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Sleep: Are You Getting Enough? by Constance Pittman Lindner

The Function of Sleep

sleep Why is sleep so critical to our well-being? If resting in bed were all it took to recharge body and mind for the coming day, insomniacs could take in their favorite late night television and start the next day fresh. But surprisingly, it's not how much sleep you get that's important—it's the level of sleep you achieve that truly restores you, body and mind.

Sleep can be divided into two crucial phases:

Non-rapid eye movement (NREM) sleep takes up about 75% of the average dreamer's night. The earliest phase of NREM sleep begins with general relaxation of muscles. This relaxed state eventually culminates in the deepest sleep level when it appears that protein synthesis, growth hormones, immune function, and the mind are given a boost. Delta waves—the slowest and largest waves—signal the onset of this most rejuvenating sleep level.
Rapid eye movement (REM) sleep takes up about 25% of an average sleeper's night. Dreams that occur during REM sleep might provide, in a sense, a sorting through of free-floating information. REM sleep is thought to be a very important period for mental revitalization.

Risky Consequences From Sleeplessness

In addition to productivity and safety consequences, research shows that people who have insomnia or are chronically sleep deprived may be more likely to have an increased risk of:

Depression
Headache and migraine
High blood pressure
Cognitive decline

People who do not get enough sleep may also:

Have behavioral problems (especially in children)
Drink more alcohol and use more sedatives than they usually do
Experience a decreased enjoyment in life

Who Is Most Affected?

Late Shift Workers

Not only do Americans give up a good night's rest in an attempt to keep up with the hectic pace of the electronic age, many, including late shift healthcare, military and public safety workers, nuclear power plant operators, medical residents, and long-haul truck drivers, are building daily schedules against the body's natural circadian rhythm. That rhythm dictates that the longest period of sleepiness occurs during the hours of 2:00 am to 4:00 am. Thus, people who work the late shift lose out on the time that the body is programmed for the deepest and most beneficial sleep.

Older Adults

The elderly, too, cope with a special set of difficulties that keeps them from getting the sleep they need. Aging brings on a host of health-related problems that interrupt sleep, such as having pain from conditions like arthritis and taking medicines with side effects that disturb rest. More than any other population, the elderly rely on medicines that keep them up at night. Moreover, a more sedentary lifestyle doesn't allow for the expenditure of energy that results in restful sleep. Lastly, the brain doesn't allow for the same degree of deep sleep per night as enjoyed in youth.

But none of this means that the elderly don't need as much rest as everyone else. The combination of conditions that change the sleep habits of the elderly only indicates that they need to alter their sleep habits so that they get enough shut-eye.

Tips for Better Sleep

In general, people are so used to going without enough sleep that they don't recognize that their sleeping habits make sound slumber unlikely. Following these simple tips will help you settle down for a good night's rest. Do the following to improve the quality of your sleep as well as to get more restful sleep:

Avoid caffeine, nicotine, alcohol, and exercise at least four hours before bedtime. Caffeine and nicotine are stimulants, and alcohol, though a depressant that makes falling asleep easier initially, interferes with deep sleep later on during the night. Exercise also acts as a stimulant, but a workout earlier in the day can improve nighttime rest.
Leave worrying outside the bed. If you stay awake worrying about things you have to tackle the next day, write out a list of "to-dos" to take the pressure off. Then put the list aside to deal with the next day.
Keep other activities out of the bedroom. Don't confuse your bedroom with your family room. Keep your television viewing and internet surfing out of your sleeping quarters. You need to associate your bedroom with sleep and not activities that will keep your mind engaged.
Don't try to "force" yourself to sleep. You'll just lie awake staring at the clock. After 20 minutes of wakefulness, go to another room to read or perform some other quiet activity. Return to your bedroom only when you've become tired enough to sleep.
Temperature counts. Keep your bedroom set up for a restful night's sleep with a comfortable mattress and proper temperature setting. A too-hot or too-cold room can keep you awake.
Reduce noise levels. Apartment-dwellers with noisy neighbors or those on heavily trafficked streets can block out noise with a fan or a white noise machine.
Avoid stimulation before sleeping. Try not to engage in anything that will give you a second wind just before bed, such as viewing an action-packed movie or sitting in a brightly lit room. Instead, try listening to soothing music or reading.
Slow down. Don't hurriedly get ready for bed at the last minute. Brush your teeth and wash yourself a while in advance. Try to stick with an early-to-bed, early-to-rise pattern. That way, you won't go to bed too late during the work week and need an alarm clock each morning to wake you out of a sound sleep.

If you're troubled with chronic difficulties falling asleep—or staying asleep—see a doctor.

RESOURCES:

American Academy of Sleep Medicine http://www.aasmnet.org/
National Sleep Foundation http://www.sleepfoundation.org/

CANADIAN RESOURCES:

Better Sleep Council Canada http://www.bettersleep.ca/
Canadian Sleep Society http://www.css.to/

References:

Drugs and insomnia. NIH Consensus Development Conference. Consensus development conference summary. Vol 4, No 10, National Institutes of Health, Bethesda, MD, 1984:1.
Insomnia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated March 29, 2012. Accessed April 12, 2012.
Sateia MJ, Nowell PD. Insomnia. Lancet . 2004; 364:1959.
Shift work and sleep. National Sleep Foundation website. Available at: http://www.sleepfoundation.org/article/sleep-topics/shift-work-and-sleep. Accessed April 12, 2012.
Silber MH. Clinical practice. Chronic insomnia. N Engl J Med. 2005; 353:803.
Sleep drive and your body clock. National Sleep Foundation website. Available at: http://www.sleepfoundation.org/article/sleep-topics/sleep-drive-and-your-body-clock. Accessed April 12, 2012.
Sleep tips. The Better Sleep Council website. Available at: http://www.bettersleep.org/OnBetterSleep/sleep-tips.asp. Accessed April 12, 2012.
What happens when you sleep? National Sleep Foundation website. Available at: http://www.sleepfoundation.org/article/how-sleep-works/what-happens-when-you-sleep. Accessed April 12, 2012.

Last reviewed May 2012 by Peter J. Lucas, MD

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