Give Sleep a Chance
One in three Americans may be suffering from a sleep disorder. One in four report problems in their sex lives from lack of sleep. Are New Yorkers too tired to admit that they are exhausted in the city that never sleeps?
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Alix Florio January 21, 2006
 Occasionally, a book changes your life. Rummaging through the stacks of a used bookstore near my house, I picked up a copy of Power Sleep: The Revolutionary Program that Prepares Your Mind for Peak Performance, by Dr. Edward Maas. As I carried it home, I began to wonder if I had been bamboozled by the book’s glamorous self-help promise of increased productivity and happiness. I really couldn’t imagine anything about sleep that would make it terribly exciting.
The book, it turned out, despite the name, offered no gimmick at all. In fact, it reminded me of the diet book my dad used to joke would make him rich one day. The one with only two words in it: Eat less.
Dr. Maas’ revolutionary proposal for improving your life was, get this: Get more sleep. And for some of us: Get a lot more. And finally: Get so much sleep that you don’t feel tired anymore. For me, this was news, and I was riveted.
The idea that getting too little sleep was truly unhealthy, and so serious that one should try to do something about it, even if it meant accomplishing less some nights, was, frankly, somewhat new for me. In my day, going to bed, just because you were tired, before you had finished with everything, seemed, well, kind of lazy, more than healthy.
Sleep hasn’t always gotten such a bad rap. We have two major historical changes to thank for the deterioration of our formerly positive relationship with rest: the electric light and caffeinated beverages.
During the industrial revolution, coffee and tea began to replace beer as the beverage of choice for most people. The popular introduction of these caffeinated drinks was a significant force behind the rise of a quickly industrializing society. That mind-sharpening buzz eased the transition from the more natural (and more forgiving) pace of agricultural life, to the modern, machine-driven tempo of today’s working world .
In addition to tweaking our metabolism with caffeine, by the end of the 1800s, the widespread use of electric light allowed everyone to perform tasks late into the evening. Without the sleep-inducing cue of sundown interfering with our nighttime alertness, the sky was the limit, in terms of productivity. By the close of the 19th century, we had successfully bent our natural sleep rhythms to the will of work.
Today, the magnitude of sleep depletion is so profound that the Federal government has classified sleep deprivation as a public health problem, and sleep doctors often refer it to as an epidemic.
In 1988 The National Commission on Sleep Disorders Research was established by Congress to investigate the breadth of American sleeplessness and establish a plan to promote improvements.
The Commission’s research was presented in 1993 to Congress in a report entitled, “Wake up America: A National Sleep Alert.” At the time the Commission found that, “40 million Americans are chronically ill with various sleep disorders and an additional 20 to 30 million experience intermittent sleep-related problems. The consequences of sleep disorders are diverse, serious, and often catastrophic.”
The most dangerous results of national sleeplessness are found every day on the road and on the assembly line. Sleep deprivation in these populations creates not just nuisances, but fatalities, because of the steady concentration required in such high-attention tasks.
“Falling asleep at the wheel is the most costly and devastating problem on American highways. Accidents in the workplace due to sleep deprivation are commonplace and damaging to industry.” The commission found, however, that no category of the population was immune from the ill effects of sleeplessness.
In response to the Commission’s findings, Congress created the National Center on Sleep Disorders Research (NCSDR) 2003. The NCSDR conducts and supports research, scientist training, dissemination of health information, and other activities on sleep disorders and related concerns. The Center is also responsible for coordinating sleep research activities with other Federal agencies, and with public and nonprofit organizations.
Making information about sleep available, not only to the general public, more importantly, to healthcare professionals, is a critical part of the center’s mission. The typical medical student receives only a few hours of instruction on the nature of sleep and its associated disorders. It is no surprise then that sleep related illnesses are rarely identified correctly by doctors presented with their symptoms.
