A WIDE-EYED LOOK AT SLEEP

THE BALTIMORE SUN

You know how it is.

You work all day and when you get home, there are the kids, your spouse, dinner to get and clean up and later "L.A. Law" to watch, maybe some work from the office to clear up, and then, of course, Arsenio/Johnny/David.

So with one thing or another, it's later than you really had in mind before you hit the sack. And, since you want to get in a little run before work tomorrow, you set the alarm for 6:30.

When it rings, you don't feel too hot -- but who does, when the alarm clock rings? That's why God gave us coffee. Of course when 4 p.m. rolls around, you're sagging, but a Diet Coke fixes you up again, and you're ready for the evening round.

By Friday you're feeling pretty stressed out, but that's normal, isn't it, that's why people say thank God it's Friday. Saturday morning you can sleep in -- or no, got to take the kids to soccer. Sunday, then. Oh no, that tennis game with the Joneses. Oh well, once you get going, you'll feel better.

And you can sleep any time, after all. Life is short and you don't want to spend it with your eyes shut. You're not that type. Sleep's cheap. You'll catch up one of these days.

SOUNDS A BIT LIKE PAYING off your Visa account, doesn't it? Live now, pay later. Live now, sleep later.

The problem, says Lydia Dotto, author of "Losing Sleep: How Your Sleeping Habits Affect Your Life," is that sleep debt is just like financial debt: Build it up far enough and in the end, you have a crash.

She names some of the notable ones: Three Mile Island. The Exxon Valdez. Chernobyl. Challenger. In each case decisions were made -- and made incorrectly -- by people who were short of sleep. In addition, she continues, there are the approximately 6,500 deaths caused by people falling asleep at the wheel and the several hundred thousand accidents fatigue causes in industry and the home.

In other words, sleep matters. More than we think.

During the go-go '80s, anybody with an M.B.A. or a respectable dose of ambition was trying to find his or her way around sleep, bragging about how he or she could do with less and less of it. Getting eight hours of shut-eye began to seem as outdated as using carbons in the age of fax and photocopy.

But now, at the dawning of the think-twice '90s, some sleep researchers are beginning to say whoa, wait a minute, wake up and smell the coffee. Doing without enough sleep, their research suggests, can do a number not only on your mood but also on your performance. In other words, while you think you're improving how you perform by skimping on sleep and splurging on work, you might actually be doing the exact opposite.

And -- here's the radical thing -- when these researchers talk about "enough" sleep, they're not talking about more than four or five hours of shut-eye a night. They're not even necessarily talking about the traditional seven to eight long ones a night.

"One of the myths about sleep is that if you get seven to eight hours of sleep you get plenty," says board certified sleep-medicine specialist Dr. David Buchholz. But "the truth is, for most people that's not enough."

"One of our most important findings is that eight hours of sleep - the commonly believed ideal amount -- fails to provide all-day alertness in many people," writes Dr. William C. Dement, one of the pioneers of sleep research and the director of the Stanford Sleep Disorders Clinic and Research Center, in a recent issue of Executive Health Report.

In support of this view, Ms. Dotto cites a study that took normal sleepers -- people who were not complaining about getting too little sleep -- and gave them nine hours of shut-eye instead of their usual seven or eight.

The result? "They did much better both on performance and mood," Ms. Dotto says. And the effects weren't a one-night deal; the improvement continued to grow over a span of equally well-rested days and nights.

It may be that's what nature has us set up for, suggests Dr. Buchholz, who is director of the Neurological Consultation Clinic at the Johns Hopkins Hospital and neurological consultant to the Johns Hopkins Sleep Disorders Center at Francis Scott Key Medical Center. Evidence indicates that before the advent of electric lights, the average individual slept nine to 10 hours in each 24, he notes. And that, he continues, may tell us what our "natural sleep need" is.

Not that we pay any attention to it.

What with shift work, jet travel and the expectation that if we're important we'll be available 24 hours a day, the old idea of sleep-when-it's-dark, rise-when-it's-light seems hopelessly outmoded. Besides, with inducements like electric lights, television and alarm clocks, it becomes all too easy to stay up too long and cut your sleep too short.

