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A Good Night's Sleep?
Merely a Dream for Millions
"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.
Work Related Sleep Lost
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.
Sleep Disorders
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.
Impact of Sleeplessness
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
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