Sleep; the Good the Bad, and the Ugly by Rocky Hinkle

It is a real challenge to wrap your arms around what healthy sleep truly is. Scholars and scientist have been pondering and studying why we sleep for thousand of years. Socrates, Plato, and even Shakespeare discussed it in their literary works. In the middle ages people that snored were considered evil. Freud said that sleep was the gateway to the subconscious. At one point the great minds of their times believed that all of the blood rushed from our heads inducing sleep. With all of these great minds working on it the greatest discoveries of sleep have come in the last sixty years.

We spend one third of our lives doing it. Like food, water, and oxygen, the human body needs sleep to survive. Sleep is defined as “a natural and periodic state of rest during which consciousness of the world is suspended. Sleep is a state during which the body and mind are allowed to rest and become restored.” At the turn of the 19th century the average person slept ten hours a day. Today that same person gets 7.5 hours a day. That is a 25% reduction in 100 years. The present day fast paced lifestyles and the evolution of technology are the 2 biggest culprits of this sleep loss. Today people often do not get enough sleep; or their sleep is often disrupted by any of several different causes.

When a person does not receive the length, consistency, or type of sleep necessary, we say that person is suffering from sleep deprivation. While the average person needs at least 8 hours of sleep every night for optimal performance and health, only 37% of Americans receive this much. Nearly 31% of Americans report sleeping less than 7 hours of sleep each night during the week. 40 million American are predicted to have a sleep disorder. While only 25% of these numbers have been diagnosed and treated. This chronic sleep deprivation or a lack of necessary sleep over a long time can have drastic and sometimes deadly effects. As a person consistently fails to receive adequate sleep, sleep debt is increased. Sleep debt refers to the amount of sleep a person has lost over a period of time compared to what they should receive. If a person needs 8 hours of sleep every night, but only gets 6 hours in a night, that person has accumulated 2 hours of sleep debt in just one night. If this were to continue through 4 nights, the person would have accumulated 8 hours of sleep debt. The same pattern of a 2 week period and that same person would feel like they had not slept for 24 hours. Studies have shown that sleep debt is directly correlated with adverse effects including daytime sleepiness, poor performance, lack of concentration, and multiple health problems. Other potential problems of large sleep debt difficulty waking up, irritability, and a lack of motivation.

Have you ever dozed off while driving? Some of the most visible effects of sleep deprivation and sleep debt in the world are seen in traffic accidents. The National Highway Traffic Safety Administration (NHTSA) estimates that 100,000 police reported automobile accidents, resulting in 15,000 fatalities and 71,000 injuries are caused by drowsy drivers every year. These accidents alone cost an estimated $12.5 billion in lost property and productivity. According to the NHTSA nearly 37% of all drivers have “nodded off” while driving.



In August of 2003, New Jersey became the first state to criminalize drowsy driving that leads to fatal accidents. Penalties can reach as high as 10 years in prison and $100,000 in fines. In Salina, Kansas May of 2005 a truck driver fell asleep at the wheel and crashed into an SUV, killing a mother and son and injured two others. In October of 2007 the driver was sentenced to 6 months in prison for two counts of vehicular homicide. Many states are beginning to understand the gravity of drowsy driving. In some states drowsy driving can draw penalties almost as serious as driving while intoxicated.

Work related accidents and loss of work productivity resulting from sleep debt are a plague to our world today. 50% of adults age 18-30 say that daytime sleepiness interferes with their daily work, resulting in $15 billion in additional health care cost and 50 billion in lost productivity and revenues in the United States. Among the most costly and devastating known work-related accidents that are at least somewhat contributable to sleep deprivation include the Three Mile island meltdown in 1979, the Gas Leak in Bhopal India in 1986, the Chernobyle Nuclear Accident in 1986, and the Exxon Valdez Oil Spill in 1989.

More recently a Boston trolley operator killed in a crash last year likely
had a sleep disorder and fell into a “micro-sleep” shortly before the
collision. The safety board, completing a 14-month investigation, faulted operator Terese Edmonds for ignoring a red signal along the tracks, but directed harsh
criticism at the Massachusetts Bay Transportation Authority, operators of
the train system. The transit authority failed to screen operators for
sleep disorders while enforcing a work schedule that could prevent train
operators from getting enough sleep, the NTSB said.

The good news is that bad or poor sleep is correctable. Sleep Debt can be paid back. Yes it is a myth that lost sleep cannot be made up. Poor sleep hygiene and stress are the biggest causes of poor sleep quality. Over the years many doctors and sleep professional have come up with a few guidelines to help you get a better quality of sleep. Remember that these are just helpful guidelines. Everyone’s sleep is different. You need to develop your own rituals and patterns to lead to a healthy night’s sleep.