William C. Dement, M.D., PhD, former chairman of the National Commission on Sleep Disorder’s Research gives a disturbing example of the failure of the medical profession to properly identify sleep apnea in his book The Promise of Sleep. Reviewing a total of more than 10 million primary care physician’s patient records, Dr. Dement and his staff discovered only 73 diagnostic codes for obstructive sleep apnea and 7 for narcolepsy. No other specific sleep diagnoses were found.
Based on previous population studies, Dement and his staff determined that roughly 95-99 percent of all sleep disorder sufferers in 1991 remained undiagnosed and untreated, or misdiagnosed and mistreated.
Sleep hasn’t gotten much better since then. According to the National Sleep Foundation, a non-profit organization focused on raising awareness of sleep disorders in the United States, more and more Americans are reporting sleep problems every year. Based on the results from a phone survey of 1,500 U.S. adults in 2005, 75 percent of those surveyed reported experiencing at least one symptom of a sleep problem a few nights a week or more. This continues a significant increase from the NSF’s first poll in 1999 (62 percent reported regular sleep problems), but similar results from more recent polls.
Despite their severe repercussions for overall health, the two most common sleep disorders (obstructive sleep apnea and insomnia) often go undiagnosed.
People who have sleep apnea suffer from fragmented sleep and may develop cardiovascular abnormalities because of the repetitive cycles of snoring, airway collapse and awakening. Symptoms include: loud snoring, excessive daytime tiredness, frequent nighttime waking, headaches, irritability and other problems.
According to Dr. Rodriguez, Assistant Professor of Neurology at the NYU School of Medicine, and a doctor at the New York Sleep Institute, a private sleep center on Manhattan’s East Side, the symptoms of insomnia, the second most common sleep disorder, can be even harder to identify than those of obstructive sleep apnea.
With generalized sleep-deprivation so common, it is very hard for a patient to determine on their own whether or not they have a real disorder, or merely the garden-variety lack of sleep. In reality, there is a continuum, and the answer is often very individual. Commenting on the complexity of the disorder, Dr. Rodriguez noted, “There are seven different kinds of insomnia. I see a lot of it in New York City, often anxiety related. The symptoms include trouble falling asleep, or trouble staying asleep.”
Although he stresses that different people have different sleep needs, Dr. Rodriguez offered a general rule about sleep deprivation, “If you need the alarm clock to wake you up every day, you are not getting enough sleep.”
The difficulty in diagnosing a patient’s sleep disorder does not lie solely within the medical profession. Patients themselves are often unaware, or unwilling to admit that frequent daytime sleepiness constitutes a problem worthy of discussion with a doctor. Although 75 percent of those polled by the NSF reported symptoms of sleep problems, 76 percent surveyed still reported that they did not have a sleep problem.
Ron Elton, a New York professional in his forties, had grappled with allergic asthma since childhood. Over the past few years it seemed to him that his condition was getting worse. He was becoming increasingly congested at night, and found himself waking up frequently, rising earlier and earlier due to “achy” discomfort in the morning.
Ron knew he was not getting enough sleep, and was more and more hindered by his exhaustion, “I was getting up incredibly early, around 5:30, 6:00 because I was so uncomfortable. By 9 at night I was exhausted. There was an hour or two block during the day when I was just getting nothing done. It was terrible.”
At first, Ron considered his sleeplessness just an unpleasant side effect of his asthma. But Ron took a further step that many patients do not: he began to recognize and admit, that his frequent night waking and early rising, was itself, becoming a serious problem, one that was not being addressed by his doctor. Once Ron was able to realize that his exhaustion was interfering too heavily in his day to day activities, he began to seek the help that his primary care physician was unable to provide.
Several months earlier, Ron had made the acquaintance of sleep specialist Doctor Gerard Lombardo, Chief of Clinical Pulmonary Medicine at New York Methodist Hospital, and Chief of the Division of Sleep Medicine at the Sleep Disorders Center, on the golf course where he typically played. At the time Ron had mentioned to the doctor that his wife had complained that he snored loudly and irregularly at night.
