar; 15(1): 7-13. PubMed PMID: 16489997.

ii Angus, R.G., Heslegrave, R.J., & Myles, W.S. Effects of prolonged sleep deprivation, with and without chronic exercise, on mood and performance. Psychophysiology 1995, 22: 276-282.

iii Harrison Y, Horne JA. The impact of sleep deprivation on decision making: a review. J Exp Psychol Appl. 2000 Sep; 6(3): 236-49. Review. PubMed PMID: 11014055.

iv McKenna BS, Dickinson DL, Orff HJ, Drummond SP. The effects of one night of sleep deprivation on known-risk and ambiguous-risk decisions. J Sleep Res. 2007 Sep; 16(3): 245-52. PubMed PMID: 17716272. "SLEEP is a monthly peer-reviewed scientific and medical journal featuring a wide spectrum of sleep-related research. The journal is the official publication of the Associated Professional Sleep Societies, LLC (APSS), a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society." www.journalsleep.org.