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SLEEP

    It's a basic necessity of life, as fundamental to our health and well-being as air, food and water. When we sleep well, we wake up feeling refreshed, alert, ready to face the day. When we don't, every aspect of our lives can suffer.

A National Sleep Debt

    Sleep problems have become a modern epidemic that is taking a catastrophic toll on our bodies and our minds. According to a Gallup Poll conducted for the National Sleep Foundation, one out of every two people suffers from sleeplessness at some point in their lives, many of them chronically. It's estimated that 30-40 million Americans suffer from serious sleep disorders that undermine their sleep quality and their health. For the victims of disordered sleep, the night is a source of anguish, not rest.

    For millions more, the body's need to sleep is treated as a waste of time. In our 24-hour society, we steal nighttime hours for daytime activities, cheating ourselves of precious sleep. In the past century, we have reduced our average time asleep by 20 percent and, in the past 25 years, added a month to our average annual work/commute time. Our national sleep debt is on the rise. Our society has changed, but our bodies have not, and we are paying the price.

The Cost of Sleeplessness Is High

    What happens when we're deprived of the restful sleep we need? We're less alert and attentive, more inclined to irritability and other mood problems that can make our relationships with family, friends and co-workers difficult. Our concentration and judgment suffer, our ability to perform even simple tasks declines, our productivity is sabotaged. Sleeplessness, whether it's the result of a sleep disorder or an overextended lifestyle, invites diminished quality of life and deteriorating health.

    When we lose sleep or our sleep is poor, we also put ourselves and those around us at high risk for accidents. Major industrial catastrophes such as the Three Mile Island incident have been attributed to human error that occurred during times when the body is at its sleepiest. If we ignore our sleep needs and get behind the wheel of a car, lives may be at stake. It only takes a few seconds - just long enough for a tired body to steal a needed "microsleep" - to run off the road or into an oncoming car.

What Is a Good Night's Sleep? 

    The amount of sleep you need to be at your best is as individual as the amount of food you need. It isn't simply how many hours of sleep time you're logging in that matters, but how good you feel and how well you're able to perform each day.

    Unfortunately, too many of us think we're getting adequate sleep, but really aren't. Do you routinely roll over and snatch a few extra Zzzz before rolling out of bed? Do you look forward to "catching up" on your sleep over the weekends? Do long meetings, overheated rooms or heavy meals "put you right to sleep"? If you're getting the right amount and quality of sleep, your answer should be "no."

    On your next vacation, go to bed when you feel tired and get up whenever you're ready, with no alarm clock. Sleep until you're slept out. You may spend the first few days getting rid of the sleep debt you've been accumulating, then your body should tell you how much sleep you need on a regular basis. If vacation plans don't allow this experiment, try getting up at the same time every day (even on weekends), but varying your bedtime until you've discovered the amount of sleep that seems to be the most restorative for you. Listen to your body and adjust your schedule accordingly.

What Happens During Sleep?

    Sleep is a dynamic process with a complex "architecture" all its own. You begin your nightly journey by descending into Stage 1, a light sleep. Your muscles relax, your brain waves are irregular and rapid. In Stage 2, brain waves become larger, with bursts of electrical activity. Then you move into deep sleep, Stages 3 and 4, in which the brain produces large, slow waves (sometimes called "delta" or slow-wave sleep). You're more difficult to awaken in slow-wave sleep.

    After an hour or so, you shift into a highly active stage characterized by rapid eye movements, hence the name REM sleep. Suddenly your brain waves are almost the same as if you were awake. You're in the dreaming stage, which occurs several times across the course of the night.

    About 75 percent of your night is spent in non-REM sleep and about 25 percent dreaming. REM periods tend to become longer and more plentiful as the night wears on. Fortunately for your partners and neighbors, you're essentially paralyzed during REM so that you're not acting out your dreams no matter how real they may seem. Occasionally, you may awaken before this paralysis has entirely ended - Don't be alarmed, it will pass in a matter of moments.

Sleeping Through the Ages

    Sleep patterns change as we age. Newborns and children spend more time in deep sleep than adults. As we grow older, sleep tends to become more fragmented and we spend more time in the lighter stages. We'll probably need to turn in earlier and get up earlier.

    It's a myth that we need less sleep in our senior years. But it's a fact that most of us sleep less at a stretch than we did when we were younger. Changes in sleep patterns can be dramatic, and sleep problems are more common among the elderly.

Watching Nature's Clock

    Sleep needs and patterns are regulated by an internal biological "clock" that's located in the brain. Most people's clock runs on a cycle of about 24 hours, but some of us are morning people, or "larks," and some of us "owls," who find ourselves more alert late in the day.

    Almost everyone's clock is set for sleep at night, especially in the early morning hours between midnight and dawn. If you really listen to your body, you'll also discover that it gets sleepy in the middle of the day, between about 1 p.m. and 4 p.m., as well. Some call this the "Siesta Zone," but if your daytime schedule won't permit a siesta, try to reserve this period of less alertness for less critical activities. This may not be the best time to start on a long drive, and it's especially important to stay off the roads between the hours of 2:00 a.m. and 6:00 a.m. when your internal clock makes sleep almost irresistible. Crashes are most likely to happen in these hours. When our lives force us to work against our biological clocks, sleep problems are inevitable.

Jet Lag

    You may become acutely aware of your biological clock when you travel from one time zone to another. Jet lag is what happens when your clock is out of sync with the new environment. You try to sleep when your body is not sleepy and struggle to stay awake while the sun is shining. You can't prevent jet lag, but you may be able to minimize the effects by easing yourself into the new time zone for a few days before you depart, resting as much as possible in transit, and planning a relaxed schedule for your first day or two after arrival.