Once Ron realized that his sleep life was deteriorating, he contacted Dr. Lombardo to set up a consultation. The doctor recommended that Ron spend a night in the New York Methodist Hospital Sleep Center, for overnight testing. Within a few weeks Ron was checked into a comfortable room, appointed like a hotel with a TV, bed, and nightstand, and was connected to 24 or so diodes attached, mostly on his head, with a belt placed around his chest. It took an hour to hook him up completely.
Needless to say, the 24 diodes made it hard to sleep. But though, Ron did not get fantastic rest that night, he did manage to sleep. During the periods in which he was sleeping, they recorded sleep disruptions occurring at a rate of nearly 68 times an hour, representing a frequency of arousal that definitely warranted intervention.
Since then, Ron has made one more visit to the sleep center to get fitted for a CPAP (Continuous Positive Airway Pressure) machine. This machine is a bedside device that, using a light airflow through a small mask put on at bedtime, will allow him to breathe more comfortably at night. On Dr. Lombardo’s suggestion he has also changed the way he is treating his asthma.
“This has changed my life dramatically. I’m not tired. I can talk to you at this hour.” Ron said of our 9PM interview, “I feel like a different person.”
The life altering nature of improved sleep is not unique to Ron, or even to people with confirmed sleep disorders. It seems that the rest of us who merely avoid sleep for all the normal reasons, wanting to get more work done, enjoying the quietness of the evening hours, could be enjoying a similarly improved quality of life.
Shortly after finishing the book, I began to experiment with actually sleeping for seven or eight hours every night, something I had not done regularly since childhood. As difficult as I found it initially, a little embarrassing even, I started going to bed around 9:30 or 10:00pm, knowing that my early rising children would wake me up in the morning around 6 as they had for years.
The first few days of getting seven or so hours of sleep, I actually felt groggier than usual, but more relaxed. It was my guess that my sleep debt had probably been so extreme that the feeling I often identified as alertness, was in fact, just stress, due to exhaustion.
But after the initial two or three days, where I can best describe the feeling I had as ‘in recovery’, I started to feel uncustomarily great. I was becoming more patient, less tense, and happier overall. I felt more optimistic, alert and creative.
Now after a month of making every effort to sleep eight hour nights as often as I can, I can honestly say, my life is improved. I laugh more, I make up my mind more easily. My outlook is generally brighter.
For all the trouble the human need for adequate sleep can be, I realize now that going to bed when I am tired is a need, not an indulgence. My attitude towards sleep has changed permanently.
The proper number of nightly sleep hours is an imperative for wellness, like the proper number of nutrients a body requires in a given day, the right amount of water, or a healthy amount of exercise. One may choose to settle for less sometimes, but the body will feel deprived and long-term shortages will result in health problems as real as starvation.
So how are you sleeping?
About the Author
Alix Florio is the managing director and owner of
Beautiful Fitness, a NY based
company offering premium fitness
and self-care services for women
in their homes. A
nationally certified
personal trainer who enjoys an extremely varied fitness background,
find out more at
beautifulfitness.com
Sleep Centers in NYC
New York Sleep Institute
724 Second Ave.
New York, NY 10016
212.871.0227
Sleep Disorders Laboratory at New York Methodist Hospital
521 6th Street
Brooklyn, NY 11215
(718) 780-3017
Narcolepsy Institute at Montefiore Medical Center
111 East 210th Street
Bronx, NY 10467
718-920-6799
Long Island College Hospital
339 Hicks Street
Brooklyn, NY 11201-5509
718-780-2940
Columbia Presbyterian Medical Center
Sleep Disorders Center
161 Ft Washington Avenue
New York, NY 10032
212-305-1860
Mount Sinai Center for Sleep Medicine
1176 Fifth Ave.
New York, NY 10029-6500
212-241-5656
New York University Sleep Disorder Center
462 First Avenue
Building NBV
Room 7N3
New York, NY 10016-9196
212-263-8423
References
National Committee on Sleep Research
New York Sleep Institute
National Sleep Foundation
American Academy of Sleep Medicine
U.S. Library of Medicine and National Institutes of Health
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