- The Washington Times - Monday, October 10, 2005

In this market-driven, on-the-go, 24-7 society, sleep can be a hard-to-come-by commodity. That is because 75 percent of adults have a symptom of a sleep problem, which can be anything from a sleep disorder to not allowing sufficient time for sleep, according to the National Sleep Foundation’s (NSF) 2005 Sleep in America Poll. A market research firm conducted the telephone poll in fall 2004 for NSF, using a random sample of 1,500 adults. NSF is a nonprofit organization in Northwest that supports research and education on sleep and sleep disorders.

Few polled think they have a sleep problem and ignore their symptoms, the poll states.

The average adult needs seven to nine hours of sleep, as recommended by sleep experts, but the average American gets 6.9 hours, according to NSF.

“Sleep deprivation is a pervasive problem,” says Dr. Helene Emsellem, spokeswoman for NSF. She is director of the Center for Sleep and Wake Disorders in Chevy Chase and associate clinical professor of neurology at George Washington University in Northwest.

“We have a 24-7 society. We don’t allocate enough time for sleep, and many of us are tired,” she says.

Shift work, working long hours and jet lag can cause sleep deprivation. So can taking certain medications, chronic pain syndromes, arthritis, diabetes and other health problems.

Insomnia, the most common of the 85 recognized sleep disorders, is characterized by having difficulty falling to sleep or maintaining sleep or waking too early, resulting in poor sleep quality. The disorder can result from medical or psychological causes, particularly anxiety or depression.

Other sleep disorders include sleep apnea, or pauses in breathing that interrupt or disrupt sleep; restless legs syndrome, having uncomfortable leg sensations when trying to fall asleep; and narcolepsy, a neurological disorder that causes a person to suddenly fall asleep at inappropriate times.

“No one exactly knows the purpose of sleep. We just know what happens when you don’t get enough sleep,” says Dr. David Gross, pulmonologist and medical director of the Sleep Disorders Center, which is affiliated with Washington Hospital Center in Northwest and located at the neighboring National Rehabilitation Hospital.

Sleep is thought to be involved in repairing the nervous system and sorting and consolidating memories and thoughts to make them more permanent, Dr. Gross says.

“Sleep is necessary. It’s a time for us to reset, rest and restore our bodies,” says Dr. Robert Herscowitz, a pulmonologist associated with Inova Alexandria Hospital and in private practice with Pulmonary Associates Ltd. in Alexandria.

Sleep consists of five stages.

The first stage is the lightest stage with some awareness of sound and smell, says Dr. Nancy Collop, spokeswoman for the American Academy of Sleep Medicine, a professional membership organization in Westchester, Ill., focused on advancing sleep medicine. She is an associate professor of medicine at Johns Hopkins University and director of the Johns Hopkins Hospital Sleep Disorders Laboratory in Baltimore.

The second stage involves a deeper level of sleep, while the third and fourth stages consist of deep sleep that predominates the first third of the night, Dr. Collop says. Those who are sleep-deprived make up deep sleep first, she says.

The brain is in a restive state during the first four stages of sleep, but during the last stage, called Rapid Eye Movement (REM) or dream sleep, brain activity is similar to that of a wakeful state, says Dr. Collop, adding that REM sleep is when the best recall of dreams occurs.

“The rest of the body is paralyzed essentially, but the eyes and diaphragm are both active,” she says.

After falling asleep, a person typically takes 90 minutes to go into dream sleep and cycles through the sleep stages several times, spending less time in deep sleep and more time in dream sleep as the night goes on, says Dr. Dina KiaNoury, assistant professor of medicine at the Division of Pulmonary, Critical Care and Sleep Medicine at Georgetown University Hospital in Northwest.

“What’s important is the duration — the number of hours — and quality of sleep,” Dr. KiaNoury says.

Sleep deprivation can cause a short attention span; affect memory, alertness and concentration; decrease motor and problem-solving skills; and cause irritability, mood changes and depression. Daytime sleepiness also can occur.

Those deprived of REM sleep have more difficulty with cognitive tasks, while those awakened during deep sleep can experience muscle aches and body discomfort, Dr. Collop says.

“Learning and memory can be affected by one night of sleep deprivation,” says Dr. Carl Hunt, director of the National Center on Sleep Disorders Research at the National Institutes of Health (NIH) in Bethesda.

Sleep deprivation is becoming recognized as a public health problem.

For instance, at least 1,500 deaths a year are caused by drowsy driving, a problem that costs $50 billion a year, Dr. Hunt says, quoting statistical information from NSF and NIH. Twenty percent to 30 percent of all automobile accidents with injuries are related to drowsy driving, he says.

Obesity is another public health problem that can be related to sleep deprivation, Dr. Hunt says. Insulin sensitivity and levels of hormones that regulate appetite are affected by lack of sleep, he says.

“Sleep is just as important as diet and exercise to our overall health,” Dr. Hunt says.

Chronic prolonged sleep deprivation can decrease the immune system’s ability to fight off infection and affect the cardiovascular system, Dr. Collop says.

Blood pressure usually drops during the sleep cycle, but interrupted sleep can affect that normal decline, leading to hypertension and cardiovascular problems, according to NSF’s sleep facts and myths information sheet, available on the organization’s Web site (www.sleepfoundation.org).

“People have this perception that you can train yourself to get less sleep, but you really can’t,” Dr. Collop says. “The only substitute for sleep deprivation is sleep. Sleep is important for health and well-being and optimal functioning. People often function without sleep for so long, they consider fatigue to be normal.”


Good sleep hygiene may help a person who experiences sleep problems improve their quality of sleep, according to metro-area pulmonologists and sleep center directors. “A lot of people believe they don’t need as much sleep as they do,” says Dr. David Gross, pulmonologist and medical director of the Sleep Disorders Center, which is affiliated with Washington Hospital Center in Northwest.

Dr. Gross suggests the following sleep tips:

• Go to bed at the same time each night and get up at the same time each morning.

• Sleep an extra hour on weekends if additional sleep is needed.

• Once the lights are turned off, do not worry or plan ahead.

• Reserve the bedroom for sleep and sex and move other activities to other rooms of the house.

• Read something relaxing or listen to relaxing music until a feeling of sleepiness occurs, then go to the bedroom to sleep.

• Cool rooms are better for sleeping than warm rooms.

• Avoid heavy meals in the evening and alcohol in late evening.

• Stop drinking caffeinated beverages by lunchtime.

• Do not exercise within six hours of bedtime.

Shelley Widhalm



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