Sleep is for wimps � or is it?

The simple fact that most of us are sleep deprived could be the cause of much family tension and psychological angst.

This week saw the commercial launch of a New Zealand invention, a dummy for adults, and if you are one of the 60 million people in the world who suffer from obstructive sleep apnea, it may be just the thing to give you a good night’s rest.

In obstructive sleep apnea the throat briefly collapses during sleep shutting off airflow into the lungs. Efforts to breathe continue, however, resulting in the sounds we all know as snoring. Breathing may even stop, resulting in those moments of silence on which, as roommates of snorers, we have all pinned so much hope, only to have them dashed as the apnea passes and laboured breathing resumes.

While the long-suffering spouse and housemates may seem to come off worst in this situation, the person with the condition suffers too. Moving out of deep sleep and into light sleep several times during the night leaves them unrefreshed and sleepy during the day, at risk of accidents at work or driving. Untreated sleep apnea increases the chance of having high blood pressure, heart attack or stroke, and diabetes. Hence the importance of Dr Chris Robertson’s “dummy” – a simple plastic device which fits over the tongue and holds it forward so as to keep the throat open during sleep. “It’s not pretty,” admits the inventor, a Dunedin orthodontist, “but when the lights go out, who cares?”

The walking weary
All this is by way of introducing one of the biggest health issues of our time: sleep deprivation. Growing legions of sleep-starved citizens of the global metropolis are dragging themselves out of bed in the morning, under-performing at work and school, and letting relationships slide – with grim results for their families, employers and society at large.

In the European Union, around 80 million people (20 per cent of the population) suffer from stress and sleep disorders that affect their health, says the World Health Organisation. The United States has about 40 million people with a sleeping disorder and perhaps as many again get inadequate sleep – all told, nearly 40 per cent of the teen and adult population. Whether in New Delhi or New Zealand, the pattern is much the same.

Drowsy people are a safety hazard. They have been found to microsleep while landing planes and fall sound asleep in charge of nuclear power plants. According to the US traffic safety authority, an estimated 1.35 million drivers have been involved in a drowsy driving related crash in the past five years. The direct and indirect costs of poor sleep to the American economy are estimated at $100 billion.

Sleep deprived moms and dads set the tone for the whole family. American educationist James B. Stenson has warned: “The biggest single cause of upset and tension in family life is just plain lack of sleep. A lot of the spats and arguments that take place in families come about because of lack of sleep and fatigue.”

Why, as the human race gets wealthier and more comfortable, does it sleep worse? Part of the answer seems to be that we are too wealthy and too comfortable. Sleep apnea, for example, is often linked with being overweight – the extra soft tissue in the throat makes it harder to keep the throat area open.

But physical disorders are only part of the story. Much insomnia is caused by stress relating to work or family life. For shift workers it can be an occupational hazard. Then there are the countless people who deliberately cheat on sleep in order to meet work or family responsibilities, to earn more money, or simply to get their quota of entertainment at the end of day of work or study. “Sleep is for wimps,” Margaret Thatcher famously said, and young workers who burn the midnight oil partying and pubbing seem to agree.

Psychologists and various health experts beg to differ. Increasingly, they see sleep deprivation in its various forms as the underlying cause of stress-related physical and mental illness, and they insist that eight hours sleep a night is the norm for basic wellbeing. Clinical psychologist Patricia Dalton wrote recently in the Washington Post: “I sometimes fantasize that if I had a magic wand and could ensure that everyone would sleep at least eight hours a night, visits to therapists would drop by, perhaps, a quarter. Sleep – particularly REM [rapid eye movement] sleep and dreaming – helps discharge tensions, restore energy and rebuild a foundation for stable functioning.”

Yet surveys by the US National Sleep Foundation show that only 26 per cent of Americans get eight hours sleep a night on weekdays, and this represents a fall from 35 per cent in 1998. What is more, 40 per cent get less than seven hours and a growing percentage get less than six. There is some catching up at the weekends, but that too is in decline. In fact, on average, people surveyed this year thought they could function well on 6.5 hours of sleep.

In a 24/7 wired world, there’s just so much to do. As Patricia Dalton says, “Ever since the first electric bulb shed artificial light, we have been detaching ourselves from our natural rhythms. Business travelers cross time zones and go right back to work; adults extend their hours by bringing work home with them; teenagers contact their friends anywhere at any time of the day or night.” Under the guise of relaxation, television and the internet kill sleeping time with the latest gossip and games.

Sleep debt
But we can’t get away with it forever. Lost sleep creates a debt that has to be made up, according to Stanford University psychiatrist William C. Dement and other sleep researchers. That means if you miss two hours sleep a night for five days you will eventually have to pay back the whole 10 hours. People who habitually skimp on sleep and get used to feeling below par may find that hard to believe, but Professor Dement assures them it is true.

