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.