More on Sleep

50% of Health: SleepUntil very recently, medical doctors received virtually no training at all on the value of sleep — physiology, pathology, effects of sleep deprivation, causes of insomnia, and natural vs. pharmacological treatments. Indeed, research into sleep did not take hold until the last half of the last century, primarily because of the difficulties of staying up all night to observe patients willing to have their sleep monitored.Nevertheless, science has advanced considerably, and Stanford Medical School has been one of the true pioneers. For myself as a clinician, I am grateful for the autobiographical tome written by William Dement, MD, of Stanford — The Promise of Sleep, Dell Publishing (1999). It describes the major research developments of the last several decades in an interesting personal style. Since reading this book. I have been able to recognize and treat sleep disorders with success, witnessing profound benefits in chronic disease.Basically, when sleep studies are done on general populations, rates of sleep deprivation range to 63%. Considering adults from 18 to about 75 years of age, the average need for sleep is about 8 1/4 hours per night. Moreover, the statistical distribution is very narrow, ranging from 8.0 hrs/night to 8 1/2 hours per night. It is true that there are a few percent of the population who need 6 or 7 hours of sleep a night, but the vast majority require between 8 and 8 1/2 hours, with very few exceptions.A 28 March 2002 survey of the American population published in the media found that adults generally get just under 7 hours of sleep a night: “A poll by the National Sleep Foundation found that almost two-thirds of Americans fail to get eight hours sleep a night and many routinely drive drowsy and struggle to keep from napping at their jobs....The poll found that 63 percent get less than eight hours a night and about 31 percent get less than seven hours.”In truth, sleep deprivation of one hour per night is very severe. It results in sleepiness during the day (and while driving), mental mistakes, poor concentration, impaired reflexes, heart palpitations, and “nervous energy.” To compensate, people consume more caffeine and sugar to keep up needed energy.Two nights in the range of 2 hours of sleep debt each leads to measured decline in performance on mental acuity and reflex testing equivalent to two strong drinks of alcohol. In addition, when alcohol is consumed on top of sleep deprivation, the effect is multiplied. For these reasons, recent investigations of auto accidents find that sleep deprivation contributes as much to fatal auto accidents as alcohol does! ... This is not a generally recognized fact!How to Recognize Sleep DeprivationThe first, most common sign of sleep debt is feeling sleepy during the day, especially after lunch. It is often imagined that falling asleep after lunch while listening to a lecture or reading quietly is due to blood engorging the stomach and draining from the brain. Studies with Stanford students prove otherwise. When sleep debt is eliminated, this tendency disappears and, in fact, the brain functions much more efficiently in learning and getting work done.Another measure of sleep debt is the length of time it takes to fall asleep at night. People often brag about their ability to fall asleep as soon as they put their head on the pillow. As a matter of fact, this is a prime sign of “extreme” sleep deprivation. To quote Dr. Dement, p. 60: “...in this range [0 to 5 min. to fall asleep], physical and mental reactions often are very impaired. A score of 5 to 10 minutes is borderline, while a score of 10 to 15 indicates a manageable sleep load. A score of 15 to 20 represents excellent alertness.”How do we measure this time-to-fall-asleep? A simple tool is to place a saucer on the floor by the bed and hold a spoon in your hand above it. Note the time on the clock and proceed to fall asleep. When the spoon hits the saucer, glance again at the clock and note the interval.One phenomenon which can be a contributor to sleep deprivation is snoring. Moderate snoring may mean nothing, but loud snoring to the point of keeping others awake in the adjacent room should be investigated. Snoring commonly happens because of anatomical problems in the pharynx, and it may be aggravated by allergies. However, when it is associated with weight gain, chronic alcohol consumption, or very loud, it can be a sign of sleep apnea.In sleep apnea, the breath and even heart may stop hundreds of times an hour throughout the night, preventing deep sleep and putting stress on blood pressure, heart, and brain. This is a very serious condition which deserves a full sleep workup, which can lead to miraculous therapeutic results.Good Sleep HygieneThe first principle of sleep hygiene is being aware of sleep deprivation. Most of us are used to fighting sleepiness as a routine state, running on “nervous energy.” Once sleep debt has been corrected by whatever means, though, we gain an efficiency of mental alertness and effortlessness of stress management that motivates us to attend to sleep needs.Once you are used to being free of sleep debt, it becomes easy to recognize it when it arises — sleepiness during the day, poor concentration, frequent mistakes, clumsiness, irritability. Reflecting back, you may recall missing sleep in the previous few days, and the solution is easy — get a few extra hours in the next few nights. After awhile, the process becomes second nature.However, the very first task is to correct what may have accumulated over a span of years!One study required participants to eliminate their sleep debt before starting the study. This was done by requiring them to sign into a dorm room at 4 PM every day. They were not allowed to nap during the day. Then they were shut into a sealed-dark room, alone with no radio or TV, for 14 hours each night, for as long as it took for their sleep to normalize. At first, they slept 12 or more hours while catching up. Eventually, they settled into their 8.25 hours of sleep a night with great uniformity. This took 4 weeks before they normalized!....A typical measure of how long it takes to truly correct sleep debt for most of us!Next, the principle is to set sleep as a priority. This is not as easy as it sounds. Most people have children, chores, study, homework, work, or hobbies that seem more important. However, as sleep debt develops, these become less efficient and less satisfying, so the effort to set aside the time pays off!The body responds well to habit and rituals. Have a regular bedtime, and regular rise-time. Follow a routine before bed. Do not use the bed for reading, watching TV, or work — essentially only for sleep and intimacy. Make sure the room is kept as dark as possible and eliminate extraneous noise. If you wake in the night, do not lie for a long time trying to fall back asleep. Just get up, walk or eat or read a bit, then go back to bed when sleepy again.Eventually these habits lead to a good night of sleep. From then on, plan sleep with the idea of getting adequate amounts rather than cutting corners. If there is a need to incur sleep debt, set aside time as soon as possible to compensate by getting the proportionate extra amounts. Take naps to help out.Reading Dr. Dement’s book is an important suggestion in developing knowledgeable sleep habits. It is loaded with points of view and tips.If there is a sleep disorder or insomnia that goes on longer than a few weeks, seek help. Homeopathy can often help, and sleep studies can be ordered if needed.Above all, do not ignore the problem. As I often say, in talking about health, people talk incessantly about food/nutrition, a little about exercise, and almost never about sleep. These priorities should be reversed. Sleep is a fundamental biological need which is too often disregarded in our hyperactive culture. The consequences are inefficiency and chronic disease.