Are you wondering if you cut yours too short?

If you wake up to an alarm clock, says Dr. Buchholz, then you are.

"Most of us do," he adds kindly, but somehow it's not very reassuring.

MS. DOTTO KNOWS ALL about truncated sleep, seriously truncated sleep. She once went 50 hours without sleep as part of an experiment, and found to her dismay that her ability to reason and her motor skills began to disintegrate well before the 50 hours were over.

She'd start a sentence and by the time she got to the middle she couldn't remember any more what words she'd meant to use. As for problems such as which comes first, A or B, well, that took concentrated effort, which she wasn't always able to achieve. Worst of all, she just didn't give a damn about any of it. Motivation? Forget it. All she wanted to do was put her head down and drift away.

Which is only natural: When you're sleep-deprived, getting sleep takes precedence over sex, over food, even over avoiding danger, says Richard P. Allen, co-director of the Johns Hopkins Sleep Disorders Center.

It's not known for sure that human beings will actually die without sleep -- researchers that unethical haven't been seen since the Third Reich -- but it is known that rats will. They're a hardy species, so it takes them a week or two to a month to die, at least according to a University of Chicago study cited by Ms. Dotto. They're pretty miserable at the end, too, skinny and chilly and with ulcers on their tails. The ones who are deprived only of REM sleep -- sleep that's characterized by rapid eye movements and intense brain activity -- take somewhat longer to pass on, but they do it in an extraordinarily bad mood.

Of course going entirely without sleep is a measure even the most driven yuppie is unlikely to attempt, but the effects of extreme sleep deprivation are only an exaggerated form of what happens with lesser sleep loss.

"People can train themselves to do with five or six hours," Ms. Dotto says, but how they do is another question. "You can show a lengthening of reaction time after missing just two or three hours of sleep for a single night," Dr. Buchholz says.

What causes this impairment of function, he continues, is that the tired person is actually falling asleep for tiny amounts of time, called microsleeps. "That is, the brain is momentarily pausing, going on hold, while you are entering without recognizing it a brief sleep episode," he says. "It's not perceptible to the person" doing it.

Dr. Buchholz notes that the two periods when people naturally tend to be sleepiest, and thus most vulnerable to microsleeps and the other effects of sleep loss, are in the early morning from around 4 to 6 o'clock, and in the afternoon from around 3 to 4 o'clock.

Don't be surprised, then, that these two periods coincide exactly with the highest incidence of accidents, both in industry and on the road. And in the air. Ms. Dotto includes in her book an anecdote about a plane scheduled to land in Los Angeles that instead headed out over the Pacific on automatic pilot.

"The plane was about 100 miles out to sea before air controllers found a way to sound an alarm in the cockpit," Ms. Dotto writes. "The entire flight crew had fallen asleep on the flight deck."

IT GETS WORSE.

Combine insufficient sleep with alcohol, and what you get will keep you awake at night if you think about it too hard.

"It is just stunning how susceptible a sleepy person is to small amounts of alcohol," says Dr. Mary A. Carskadon, director of chronobiology at E. P. Bradley Hospital in Providence, R.I., and professor of psychiatry and human behavior at Brown University.

This is so even though the sleepy person's degree of impairment won't be revealed by blood-alcohol tests. "Someone can have two small drinks of alcohol, and if they're really sleepy they can be entirely unable to navigate in a car," she says, while their blood-alcohol level remains legally low.

But "how many people know that?" she asks. "How many people, out of ignorance of that, put themselves and the rest of us at great risk?"

Also particularly affected by the loss of a good night's sleep are adolescents and young adults, she continues.

With Stanford's Dr. Dement, Dr. Carskadon collected data showing that "adolescents who sleep eight hours are very sleepy and vulnerable to falling asleep in school" -- and in other less-than-stimulating situations such as long car drives, during which they may be behind the wheel.

In addition, says Hopkins' Dr. Allen, high school students tend to be extraordinarily sleepy in the first part of the school day, when they need to be wide awake for best learning. They only become alert later in the day -- around 2 or 3 o'clock in the afternoon, when they get out of school.

