Last week we talked about sleep. We talked about how much the average person needs, and how much they get. We also talked about how you can't just rely on averages to determine how much sleep you need. Sleep is a personal thing; we all need different amounts.

Sleep is incredibly important. You have to do it. Not getting enough sleep, or having sleep deprivation, is a real and bizarre thing. It's also the topic of this week's Healthcare Triage.

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Sleep deprivation can leave people more sensitive to pain. A study published in 2010 took people and randomized them to codeine or placebo. They also measured the quality of their sleep. They found that people who were in the sleepy group were more sensitive to pain. They also found that codeine didn't work as well in the sleepy group.

Another study published in 2012 confirmed these findings. Volunteers were randomized to normal sleep habits or extended sleep. Then they measured pain sensitivity. They also found that extended sleep was associated with reduced levels of pain sensitivity. There are lots of studies like this, so sleeping away your pain might be a thing.

Sleep deprivation can affect emotional empathy. A study published just last year randomized to one of three groups. The first group wasn't allowed to sleep at all. The second group was allowed to sleep normally. Both of these groups were examined early at night and then again the next morning. A third group was examined during the daytime to serve as another control. And tests were given to all participants to measure direct and indirect empathy.

Direct empathy is how you feel about another, such as "I'm angry or sad that happened to someone else." Indirect empathy is how it affects you, such as your heart racing or you feel nauseous. 

They found that the sleep deprived group had significantly less direct and indirect emotional empathy. They measured everyone twice to confirm it.

It's hard to do long-term studies in this manner, though. You can't deprive people of sleep for months to see if they develop physical or mental problems. But there are many cohort studies that show that sleep deprivation is associated with diabetes and obesity. We don't know the causal direction, though.

It's also hard to do studies in kids. They have to go to school, after all. But there are comparative studies for them, too. Many of them show that kids who are sleep deprived are more likely to be depressed.

Last year, a study with more than 100 adolescents in Korea with and without behaviorally induced insufficient sleep syndrome were studied. The academic performance of the kids with insufficient sleep was significantly worse. This also confirmed the results of many other studies that have had similar results.

The results also hold true for kids in middle school, high school, and even in college. Sleep deprivation is a bad, bad thing academically.

And if you demand controlled trials, they do exist. In 2003, a study was published in the Journal of Sleep Research that took 50 college students and compared their performance on math effort tasks after a night of normal and sleep deprived sleep. It should come as no surprise that the sleep deprived kids were more likely to show less effort in selecting tasks.

Another study published in 2010 showed that female athletes who were sleep deprived were less likely to believe in themselves. Not getting enough sleep may strip kids of their ability to challenge themselves and become better.

There's a growing chorus that believes that we as a society are setting teens up to fail. We know they need this much sleep, but we make them get up at the crack of dawn. When I go to the gym at 6:45, all the high schoolers are already out waiting for the bus. So unless they go to bed at 9 P.M., it's almost impossible for them to get nine hours of sleep, let alone ten.

Because of this, groups like the American Academy of Pediatrics have asked for school start times to be pushed back to a more civilized hour. After all, there's no reason school has to start so early. More than 40% of high schools start before 8 A.M. The later they start, the more likely kids are to get more sleep.

A study from the Center for Applied Research and Educational Improvement from the University of Minnesota found that when school started at 7:30, about a third of kids got at least eight hours of sleep a night. If school started close to 9 A.M., then two-thirds of adolescents got that much sleep.

Academic tests and athletic performance aren't the only things at stake here, though. Sleep deprivation causes lots and lots of car accidents. The American Academy of Sleep Medicine reports that more than 80,000 people fall asleep at the wheel each day in the United States.

They also report more than 250,000 sleep-related motor vehicle accidents each year. About 20% of serious injuries due to accidents are related to sleep. Alcohol use doesn't help, either.

Studies show that astronauts who are sleep deprived are more likely to have errors in performance. They show the same in airline pilots and physicians. Because of this, pilots are forced to work only a certain number of hours at a time. And recent regulations have placed the same requirement on physicians-in-training.

When people work too much and get too little sleep, accidents happen. Sometimes they cost lives. Sleep deprivation has real effects with serious consequences.

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