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THE HARVARD MEDICAL SCHOOL GUIDE TO A Good Night's Sleep

The McGraw-Hill Companies, Inc.

Excerpt

Good Sleep: An Essential Element of Health

Some nights, sleep comes easily, and you cruise through the night with minimal interruption. Waking up after a night of good sleep is wonderful—you feel refreshed, energized, and ready to take on the world. Other nights, sleep comes slowly or not until the early morning hours. Or you may fall asleep, only to awaken throughout the night.

As you probably know from experience, sleepless nights often trigger a series of unwanted events. Merely getting out of bed when the alarm goes off can seem like a Herculean task. You may snap at your spouse over cereal for something trivial. At work, you may lack motivation to do normally enjoyable tasks. Perhaps you doze off while watching the evening news—just before the segment you most wanted to see. A few hours later, it's time to go to bed again, and you're faced with the uncertainty of whether you're in for another night of tossing and turning. How can something so right go so wrong?

In this book, I'll help you find the answer. You'll understand what happens during sleep, what can go wrong, and how you can help yourself get a truly good night's sleep.

Too often we forget that sleep is a basic physiological drive, like hunger or thirst, and necessary for life and proper functioning. Those who don't pay attention to ensuring they get adequate, restful sleep can suffer ill health and enjoy life less. I've treated people with sleep problems for more than fifteen years, and I've found that the overwhelming majority of individuals can get better sleep—if they're willing to make sleep a priority, identify the source of their sleep problem (possibly with a physician's assistance), and then follow through on the recommended treatment.

There is much to look forward to, but before we dive in, I'd like to start by raising a few key points about sleep.

You Are Not Alone

If you don't sleep as well as you'd like to, you have plenty of company. A 2005 survey by the National Sleep Foundation (NSF) found that, during the preceding year, 75 percent of adults had at least one symptom of a sleep problem, such as waking a lot during the night or snoring, and 54 percent experienced at least one symptom of insomnia. Here are some additional statistics:

• An estimated 30 to 40 percent of the U.S. population suffers occasionally from insomnia, with 10 to 15 percent having a chronic problem.

• Forty percent of adults snore; 2 to 4 percent suffer from obstructive sleep apnea (pauses in breathing during sleep); and about 5 to 10 percent have restless legs syndrome (RLS), causing them to experience painful or unpleasant tingling in their legs at night.

• The partner of someone with a sleep disorder often experiences sleep that is just as disrupted as that of the person with the disorder. For instance, researchers at the Mayo Clinic found that treating one person's sleep apnea and snoring allowed his or her spouse to get, on average, an hour more of sleep each night during the same amount of time in bed.

• Americans average 6.9 hours of sleep a night—less than the 7.5 to 8 hours sleep experts believe most people need to function at their best.

• Each year, Americans spend an estimated 2 billion on sleep medications and make almost two million overnight visits to sleep laboratories.

The number of Americans diagnosed and treated for sleep problems has risen in recent years and is expected to continue to grow in the future. Some of this is due to increased awareness—more patients are going to their doctors with sleep complaints and more doctors now recognize the signs of sleep disorders. But other factors—the increasingly hectic pace of modern life, the rising prevalence of obesity, and the aging of the population—may also be contributing to a genuine increase in the percentage of people with sleep problems.

Poor Sleep Is a Serious Problem

We pay a high price for getting an insufficient amount of sleep, individually and as a society:

• Lack of sleep is directly linked to poor health, with new research suggesting it increases the risk of diabetes, heart disease, and obesity. A study published in the journal Sleep in 2004 found that women who averaged less than five hours of sleep per night had a significantly higher death rate than those who slept seven hours.

• Even a few nights of bad sleep can be detrimental. One study found that people who were limited to three straight nights of sleeping five hours or less were more likely to have physical ailments such as headaches, stomach problems, and sore joints. Other studies have shown that curtailing sleep to four hours a night for several nights results in changes in metabolism that are similar to those that occur in normal aging and that raise levels of hormones linked with overeating and weight gain.

• Sleep debt is cumulative. Studies have shown that performance on tests of alertness and thinking continues to get worse the longer sleep deprivation lasts. In other words, we do not adapt to sleep deprivation.

• The combination of sleep deprivation and driving can have deadly consequences. Nearly one in five drivers admits to having fallen asleep at the wheel, and the National Highway Traffic Safety Administration conservatively estimates that one hundred thousand police-reported crashes are caused by drowsy drivers each year, causing seventy-six thousand injuries and fifteen thousand deaths.

• Sleep deprivation played a role in catastrophes such as the Exxon Valdez oil spill off the coast of Alaska, the space shuttle Challenger disaster, and the nuclear accident at Three Mile Island.

• Sleep deprivation and sleep disorders are estimated to cost Americans over 100 billion annually in lost productivity, medical expenses, sick leave, and property and environmental damage.

Even when sleep deprivation does not cause illness or accidents, it can affect your quality of life. Sleep problems affect virtually every aspect of day-to-day living, such as your mood, mental alertness, work performance, and energy level. According to the 2005 NSF survey, almost three in ten working adults say they have missed work or made errors at work because of sleep-related issues in the past three months. And nearly one-fourth of partnered adults say they have sex less often or have lost interest in sex because they are too sleepy.

Unfortunately, despite some recent progress, fewer than 3 percent of Americans with sleep problems get treatment because both patients and their primary care doctors often do not consider sleep an important health issue. This is partly due to lack of training for physicians and partly because many people accept poor sleep as inevitable.

A survey of American medical schools in 1990 showed that 37 percent did not offer any training in sleep medicine. As recently as 1998, the average amount of sleep education averaged a little more than two hours during the four years of medical school. As a result, doctors frequently fail to ask patients about their sleep.

On the patient side, people with sleep problems often do not report them to their physicians. They believe poor sleep is not a medical problem and incorrectly assume it is normal to feel tired throughout the day or have difficulty getting to sleep at night.

The good news is that this situation is starting to change. Medical training institutions are adding sleep medicine training programs, sleep medicine is now recognized as an official medical subspecialty, and physicians can demonstrate their proficiency by ta
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Excerpted from THE HARVARD MEDICAL SCHOOL GUIDE TO A Good Night's Sleep by LAWRENCE J. EPSTEIN. Copyright © 2007 by President and Fellows of Harvard College. Excerpted by permission of The McGraw-Hill Companies, Inc..
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