Be Consistent
our bodies are set up for consistency. That means going to sleep and waking up at the same time every day, on both weekends and weekdays. This plays into the brain's natural "circadian clock" or “biological clock” which regulates our overall sleep/wake physiology. To strengthen this circadian function, we should get in the habit of dimming our lights each night before bedtime, and exposing ourselves to natural light as soon as we wake up. I'm not saying all this is easy to do. I find that avoiding light before bedtime is especially difficult, since even computer screens and television screens emit light that sends an alerting signal to the brain. And I should be spending the first 15 minutes of being awake in the mornings outside, exposed to natural light, which is not a welcoming way to start a chilly day in January. These are ideal behaviors that give you something to shoot for.

Create a Peaceful Sleep Environment
All the experts agree that the bedroom should be a peaceful place. Sleep and sex should be the main uses of your bedroom. If your bedroom doubles as your office, you're in trouble. Computers, cell phones and yes, even pets, should be left outside because they all have the potential of interrupting sleep. The bedroom should be quiet, cool and dark. Consider earplugs, blackout curtains, eye shades, white noise and other ways to set the right tone. And make sure you've got a comfy mattress and pillows that haven't exceeded their life expectancy.

A good night sleep is influenced by many things. If you are suffering from insomnia the first thing you should do is rule out where you sleep as the cause of the problem. The easiest thing to do is to look at your room and see if a change here could change your sleep problems.



1. Is your bedroom and office the same room?

Life is stressful especially in this economy. If you are using your bedroom as your office to manage the household, do work at home, study for school or plan your volunteer activities. This can keep your mind going so you can not relax and sleep.

2. How cluttered is your room?

Do you make the bed each morning? Is the laundry picked up? What is on the top of your dresser, night stand and other furniture? Clutter causes thoughts of what chores need to be done. It also causes chaotic thoughts. These do not help anyone to relax and go to sleep. Plus there is the issue of having to get up in the middle of the night, the clutter could cause you to become more awake if you hit or trip on it.

3. What sounds are in your room?

Is a television or radio on in your room? What about the noise outside your room. Is there a loud television in the room next door? Are your neighbors noisy? If this is the case there are several things you can do to help ease the problem. White noise will help to mask the issue. This can be a fan, a white noise machine, or other consistent noise that will mask the outside noises. This does not include television or radio because the level of volume and the sound itself changes. You can also use light absorbing curtains because they also help to absorb noise from the outside. This is especially helpful to those who live on a busy street.

4. How much light is in your room?

A small night light is acceptable for sleeping but any more light and it can disturb your sleep. We all arouse several times during the night to change positions as we change from one stage of sleep to the next. The light can disturb you and actually change that short arousal into an awakening and take you longer to go back to sleep.

Outside light can also disturb your sleep. This can affect you if there is a streetlight outside your bedroom window, or if you are a shift worker. The investment in room darkening curtains is relatively inexpensive if you shop around. The help in getting a good seven to eight hours of quality sleep is priceless.

5. Who is sleeping in your room?

When you go to bed at night is there more then just your significant other in your bed. Pets can be one of the biggest disturbances when you sleep. They can be noisy they move around at night and can keep you from getting the sleep you need. The best place for them is outside your bedroom.

Where do your children sleep? Many parents share there beds with their children, however you need to be aware of the size of your bed and the more people sleeping in it the less space you will have to get comfortable. The idea is for everyone who shares the bed to get a good 8 hours of sleep not just the kids.

6. How is your bedroom decorated?

A relaxing surrounding is important to sleep. The color and comfort of your bedroom contributes to this. A soothing color is important to a good night sleep. So is the comfort of the bed you sleep in. Investments in such things as an egg crate or pillow top for your bed might make a mattress that is a little too hard more comfortable. Good quality sheets and bed linens are important. Softer sheets whether they are high thread count, flannel, satin or other materials that you like will help you to sleep better. A pillow that is right for your body position is also a good investment. They should be replaced on a regular basis. Pillows are not really lifetime investments, especially if they are of the foam variety. They wear our and you do not get the support you would get when you bought it. If you tend to like using three or four pillows when you sleep you might want to consider buying a wedge pillow. This will allow you to sleep at a 45 degree angle and would not require you to wake up and readjust your pillows several times a night.

7. What temperature is your room?

I know that many people think they sleep best when the room is warm but our bodies are designed for a cooler temperature at night. This is a natural thing, as our body temperature falls and is lowest during the 3am to 5am time period. If you get cold during the night consider adding a blanket or socks.



When you create a bedroom that is designed to help you fall asleep you will find that insomnia may not be as big a problem as it has been in the past. If you find that you are still having issues with insomnia look at your sleep routine and talk to your doctor. Sleep is too important to let anything stand in its way.

