Maintaining Your Health on Mackinac
Insomnia Can Affect Your Health
By Yvan Silva, M.D.

More than 50 years ago, a seminal medical treatise on sleep defined it as a "periodic temporary cessation or interruption of the waking state, the latter being the prevalent mode of existence of the healthy adult." An English poet called sleep, "the poor man's wealth, the prisoner's release, the indifferent judge between the high and the low." A "good" night's sleep is the key to feeling good, all other physiological factors considered. Sunrise and nightfall calibrate our internal clocks, keeping us in biological rhythm with day and night, the so-called circadian rhythm of sleep/wake cycles. All living things rely on cycles of rest and activity to sustain them.

In 2005, Americans spent more than $100 million on over-the-counter remedies and $2.4 billion on prescription drugs to aid them in sleeping. Clearly, more scientific research is required in this very fundamental area of human biology. While we know about the physiology of sleep, we know little about the function of sleep. Indeed, we have come a long way from the old standard brain wave testing into studying both the quantity and quality of sleep in people. Each night of sleep is divided into two stages, nonrapid eye movement sleep (non-REM) and rapid eye movement (REM) sleep. During non-REM sleep, brain waves slow down, information processing in the brain tapers, and the deepest sleep occurs. This is followed by an REM period, a dreaming stage when the eyes oscillate and sleep is lighter.

Insomnia is defined as trouble falling asleep or staying asleep. Sleep is very important for good health. Insomnia can cause daytime tiredness and sleepiness and difficulty paying attention or staying alert during important tasks. Insomnia can occur over a short term when it is related to a specific cause, or it can be chronic and persist for a long term.

Real lack of sleep is a way of life for millions of us. In 1910, a survey found that Americans slept an average of nine hours a night. A 1995 national poll reported that 49 percent, almost every other adult, reported trouble falling asleep or staying asleep, an increase of 33 percent from just five years prior to that. In 2005 a national poll found that American adults average between 6.7 and 6.9 hours of sleep a night, and 13 to 17 percent sleep less than six hours on weekdays. Importantly, three out of four adults reported frequent awakening during sleep, snoring, or other problems that disturbed their sleep. Insomnia is reported in nine to 25 percent in studies of people older than 55 years of age and resulted in reduced quality of life. The economic burden is estimated to lead to increased medical costs around $13.9 billion annually.

What are the reasons for this? We live in a 24-hour society. We work in shifts, and many work two jobs. Working parents, especially those with young children, are sleep deprived. Many taking care of elderly parents live in a similar situation. The light bulb, the television set, and the Internet can make night into day. You can go shopping through the night, and it is difficult to find the darkness that drove people to sleep decades ago. Business travel has become a way of life for many, and jetting across time zones forces change in the biological clocks of all travelers.

There are many possible causes of insomnia. They include persistent stress, use of caffeine, diet drugs, alcohol, and stimulants, problems with relationships, shift work or irregular work hours, an inactive lifestyle, and environmental factors like noise and excessive light. Depression and anxiety disorders are important contributory factors. There are underlying medical problems that can cause insomnia. Sleep apnea is an important cause that needs medical investigation. This consists of frequent awakening during sleep, severe snoring, and brief periods of not breathing. Restless legs syndrome is manifested by uncomfortable leg sensations during sleep that need relief by walking, rapid movements, or rubbing the legs.

The notion that you need less sleep as you get older is not really accurate. The amount of sleep required through adult life is generally constant. The occasional sleepless night or two is of little consequence. It is when insomnia becomes chronic that problems ensue. Sleep deprivation and irregular sleep patterns take their toll in a variety of conditions and diseases. Memory impairment is one. Lack of sleep impairs learning and leads to loss of memory. Even young 10to 14year-olds, when allowed to sleep a good 10 hours prior to taking tests, did better on memory, verbal fluency, and creativity when compared with their peers who were allowed only five hours. High blood pressure is another. The immune system becomes deprived, and resistance to disease drops, as shown in analysis of immune cell functions studied in the morning in volunteers who were kept awake through most of the night. This makes it difficult to fight off infections of bacteria and viruses. People who are sleep deprived experience reduced energy levels, greater difficulty concentrating, greater irritability, and are more accident prone. Drowsiness plays a significant role in more than 100,000 traffic accidents every year. Drivers falling asleep at the steering wheel are recorded as the leading cause of fatal truck accidents. Highway authorities in two highly populated states report that nearly half of all fatal road accidents involve sleepy drivers.

Each one of us has a genetically determined sleep need, and running up a sleep debt becomes cumulative. Research on humans in a sleep laboratory showed that reducing total sleep resulted in impairment of memory and cognitive functions, lack of appropriate response to a variety of stimuli, and slowing of response time. On the job, performance efficiency is lowered 20 to 30 percent in a sleepy person. Workers in team settings suffer from mood disturbances and irritability. Concentration is impaired and intellectual function loses sharpness. A recent national study showed that older adults who slept seven to nine hours a night fared much better than a group of older adults who got less sleep - they had more positive outlooks, fewer health problems, and a healthier lifestyle. Here are a few guidelines:

1. Make sleep a priority. Make the time in context with your tasks.

2. Try sticking to a sleepwake cycle by going to bed and waking up at the same time every day. If it's not always possible, catching up on weekends might work.

3. Don't eat or drink large amounts before bedtime. Have a light dinner about two hours before bedtime. Spicy and heavy foods that predispose to heartburn should be avoided, as should large amounts of liquids that might lead to nighttime trips to the bathroom.

4. Avoid caffeine, nicotine, and alcohol, which will stimulate you when asleep. Elimination of the stimulant effects of caffeine takes about eight hours. Alcohol, while a depressant, can help initiate sleep but it can cause restlessness during sleep.

5. Keeping active and exercising regularly help in making sleep more restful. Don't exercise three hours or so prior to bedtime.

6. The bedroom should be free of disturbance; radio, television, pets, and other possible disruptions can get in the way.

7. Sleep primarily at night in a relaxing setting, which might

include light reading, listening to music, or other personal choices. Work activities with laptops, checkbooks, and other workrelated chores are not beneficial.

8. Pain is a sleep deterrent. You should be on effective drugs or treatments for pain, as advised by your physician.

9. Sleeping pills should be used only when prescribed by a physician after careful review of all factors that are causing insomnia, as well as of all other medications and supplements.

10. It is very important not to use stimulant drugs to compensate for insufficient sleep.

11. If you are suffering from a sleep disorder such as sleep

apnea or restless legs syndrome, appropriate medical evaluations and treatment should be undertaken.

12. If you choose to nap during the day, try to do so at the same times, and for an hour or less.

Insomnia that leads to sleep deprivation can be cumulative and result in deterioration of health and quality of life. It is important to define the degree of difficulty with regular sleep, and seek appropriate measures to manage good health practices.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.