Dr. Allen doesn't blame this on the schools, but on the special sleep-wake rhythms of adolescence in combination with what appears to be a chronic sleep loss. He concludes that it might be more efficient to start and finish school later in the day -- and also that it would be wise to alter the message that we're sending kids about sleep.

It's a "cultural message," he says, emphasizing that it's certainly not his message, and it tells kids "a real man can handle his booze, his women and his sleep loss."

This message about sleep affects not just adolescents but all of us. Dr. Buchholz calls it a "macho attitude, that you're a better person if you can get by with less sleep, that you're harder-working, less lazy, tougher and stronger.

"It's nonsense," he adds, "just self-destructive."

"It's basically a denial of biologic reality," Ms. Dotto says.

"It's the quality of life that matters," says Dr. Allen.

BUT NOT EVERYONE IS WILL- ing to take such a philosophical view of sleep, just as not everyone is worried about modern life's seeming epidemic of sleepiness.

Many researchers are quick to point out the wide variation of sleep need among individuals: Some people really are just fine with six or seven hours a night, or possibly less. (Ms. Dotto includes in her book an account of a man who needed only two hours a night. Tested by researchers, he was found to get groggy with more and slower to react with less, just like anybody else who gets more or less sleep than they need.)

Also, doing with less sleep than is optimal won't kill you -although if your sleep loss gets bad enough, you'll begin to wish it would. Besides, stimulation in the form of interesting tasks, exercise or other distractions can, if intense enough, make you forget your sleepiness, though if you find yourself falling asleep in the middle of "Aliens" you should probably be in bed instead of a movie theater.

In short, says Dr. Allen, it's not that you can't function, it's just that there's a "compromise" in your daytime performance.

So one alternative in dealing with what might be a chronic sleep debt in your life is to ignore it: It's not likely to be fatal, especially if you keep off the roads and away from alcohol.

Another possibility is to nap.

"Our circadian rhythm indicates that there's a midafternoon period when the body wants to sleep," says Andrew A. Monjan, deputy associate director of the Neuroscience and Neuropsychology of Aging Program at the National Institute on Aging and executive secretary of the National Commission on Sleep Disorders Research. "It fits in with the notion of the siesta" practiced in better-rested societies than our own.

"Because this is a natural cycle, that brief afternoon napping would be a natural thing" to correct the nation's sleep debt, Ms. Dotto believes. She herself is a serious napper, sleeping five hours during the night and another two during the sleepy part of every afternoon, but she admits that's not practical for most people.

But even if napping couldn't be practiced on a daily basis, perhaps it could be practiced as a preventive measure, she suggests, explaining that research has shown that people who start napping as soon as they enter a period of sleep deprivation do better than those who don't nap at all, or those who wait to nap until their sleep deprivation becomes severe.

Still, either as a preventive measure or a part of a regular sleep pattern, naps have a way to go in finding acceptance from workers and employers. But they may get help from the example of airline crews: Dr. Monjan says that a recent study involving long-haul trans-Pacific flights found that by having programmed nap periods the flight crew was much more alert than otherwise.

Another strategy, particularly for shift workers and those with jet lag, is putting to work sleep researchers' new understanding of the effect of sunlight or bright light on human sleep. Exposure to such light signals the human body that it is now time to be awake -- so, for example, people coming off the night shift should wear sunglasses if it is already light when they drive home and if possible expose themselves to an hour or two of sunlight when they get up again to reinforce their sleep patterns.

But these are tricks and techniques. Underlying them should be an understanding of just how important sleep is to human well-being and proper functioning. Don't ever take it casually, warns Brown's Dr. Carskadon, who distributes buttons to her students that say "casual sleep" on them -- with a forbidding bar drawn through it.

Dr. Buchholz notes that "in the past decade or two there's been a tremendous heightening of awareness of proper nutrition and diet, exercise and fitness. What we're just beginning to come to grips with is how we all abuse our bodies and minds by not paying enough attention to our sleep needs.

"Good health is a triad," he continues. "It's a triad of No. 1, proper nutrition and diet, No. 2, physical exercise and fitness -- and No. 3, good sleep."

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