Shift-work

    For the 20 percent of American employees who work non-traditional schedules, getting enough sleep is a common problem. Shift-workers need to sleep when their clocks are set for wakefulness, so they tend to sleep badly and not enough. They're more prone to falling asleep on the job than the 9-to-5 worker and at high risk for crashes while driving home in the morning. Maintaining a rigorously regular schedule (for both sleeping and waking activities), even on the weekends, can help the body to adapt.

To Nap Or Not To Nap?

    The mid-afternoon slump most of us experience, even when we've slept well, suggests that the human body may be meant to nap. A regular afternoon siesta isn't likely to become a part of North American culture, but an occasional restorative nap may be a very good idea, particularly if you need to tap into an alertness reserve and a longer period of sleep isn't an option.

    There's increasing evidence that a 15-20 minute nap can improve alertness, sharpen memory and generally reduce the symptoms of fatigue. If you're coping with the impact of lost sleep from last night or you know you're going to lose sleep tonight, a nap can help you through. In fact, it could be the difference between life and death if you're planning on a long drive with less than your regular quotient of sleep.

    A few cautions. First, a nap is not a substitute for a full night's sleep； it is only a short-term solution. Second, if getting to sleep or staying asleep at night is a problem, naps are probably not for you.

Insomnia: When It Comes It Seems Sleep Will Never Come

    It isn't unusual to have trouble sleeping - half of Americans do. Insomnia has many causes and is often viewed as a symptom of some underlying problem, much like a fever suggests infection. Doctors have identified three basic categories:

    Transient insomnia lasts only a few nights and is usually brought on by stress, excitement, or a change in sleep timing or environment.

    Short-term insomnia is poor sleep spanning two or three weeks and can be caused by ongoing stress, as well as medical or psychiatric problems. Alleviating the source will usually return sleep to normal. Recurring episodes are common.

    Chronic insomnia lasts more than a month and can be related to underlying medical, behavioral or psychiatric problems, such as depression.

    Insomnia's impact on waking hours can be significant and includes a decreased sense of well-being, and impaired concentration and memory. Sleep specialists recommend practicing good sleep hygiene (see box) to minimize episodes.

    Keeping a sleep log for a few weeks may be helpful in identifying behaviors that are contributing to your sleep problem. Record when you wake up, go to sleep, drink caffeinated beverages, exercise, eat and any other suspected sleep-stealers. Simple changes in daily routine may be surprisingly effective in improving sleep quality.

How Good Is Your Sleep Hygiene?

    Following a few simple guidelines, and changing a few bad habits, can do wonders for troubled sleep. Your doctor can help identify the best sleep hygiene routine for you, but here are some basics:

    Avoid caffeinated beverages for at least six hours before bedtime.
    Avoid alcohol and nicotine for at least two hours before bedtime.
    Exercise regularly, but not too close to bedtime.
    Get up at the same time every day regardless of when you went to sleep.

Can Sleeping Pills Help?

    Sleeping pills have a role in the treatment of transient and short-term insomnia, where a medication can be useful in breaking the sleeplessness cycle. Once the source of the stress or disruption is dealt with or improved sleep hygiene shows positive effects, medications are discontinued, usually within two weeks. Sleeping pills have a limited role in chronic insomnia and are not intended for long-term use.

    Prescription sleeping pills come in both shorter and longer-acting forms. The shorter-acting drugs help to induce and solidify sleep, but wear off faster. The longer-acting drugs help maintain sleep through the night, but may cause sleepiness the next day.

    Non-prescription, or over-the-counter (OTC) sleep aids use antihistamines to induce drowsiness. Be sure to allow enough time for the drug to work through your system so there's no risk of sleepiness during the day.

    If you decide to use sleeping medications, even an OTC product, be sure to talk to your doctor about the type and dosage that's best for you, as well as any cautions or side effects you should be aware of.

Sleep Apnea: Snoring That Takes Your Breath Away

    For more than 10 million Americans, loud, habitual snoring is no joke. It can be a symptom of a potentially life-threatening disorder. Sleep apnea is literally a "lack of breath." Doctors have identified three basic types of apnea:

    Obstructive Apnea

    Obstructive Apnea is the most common and severe. The muscles at the back of the throat relax to the point of obstructing the upper airway. Breathing can actually stop for 10 seconds or more causing mini-awakenings (usually not remembered) several hundred times a night as the sleeper gasps for air. Loud snoring is common.

    Central Apnea

    Central Apnea is when the airways stay open but the diaphragm and chest muscles stop working and the sleeper must awaken several times a night to resume breathing, sometimes with a gasp. Sufferers of this relatively uncommon disorder may complain of insomnia or restless sleep. Snoring may not be a symptom.

    Mixed Apnea

    Mixed Apnea is a combination of the two, usually a brief period of central apnea followed by a longer period of obstructive apnea. The combination is common.

    Sleep apnea is more common in middle-aged men and overweight people. Sufferers often experience excessive daytime sleepiness, and impaired memory and concentration. Complications arising from sleep apnea can include high blood pressure, increased risk of heart attacks and stroke, and even heart failure in severe cases.

    Not all snoring indicates a serious problem, but if you suspect that you or your partner may have sleep apnea, you should seek prompt medical attention. Obstructive apnea is often treated with a device known as a CPAP (Continuous Positive Airway Pressure), in which a small compressor is used to maintain airflow during the night. Dental appliances worn at night to reposition the tongue and/or jaw may be useful in mild to moderate cases. Surgical corrections of physical abnormalities are other options, but the results of these are variable and need to be discussed with a specialist.

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