Leave Stress at the Door, or Better Yet on a Post-It Note
Sleep and stress don't mix. It's important to clear your mind before hopping into bed. One technique that I've used successfully to prevent the mind from racing is to set aside a few minutes before bedtime to worry and think of all the things that need to get done, but that haven't been accomplished. Then get them all down on a Post-it, or a piece of paper, and set it aside. Trust me; it'll be there for you tomorrow. Watching T.V. or checking you email can also be a stressful stimulus that hinders sleep.

Napping
If you must nap, do it at the same time every day.

Avoid Food, Nicotine and Alcohol before Bedtime
Finish eating, and drinking at least 3 hours before bedtime. You should not smoke within 30 minutes of sleep. Each of these activities can lead to poor sleep if done too close to bedtime.

Exercise
In general, exercising regularly makes it easier to fall asleep and contributes to the quality of sleep. Like eating, drinking and smoking, though, be sure not to exercise too close to bedtime. Exercise is best done between 3pm and 6pm or in the middle of the day when are bodies are at their peek wakefulness.

Hours of sleep necessity by age:

Children need more sleep per day than adults to develop and function properly: up to 18 hours for newborn babies, with a declining rate as a child ages. A newborn baby spends almost 9 hours a day in REM sleep. By the age of five or so, only slightly over two hours is spent in REM.

Age and condition Average amount of sleep per day
Newborn up to 18 hours
1–12 months 14–18 hours
1–3 years 12–15 hours
3–5 years 11–13 hours
5–12 years 9–11 hours
Adolescents 9–10 hours Adults, including elderly 7–8 (+) hours
Pregnant women 8 (+) hours
Obstructive Sleep Apnea (OSA) is one of the most common sleep disorders. As easy as apnea is to diagnose it remains one of the under diagnosed deadly problems in medicine today. Apnea is an unrecognized killer, yet it hides in plain sight. As more and more studies are done on the effects of OSA I believe that within 5 to 10 years it will be the number one underlying cause of death in the world. To understand this we need to comprehend what happens to the physiology of our airways when we fall asleep. Apnea is a Greek word meaning absence of breath. Right now while you are reading this article your airway is like a plastic straw. The sides or walls are firm or tone allowing oxygen to pass freely in and out of it. When we fall asleep our airways become more like the old paper straws. The lining of your airway is made of muscle. When we sleep these muscles relax or sag. As air passes through the airway those same sagging walls begin to vibrate. This is what causes snoring. Eventually the walls lining your airway will come together causing a complete breathing cessation. It is this cessation and flow limitation that causes the oxygen desaturations that have a detrimental stacking effect on your health.

As I said previously the effects of untreated OSA are stacking or compounding. The Oxygen deprivation caused by OSA can lead to High Blood Pressure, Heart problems, or Strokes. Apnea can also make other health problems like diabetes, MS., or COPD more difficult to manage. In many cases untreated apnea will eventually lead to death as seen in the news with the recent passing of Billy Mayes. Mr. Mays died of an enlarged heart which is one of the effects of OSA.

Quote from Dr. William Dement’s book (the father of modern sleep medicine) “The promise of Sleep”

“In all of medicine, I can’t think of a single other serious condition that is so common, life threatening, treatable, and yet so unrecognized. It’s as if diabetes were well known to laboratory researchers, and effective insulin had been developed, but physicians were completely unaware that diabetes exist”

If you or someone you know has one or more of the following symptoms, it may be Sleep Apnea:

• Snoring
• Gasping for air or stopping breathing during sleep
• Falling asleep in inappropriate situations, such as while driving, at a movie, or sitting in a meeting
• Waking up feeling unrefreshed
• Large neck size (greater than 17” in men; greater than 16” in women)
• Morning headaches
• Getting up during the night to urinate
• Sweating or tossing and turning during sleep
• Depression or irritability
• Sexual dysfunction
• Problems with memory or concentration

A high percentage of people with high blood pressure (hypertension) have undiagnosed sleep apnea.

If you have any of the above symptoms you should seek advice from your doctor. The best way to prove or disprove apnea or any other sleep disorder is to have your sleep evaluated at a sleep lab.

To each and every one of my extended family members in Rocky Ripple I wish you a healthy uneventful night’s sleep.

Please feel free to contact me via email at rockhinkle@yahoo.com if you have any questions regarding this article. I also participate in open discussions at sleepguide.com.

Information was taken from “The Essentials of Polysomnography” by Spriggs, “The Promise of Sleep” by Dr. William Dement, and from post on sleepguide.com. Special thanks to the teams at the Methodist Sleep Disorders Clinic, Gehad Salah RPSGT, and Kris Abney RPSGT for providing me with the knowledge and resources. Also to the crew and members of sleepguide.com for letting me ramble on about sleep.