The National Institute of Health: Word on Health
A Good
Night's Sleep? Merely a Dream for Millions
by Jan Ehrman
"To sleep--perchance to dream," wrote Shakespeare in
his masterpiece play, Hamlet. It's a nice concept. However for many men, women
and children, the elusive road to slumberland is anything but a dream.
For many, the road is paved with obstacles--often a sleep
disorder, ranging from insomnia to restless legs syndrome (RLS) to sleep apnea--where
individuals usually snore, experience fitful sleep, and may stop breathing for short
periods, in some instances hundreds of times a night. The consequences of sleep
deprivation, specifically the "problem sleepiness" during the day that normally
follows, can have extremely serious, even life-threatening consequences.
Considering we spend nearly one-third of our lives tucked under
the sheets, you would think we would know how to get a good night's rest. Not so for many.
If you have sleep difficulties, you're not yawning alone--chances are some of your family
members, coworkers, and neighbors also have a "sleep debt," the cumulative
effect of not getting the quantity or quality of sleep that one needs. As many as forty
million Americans are afflicted with more than 70 different types of sleep-related
problems.
While some sleep disturbances may be linked to biological changes
associated with aging or certain physical diseases, especially those that cause pain,
others may be associated with a mental health disorder such as depression or anxiety. Poor
sleep may also stem from "bad" habits such as napping too long or too late in
the day, or doing shift work, which applies to nearly one quarter of the population,
according to the National Center on Sleep Disorders Research. The Center is part of the
National Heart, Lung, and Blood Institute, a unit of the National Institutes of Health
(NIH). On the other hand, you may simply not be giving yourself the opportunity to acquire
ample shuteye.
"What we can say with certainty is that there is a pervasive
nature of sleep deprivation out there--no question about it. It's part of how our society
functions," noted James P. Kiley, Ph.D., Director of the National Center on Sleep
Disorders Research.
Why isn't America getting a better night's rest? "It's a
two-part problem," the NIH scientist explained. "First, we have a society that's
on a 24-hour cycle--with multiple jobs in many cases and multiple responsibilities both at
work and home. When you're pushed for time, as many people are, the first thing that
usually goes is sleep." However, when you sacrifice hours this way, you frequently
end up paying for it in terms of decreased productivity and an increased risk for errors
in judgment and accidents, according to Dr. Kiley.
He said that the second part of the problem relates to actual
sleep disorders. Insomnia--the inability to fall asleep and remain there--affects many
millions of people. "For sleep apnea, easily another 10 to 15 million. Narcolepsy
(falling asleep uncontrollably during the day), perhaps 250,000. We don't even know how
many people have restless legs syndrome (RLS). In general, society is not well rested, and
looking at these numbers and their causes, you begin to see why," Dr. Kiley
explained.
While people of any age may be affected, there seems to be a
large prevalence of sleep disturbances among elderly men and women. Sleep studies reveal
that they get less REM (deep) sleep over time. With aging, sleep becomes more fragile,
that is, it doesn't take much disturbance to awaken the individual. Women may first notice
this during menopause.
Lack of sleep and its link to accidents--automobile and
on-the-job--now appears to be a problem of far greater magnitude than previously believed.
Fatigue leads to diminished mental alertness and concentration. According to Dr. Kiley,
it's the resultant "near miss" (in a motor vehicle or otherwise) that sometimes
makes people recognize they have a problem and need to seek professional help. He says
there could be as many as 1,500 fatalities and one hundred thousand sleep-related
automobile accidents annually in the United States. Shift workers are especially prone to
this problem. "Their biological clock is ticking at the wrong time, and they
typically drive home after work when they're extremely tired. Young males under 25 also
have a disproportionate number of auto accidents related to sleepiness. We want to target
them through education; in fact, we're currently working on a program with the U.S.
Department of Transportation that we hope will be very effective in this area," said
Dr. Kiley.
What about napping? In some countries, a siesta or short daytime
rest is a respected, time-honored daily ritual. Dr. Kiley also indicated it may have an
important role. "With older people in particular, napping is a good practice. Because
their sleep is fragmented and they get less of it at night, they typically make up for it
with naps during the day. Napping works, it definitely has a role," he explained,
adding that it can increase productivity and help restore your ability to think.
What about waking up too early, like before the birds' first
chirp? While such "early morning awakenings" may be a sign of depression or
other treatable emotional disorder, the passage of time may be the culprit. "As you
age, your biological clock ticks at a slightly different rate. Because of this, you run
into people with an advanced sleep syndrome--they go to bed early and then wake up too
early," said Dr. Kiley. "Again, sleep is very fragile with age and we really
don't know why." In some cases, going to bed a bit later may help reset your
biological clock and allow you to sleep later.
How many hours per night should you sleep? NIH sleep experts
believe you should be obtaining somewhere in the range of 7 to 8 hours of sleep a night.
This figure varies considerably across the age span and from person to person. Still, if
you're getting less than 6 hours of sleep per night regularly, chances are you're building
up your "sleep debt," and may be compromising your health and welfare, sleep
authorities contend.
If you're having chronic sleep difficulties, should you merely
lie there and take it? No. Dr. Kiley suggests you practice sensible sleep habits. However,
if you've done all you can and still aren't getting good, quality sleep, talk with your
family doctor. If you need additional help, ask for a referral to a sleep specialist. This
may be needed, in particular, for more complex conditions such as narcolepsy. While this
disease is not curable, it is treatable, though the regimen with carefully prescribed
medications is complicated, and best handled by a sleep specialist. On the other hand,
"we've made great strides in the sleep apnea area. General practitioners now do a
pretty good job of diagnosing this condition. In the next 5 to 10 years we would like to
have every physician as familiar with the other sleep disorders as they now are with
apnea," Dr. Kiley concluded.
The Greek philosopher Sophocles once remarked that "sleep is
the only medicine that gives ease." As researchers seek to unravel the remaining
mysteries surrounding sleep, many more men, women, and children should soon find a night
in the bed a more pleasant pill to take--rest assured. --a report from the NIH
Word on Health, June 1998
A Word to the Wise: Sensible
Sleep Habits:
There is no surefire method that guarantees a good night's
sleep--not even a warm bath or a warm glass of milk. However, experts now recognize that
there are some factors that may either help promote or discourage a peaceful night's
sleep. If your sleep problems persist, be sure to see your family physician or a sleep
expert. Most problems can be treated with good results.
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