WHY WE SLEEP, WHY WE DON’T, AND HOW TO SLEEP BETTER

​Why We Sleep:
Sleep is not an option. It is a necessary and vital dimension of what is essential to keeping ourselves healthy and alive. As we age, we generally need less of it. On average, newborns require 16 hours of sleep every day and the fact that infants and children need more sleep is evidence of its important role in promoting growth and health.  Still, the average adult over 65 to remain optimally healthy requires seven hours of sleep each day. 

The Effects of Sleep Deprivation:
The specific reasons we sleep are to restore equilibrium to our bodies and minds. While we are sleeping our brains are eliminating  proteins such as amyloid beta that build up throughout the day. In postmortem analyses an abundance of these proteins has been associated with certain kinds of dementia such as Alzheimer’s Disease. Sleep is vital to maintaining a healthy immune system and as most of us know from personal experience insufficient sleep compromises our mental functioning such as alertness and memory, our mood, and our motor equilibrium and coordination.

There is more. Over time insufficient sleep increases our risk of developing cardiovascular disease such as heart attack and stroke and its effects on our alertness increases our proneness to accidents. For example, drivers who get six hours of sleep or less are 33% more likely to have an accident on the road than those who get seven or eight. 

The Causes of Sleep Deprivation:
Despite its importance to our functioning, sleep can be disrupted or deficient for various reasons, stress, travel, anxiety, depression, physical illness or chronic pain, life transitions and the demands of our daily lives. In today’s world, especially here in the United States, sleep deprivation has become increasingly prevalent. Here are some facts cited from The Center for Sleep Medicine (www.sleepmedcenter.com): 
 
(1) 40% of Adult Americans and 70% of adolescents are sleep deprived.
(2) The average American sleeps less than seven hour a night Monday through Friday. 30% of all working people in the U.S. sleep less than six hours a night.
(3) Fifteen million Americans work the night shift and 40% of them get fewer than six hours of sleep per day.
(4) “Short sleepers” eat 500 calories more per day and are likely to eat more fatty foods and carbohydrates than normal sleepers.

The reasons for this growing problem in our society are a product of several factors, economic, cultural, and technological. Today’s families in the United States rely on income from both heads of the household in order to meet the demands of trying to maintain a lifestyle commensurate with their dreams of success, or worse, just to make ends meet. On average, Americans work 137 hours more every year than Japanese workers, 260 hours more than British workers, 394 more hours than German workers, and 499 more hours than the French. Some of this disparity may be explained as the general decline of the American middle class as more and more American adults find it difficult if not impossible to keep up with the standard of living they grew up with in their parents’ generation. 

Sleep deprivation may also be explained as a function of a cultural heritage that regards sleep as tantamount to laziness and lack of ambition. As such sleep is devalued for fallacious reasons as being a relatively unimportant part of life that stands in the way of success.

Finally, we live in a world rife with technology, stores that stay open all hours of the night, television whose hours of operation at one time conformed to the normal schedules of daily life broadcasting programs all hours of the night, and electronic devices such as computers and smartphones with unlimited access to text messages, the worldwide web, and social media anytime of the day or night, projecting sleep-inhibiting wavelengths of light from these devices.

Sleep Disorders:
It is normal for sleep to be disturbed or disrupted for various reasons but when these disturbances become persistent they can have deleterious effects on our well being. When this is the case, intervention might be necessary to treat what is known as a “sleep disorder.” Here are some of the most prevalent kinds of sleep disorders: 

(1) Insomnia: It is estimated that anywhere between 10% and 60% of adults suffer from chronic insomnia. People who are most susceptible include older adults due to chronic pain or medical conditions, social isolation, or medication, adolescents, and pregnant women. Some people with insomnia have difficulty falling asleep. The most prevalent causes are stress and anxiety, caffeine or stimulants, or irregular sleep habits.  Others have difficulty maintaining sustained sleep which is often associated with chronic pain or medical conditions, restless leg syndrome, or sleep apnea, and some tend to wake up prematurely, often a sign of clinical depression.

