Counting Sheep

Today's New York Times carried an article on a topic that HealthTwisty intern Chelsea Leonard and I have been discussing: sleep deprivation. Even though Chelsea, a college sophomore, and I, a middle-age working mom, are at different stages in our lives, we share the same problems that interfere with sleep: high expectations for work (and schoolwork, in Chelsea's case), personal interactions, and volunteer time. And we both suffer from a love/hate relationship with the electronic devices that allow us to manage our ever-increasing to-do lists while simultaneously keeping us tethered to our obligations when we should be focusing on winding down for the day.

And it's not just Chelsea and me who have problems with sleep. The article in today's Times notes that over 15 million women aged 40 to 59 in the US had a prescription for the generic form of the sleep drug Ambien last year. That's a phenomenal number when you consider there are only about 43 million women in those age groups in the United States, which means over one quarter of them (us!) have a prescription for one specific drug. The problem is much, more worse when you realize that 15 million does not include prescriptions for Ambien itself, or for anti-anxiety or anti-depression meds that are used off-label to encourage sleep, or the over-the-counter meds, like Tylenol PM, or even the medicinal glass of wine that is commonly used to fall, and stay, asleep.

I'd say this is an epidemic. And it seems to be starting young.

Chelsea writes from the perspective of a college student:

"It seems like no one I know gets the amount of sleep they want or need. People are always preoccupied with one thing or another, and then end up spending the next day in a sort of lethargic blur. Sleep hygiene, a combination of regular sleep and good bedtime habits, feels like an impossible task sometimes. My doctor tells me to associate my bed with sleep only (and to watch TV, eat, and do work elsewhere). But I’m a little skeptical about this strategy. I spend so much time testing out new energy drinks, but have never tested ways to just get a good night’s sleep."

And because she is a neuroscience major, Chelsea is interested why we have problems sleeping and the results of sleep deprivation:

"There’s a pretty strong connection between the rise in Internet accessibility and decline in sleep. The problem is that sleep needs are biologically determined. The “sleep clock” is located in the brain’s hypothalamus region, and (unfortunately) hasn’t evolved along with technology. When this system is tampered with consistently, it actually leads to some serious physiological effects. The most obvious of these are memory and attention level. The biggest shock to me, though, was that a seventeen-hour day could have the same results on performance as a blood-alcohol level of 0.05%.  Some states impose penalties on drivers at this level. Lack of sleep probably isn’t considered a huge concern, with drunk or high drivers on the roads, but nearly one in every ten 25-35 year olds reports falling asleep at the wheel in the last month alone. That’s a big deal. Lack of sleep is not only a health concern for the individual, but is becoming a safety concern for people around them."

So how much sleep do we need? Chelsea's research turned up this information:

"Of course, a good night’s sleep is based on what you need at your age. The National Sleep Foundation notes that newborn babies need around 18 hours of sleep a night, whereas adolescents can function perfectly well on only 9-10 hours. For adults, the general consensus is about 7-9 hours. The amount of sleep a person needs depends on two components: their basal sleep need (the hours of sleep needed for optimal performance) and sleep debt (loss of sleep due to restfulness, etc). An easy way to tell if you’re getting the sleep your body needs is how long it takes to fall asleep at night. If it takes you less than five minutes to fall asleep at night, your body needs more rest! If you’re the type of person, like me, who shifts around for a while, consider what’s keeping you up. Often, it’s too much screen time before bed or preoccupation with the day’s worries."

The National Sleep Foundation offers these tips for falling, and staying, asleep:

• Establish a regular bed and wake time
• Avoid nicotine altogether and avoid caffeine close to bedtime
• Avoid alcohol
• Exercise regularly (but complete the workout at least 3 hours before bedtime)
• Establish a consistent relaxing “wind-down” bedtime routine
• Create a sleep-conducive environment that is dark, quiet and comfortable
• Discuss the appropriate way to take any sleep aid with a healthcare professional.

However, Chelsea notes,

"A lot of commonly recommended sleep tips aren’t practical for me in my schedule. I can’t block out all noise, because I have night-owl roommates, and I don’t like herbal tea or warm milk. But there are definitely some reasonable strategies for better sleep. No one needs a can of Coke before bed, or a three-hour nap around dinnertime."

As for me, I've found the most effective way to get a good night's sleep is to vigilantly guard my time. This means saying no to too many volunteer tasks; to ensuring that all members of my family share in the details of our lives, such as making sure everyone has haircuts, or good food to eat, or is ready for the day ahead; and to ensuring that I have at least an hour of down time before going to bed at a regular time. By decreasing my mental clutter, I have found it easier to stay asleep without waking to fret over the myriad details of work and family life.

And a final word from Chelsea:

"If everyone consciously tried to get a good, consistent night’s sleep most days of the week I’m sure it would reduce most of the stresses that kept them up at night in the first place."

I think she's right about the Catch-22 of sleep - we often wake up to worry, then worry about worrying. A good night's sleep can help put it all in perspective.

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