Eyes Wide Open

Getting a good night's sleep is more important than you think



Illustration by Stephen Sauer

No small art is it to sleep: it is necessary for that purpose to keep awake all day.
- Friedrich Nietzsche

Blame it on caffeine, the pressure of having too much to do, or a society that operates 24/7 and surrounds its citizens with the siren call of social media and other tempting technology. Whatever the reason, about a third of American workers - nearly 41 million people - are sleep deprived, according to the Centers for Disease Control and Prevention.

Sleep disorders such as sleep apnea, along with certain medical conditions, certainly contribute to the problem of inadequate slumber time, but for some individuals, short-changed sleep is self-induced, as people intentionally give Mr. Sandman the brush-off and choose doing over sleeping, says Matthew Curley, MD, a pulmonary and sleep medicine specialist at Foundation Pulmonary in Nashua and Southern New Hampshire Medical Center.

Sleep requirements vary with age and among individuals, but seven-and-a-half to eight hours is typically about right for an adult, says George B. Neal, MD, a Fellow of the American Academy of Sleep Medicine who sees patients in his Bedford office and at Catholic Medical Center.

Why we are driven to sleep remains pretty much a mystery, but some of the effects of not getting enough shut-eye are clear. Inadequate sleep can hamper growth, maturation and learning in children, and missed sleep takes its toll on adults too. Its consequences form a long list that includes weakened concentration, delayed reaction time, impaired decision-making ability and a mood that is irritable, anxious and depressed. Sleep deprivation also prompts the release of hormones that make us crave sugary and high-carbohydrate foods, Curley says.

The ramifications of insufficient sleep become more pronounced as lost sleep, or accumulated "sleep debt," worsens, and the cost of chronic sleep loss can be dire, leading to an increased release of stress hormones that place the sleepless at an elevated risk of cardiac disease, Neal says.

While it's true that there is some variation in sleep requirements among individuals, needing a significant amount more or less than the standard seven to eight hours is uncommon, Neal says. "There's kind of a continuum of need," he says, but people at either extreme are few in number.

"About a third of American workers are sleep deprived."

And although some people are convinced that six hours of sleep - or less - is plenty for them, research suggests otherwise, says Curley. Self-proclaimed "short sleepers," when placed in an environment with no windows, clocks, television or other time-related cues, who were allowed to sleep when tired and wake up at will, slept longer than they would have at home, and objective measurements of the quality of their sleep indicated that they were sleep deprived.

In a way, such research creates a quandary for sleepers. After all, if we are unreliable judges of how much sleep we need, how do we know if we're getting enough? To complicate matters, some drowsiness during the day is normal; many people feel a dip in energy and alertness in the afternoon, and our internal circadian clocks influence whether we are morning people or night owls, Curley says.

Regardless of circadian rhythms, however, even if you don't necessarily feel the urge to spring from bed and burst into song when the alarm clock buzzes, you shouldn't struggle to get up. "Generally, if people are getting enough sleep and they've had adequate durations of sleep on a regular basis for the few weeks prior to that point, they should feel fairly refreshed when they wake up in the morning," Neal says.

Still, the question of how much sleep is enough remains tough to definitively answer. "It's the million-dollar question," Curley says. "I get asked that all the time, or people say, 'Well, I feel fine sleeping six hours, so why do I need to sleep more?' And I can't really give them a great answer, other than to say that we do have data out there that says that getting closer to seven or eight hours is better for you. It's hard to convince people sometimes."

Fortunately, if you have been skimping on your sleep, one or two nights of good quality rest can help your body restore itself - although we can't ever completely "make up" for lost sleep, Neal says. We regain some functioning through rebound sleep the first few nights, he says, but beyond that, some sleep will remain permanently lost.

If all this tempts you to sleep in, keep in mind that while it might seem logical to assume that more is better, like so many other things in life, moderation appears to be the way to go. In fact, indulging in an excessive amount of sleep has been linked with a variety of health woes. Too much sleep in and of itself is probably not "a major problem," Neal says, but the drowsiness that over-sleepers tend to experience often signals an underlying sleep disorder or other concern.

In some cases, to pinpoint what's driving drowsiness or sleep troubles, doctors will recommend that patients undergo a sleep study, which usually involves spending at least six hours sleeping at a sleep center while hooked up to a multitude of electrodes, wires and the like. What it lacks in comfort, a sleep study makes up for in information. The testing measures factors such as brain waves, eye movements, heart rhythms, airflow, oxygen saturation, chest and abdominal movement, and leg movement while an infrared camera records body position, capturing any abnormal movements during sleep, Neal says. It is all stored on a computer and analyzed with the hope that the patient will finally, someday soon, be able to sleep tight.

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