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Snooze or Lose It

Health Wanted


Published March 31, 2004 at 5:00 p.m.

"spring forward" is a cheery euphemism for the annual switch to Daylight Savings Time, which happens this year on April 4. Sure, we have an extra chunk of sunshine at the end of the day, but we also lose an hour of shut-eye on Saturday night -- just when we were trying to catch up from lack of sleep the week before.

Americans, you see, are not only overweight but fatigued. The Puritan ethic of "early to bed, early to rise" has morphed into "must work harder, sleep less." In 2002, the National Sleep Foundation (NSF) discovered that 60 percent of Americans have trouble getting a regular night's rest. Mean-while, 37 percent of Americans say they're so sleepy they can't function normally a few days each month; 16 percent admit serious sleep-related problems several times a week. And when we do end up in the boudoir after our multitasking marathons, many of us lie wide awake. Like Bill Murray and Scarlett Johansson in Lost in Translation, we while away the wee hours in strange ways while luckier souls slumber.

More than 70 million Americans suffer from insomnia. As many as 18 million wake up repeatedly during the night because of sleep apnea, or blocked breathing, which goes hand in hand with obesity: Extra fleshy tissue clogs up the airway. And the most common problem, experienced by about 90 million Americans, is Restless Legs Syndrome, or RLS. Those afflicted feel uncomfortable sensations that make them thrash their legs and lose sleep -- and irritate their sleeping partners.

Lack of sleep makes us look like crap and act like idiots. It can also be deadly. Drowsy drivers cause more than 100,000 car crashes and 1500 deaths each year, a number that would be much higher if the 100 million U.S. drivers who admit to feeling overwhelmingly tired on the road didn't catch themselves in time to prevent accidents. Both the Exxon Valdez and the Chernobyl disasters have been linked to individuals falling asleep or exercising poor judgment because of sleepiness. A recent study in India that monitored the brain waves of train conductors discovered that 20 percent were driving their engines in deep sleep.

The tiredness epidemic is so alarming that NSF has declared March 29 to April 4 National Sleep Awareness Week, and the organization offers a host of tips on how to create sleep-smart communities. It is not, alas, a mandate for the entire country to draw the shutters for seven days of snoozing. The initiative coincides with the release of several recent sleep-pattern studies: Some suggest we should sleep in spurts of an hour and a half, while others prescribe seven hours across the board. On March 24, the National Institutes of Health announced that too much sleep is just as troublesome as too little. So how much is just right?

I feel a little like Goldilocks the day I track down Dr. Hrayr Attarian, a neurologist and director of the Vermont Regional Sleep Center. He transferred to the University of Vermont clinic just nine months ago and is already booked solid with appointments. Some 45 to 50 bleary-eyed patients visit his office every week. Most are in their mid-thirties to mid-fifties, the prime age range of overworked professionals.

"The most common complaint is sleep deprivation," Attarian says. "As a society we don't get enough sleep... And this is my first impression, but it seems that the Vermont culture tends to look at sleep in an unfavorable light. People like to get up early; sleep is not that important."

The first symptom of sleep-deprivation is inattentiveness, which is often followed by falling asleep at completely inappropriate times: in school, at work, in the car. "People may not realize that falling asleep in classes or in meetings, however boring they are, is not normal," says Attarian. "And it's not a sign of laziness or a character flaw, it's a sign of being sleep-deprived. I teach at UVM, and I joke with my students that as a sleep specialist I'm not offended if they fall asleep in my class."

Even those who manage to stay awake all day are not in the clear: If you need an alarm to wake up in the morning, you're sleep-deprived. The best way to figure out your sleep needs is on vacation -- provided you do, in fact, take vacations. Go to bed when you're sleepy and wake up when you feel like it. After a few days of compensating for lost sleep, your body will stabilize, and you'll probably be snoozing for the good old gold standard of eight hours.

"Human sleep need is genetically predetermined, and it falls under a bell curve," says Attarian. The highest proportion of people require between seven-and-a-half and eight hours. But some perfectly healthy folks need up to 11 hours of shut-eye, while others can get by with just four or five.

Ideally, once you return from that restful vacation, you'll adjust your schedule to get the adequate amount of sleep, and you'll take a nap between 2 and 5 p.m., one of the two low points in our circadian clocks. The other falls between 10 p.m. and midnight. Naps of 30 to 45 minutes have been shown to increase productivity, and some companies are now catching up to a global trend of siestas by creating "napnasiums" with reclining chairs, white noise, blackout drapes and mini-waterfalls to refresh exhausted employees.

"In societies outside of the U.S. and Canada, people start work a little later, come home, take a nap in the afternoon and stay at work a little later," says Attarian. "This is much more natural than getting up early, rushing to work and taking no breaks."

If you can't nap, Attarian suggests arranging afternoon tasks or meetings that force you on your feet -- and that don't involve a giant trough of java. "Invariably I have patients who drink a pot or two of coffee a day," he says. "If you use it judiciously, it's an excellent tool to help you concentrate. But people tend to overdo the caffeine and then they can't fall asleep."

What about a few drinks before bed? "It's a very bad idea," says Attarian. "Alcohol puts you to sleep right away, but then your brain goes into mini-alcohol withdrawal, which disrupts sleep. For every glass of wine -- and we're talking about a regular wineglass -- or equivalent amount of alcohol, you should give at least two hours before going to bed."

Those two hours are also necessary in order to experience two essential sleep-inducing phases. The first is what Attarian calls a "worry period," when you put aside your work, think about your troubles and try to find plans to dismantle them. "The second is an hour of relaxation, doing something not exciting," he says. "Watching some sitcoms on TV, listening to music; some people do yoga, take a warm bath, whatever."

His suggestions are part of an established set of rules for good sleep, called the sleep hygiene guidelines. There are three other key tools: Go to bed only when you are sleepy. Use the bedroom only for sleeping and sex. ("Eating in bed, working from bed, studying in bed is a very bad idea," says Attarian.) And if you're awake for more than 15 minutes in the middle of the night, leave the bedroom to avoid subconsciously associating it with insomnia. Don't balance checkbooks or undertake homework or housework. Instead, do something relaxing. Oh, and while you're up this Saturday night, don't forget to advance all your clocks one hour.