“Experiments demonstrate that individuals thought to be completely normal can be carrying a sizeable sleep debt which impairs their mood, energy and performance. If you haven’t already done so, I think it’s worthwhile to ask yourself how your sleep debt is affecting you. How often do you think about taking a quick snooze? How often do you rub your eyes and yawn during the day? How often do you feel like you really need some coffee? Each of these is a warning of a sleep debt that you ignore at your peril. I can’t over-emphasise the dangers of unintended sleep episodes or severe drowsiness.”

The average sleep debt for people in today’s industrialized societies has been calculated at 25 to 30 hours – time that could be made up during holidays. After that, says Professor Dement, keeping the sleep account in balance is a matter of adding a relatively small amount of sleep to your normal schedule: “That may just mean not watching the news at night, or putting off some other non-essential pleasure, like the bedtime crossword puzzle.”

The young and the sleepless
Sleep quality tends to deteriorate as we age, more so for men than for women, but sleep problems are on the increase among younger people. Even little children are missing one or two hours a day along with their parents, according to the National Sleep Foundation, which recommends 14 to 15 hours sleep a day for infants, reducing to 10 to 11 hours for primary school children.

A British study pinpointed lack of sleep as a risk factor for obesity, since children who slept longer were more likely to be physically active during the day. The flip side of physical inactivity for kids is usually more television and video games, and this bombardment by electronic media, along with the new habit of multi-tasking, may be partly responsible for the rise in attention-deficit hyperactivity disorder.

The multi-taskers par excellence in this context are teenagers. A Kaiser Family Foundation survey earlier this year found that kids aged 8 to 18 are exposed on average to more than eight and a half hours of media – including nearly four hours on electronic entertainment and a mere 43 minutes on books – a day, but they fit this into six hours and 21 minutes by doing two or three things at once. According to Vicky Rideout, who led the Generation M study, there was no sign that young people are sacrificing school work, sleep or physical activity.

This, to be honest, strains belief, especially since so many kids have electronic gear in their bedrooms. In the Kaiser sample, 70 per cent had a TV there, almost half a video console and 30 per cent a computer. If these dictate the last activities of the day, so much the worse, because the artificial light combined with exciting content are stimulants that make it harder to sleep.

But even if they switch off these gadgets, there is one device teens are finding it very hard to resist. A study in Belgium showed that the sleep of almost half of 16-year-olds and one in four 13-year-olds could be interrupted by text messaging on mobile phones. The teenagers are taking their phones to bed so they do not miss anything, said Jan Van den Bulck of the Catholic University of Leuven, and this could pose more of threat to healthy sleep than that posed by other media. “The latter mainly appear to influence time to bed, while mobile phones actually seem to lead to interrupted sleep.”

Add to late nights and interrupted sleep the need of teens to rise early for school – a 2003 survey found that more than one-third of American high schools begin classes at 7.30 am or earlier, and 85 per cent began before 8.15 – and it is easy to see why teenage sleep deprivation has become a major issue in the US.

Contrary to what one might expect, teenagers need as much sleep as younger children – 9 to 11 hours, according to the American Academy of Sleep Medicine. Yet a recent study published in the journal Pediatrics found that students aged 12 to 15 are losing up to two hours sleep on the nights before a school day. This affects not only the quality of their work and alertness in class, but also makes it more likely they will take up smoking or be involved in car crashes. They can only pay their sleep debt by sleeping until noon on weekends. (Don’t let your teenager read this!)

So why can’t they just go to bed earlier? Ah, say the researchers, because their circadian rhythms are out of phase. In research at Stanford and Brown universities, Professor Dement and others discovered that at the age of 10, the biological clock of the pre-adolescent shifts forward, creating a “forbidden” zone for sleep around 9 or 10 pm. Just when they should be feeling sleepy, they are actually more alert than earlier in the day. And, just when they should be getting up, they really need to sleep. But because they do get up and and go to school, they tend to perform poorly in the morning and better in the afternoon.

The experts have called for strategies that address the epidemic of sleep deprivation among adolescents, and there are obviously many commonsense things that can be done by teenagers themselves with the encouragement of their parents. The American Academy of Sleep Medicine has just released a series of tips for parents as they face getting their kids ready for school hours. For young children they include a very regimented bedtime routine and avoiding frightening movies and video games close to bedtime. For teens they recommend a consistent bedtime, with 10-15 minutes reading before bed, avoidance of caffeine in the afternoon, exercise close to bedtime and avoidance of stimulating activity like video games and TV in the bedroom.

It is clear, however, that many parents also need to look to their sleep routine and make sure they are setting a healthy pace for the whole family. “Early to bed and early to rise really is a good idea, because it maximizes light exposure, which in turn boosts mood,” says Patricia Dalton. Giving sleep its rightful place could transform not only family life but the prosperity of whole nations.

Carolyn Moyhihan is deputy editor of MercatorNet.