(2) Obstructive Sleep Apnea: It is estimated that one in fifteen adults has sleep apnea and only 15% who have it have been diagnosed. Common signs include excessive drowsiness during the day, snoring, and irregular breathing patterns during sleep. Sleep apnea is associated with obesity and Type 2 diabetes, and is imputed as a possible cause of heart disease. A referral to a sleep specialist is needed to diagnose this condition which is usually treated with a breathing device known as a CPAP machine. 

 (3) Circadian Rhythm Sleep Disorder: Adenosine is a neuromodulator in the brain that plays an important role in regulating our normal sleep/wake cycle, known as circadian rhythms. The sensation of drowsiness is a function of adenosine building up during the course of the day. Ingestion of too much caffeine or late in the day can interfere with this process. When our normal cycle is disrupted we may have difficulty falling asleep or feeling sufficiently rested when we normally get up. The most common causes for this disorder include jet lag, shift work, a mood disorder, medication, pregnancy, or chronic pain. Adolescents are often susceptible because of a delay in the brain’s production of melatonin which otherwise promotes sleep and older adults who have a tendency to nap during the day.

(4) Restless Leg Syndrome: This disorder is described as sensations of crawling, tingling, itching, or muscular cramps that are sometimes relieved by getting up and walking around. It can be inherited but often is caused by medical conditions such as diabetes, iron deficiency, and peripheral neuropathy, or by prescription medication. The most common onset for this disorder occurs in middle age. Women are twice as likely as men to develop restless leg syndrome which is usually treated with medication and sleep hygiene.

(5) Parasomnias: These are unusual behaviors that occur either while asleep or while transitioning in or out of sleep. Parasomnias, characterized as incomplete awakening and responsiveness to other people while in a sleep-like state, can originate from different sources. There are two types, NonREM and REM-related. NonREM parasomnias include confusional states of arousal, sleepwalking, and night terrors most often found in children. They may also include sexual behavior, talking, eating, which can be dangerous if it involves cooking or ingesting harmful substances, and even driving! REM parasomnias include REM sleep behavior disorder characterized by excessive, violent movement while dreaming that most often occurs in older adults, sleep paralysis, a prolonged period of paralysis while falling asleep or upon awakening, and recurrent nightmares often brought on by psychological stress or trauma. 

Other parasomnias include “exploding head syndrome,” in which the sleeper experiences a loud noise or bright light upon awakening, sleep-related hallucinations, and nocturnal enuresis, or bedwetting, the latter most often found in children. Parasomnias can be brought on by stress, trauma, certain medications, irregular sleep schedules, and certain neurological conditions such as Parkinson’s disease. When they occur in children they are likely to be transitory and neurological in origin though they can also be induced by stress. A parasomnia should be diagnosed by a specialist in sleep disorders and the treatment may include medication or cognitive-behavior therapy.

How to Sleep Better:
Here are some general guidelines to help you get a better night’s sleep if you are suffering from a temporary sleep disruption or a sleep disorder. If the condition persists, you should seek consultation with a sleep-disorder specialist:

1) Reduce the stress in your life if possible and, if not, learn how to live with stress better, such as with exercise, meditation, and cognitive therapy.
2) Practice meditation or autogenic training on a regular, if not daily, basis. Learn how to tame those runaway, worrisome thoughts.
3) If you have difficulty falling asleep, read a relaxing or boring book. Your focus should be on relaxing instead of trying to force yourself to sleep.
4) Exercise on a regular basis. Aerobic exercise such as running or walking improves mood and creates a calming effect.
5) Practice good sleep hygiene. Go to bed and get up on a regular schedule, don’t engage in stimulating activities the last two hours before you go to bed, engage in rituals that prepare you for bedtime, avoid bright lights, turn off electronic devices, including television before bedtime, reserve your bedroom for sleep or sex only, make your sleep environment conducive to sleep, i.e., sufficiently dark, free of noise, cool temperatures, a firm mattress, and aromatherapy scents such as lavender.
6) Limit your intake of caffeine, stimulants, or alcohol.
7) Avoid late night meals, sugary foods or spicy snacks.
8) If you have a circadian rhythm sleep disorder, try getting up earlier each morning and consider taking melatonin an hour or two before you go to bed.
9) Avoid napping during the day.
10) Get as much sunlight during the day as you can. If the sunshine is limited where you are, consider getting a sunlight-simulating lamp.