The power of sleep

Quantity and quality of sleep are essential to well-being, as demonstrated by model Shannon Speake. (photo illustration by Sarah Pastrana)

Are you tired, run-down, listless? The answer to your problem is probably not in a little brown bottle. It could be as simple as a good night’s sleep. But for 45 million Americans, that’s an elusive dream. Even worse, sleep deprivation, insomnia and untreated disorders such as sleep apnea are leading Americans down a slippery slope to early mortality, increasing their risk for obesity, stroke, hypertension, diabetes and cardiovascular problems. And that’s not even counting the danger of falling asleep at the wheel.

“As a society, it’s a safe assumption that we are chronically sleep-deprived,” says Emerson Wickwire, a behavioral sleep medicine specialist and co-director of the Center for Sleep Disorders at Pulmonary Disease and Critical Care Associates in Columbia. The center opened two years ago and offers diagnostics and treatment. It’s one of the few places in the region that offers cognitive behavioral therapy to treat insomnia. Johns Hopkins Hospital is another.

In Maryland, 28 percent of adults reported not getting sufficient sleep for 14 days during a 30-day period in 2008-2009, according to a report from the Centers for Disease Control and Prevention. Thirty percent were women, 26 percent men. The highest concentration occurred in the Baltimore-Washington corridor and westward. The lowest percentage reporting sleep insufficiency was on the Eastern Shore.

It’s not just adults having trouble with sleeping. Statistics show that more than two million children in the United States suffer from sleep disorders and that an estimated 30 percent to 40 percent of children do not sleep enough.

“It’s a public health epidemic,” says Wickwire.

Mighty shut-eye

Why is sleep so powerful, and how are Americans sabotaging their overall quality of life with shorter nights in the sack?

“Sleep is the missing link between diet and exercise,” says Wickwire. “There’s nothing that we do that we can’t do better after a good night’s sleep.”

When we sleep, our bodies slow down and cool down. The heart rate slows in a rhythmic disengaging from our active day, intended to mirror the natural circadian rhythms of the earth -- dawn to day to dusk to night. During sleep, the body goes through 100-minute cycles of levels of sleep; the deepest occurs the earliest, in the first third of the sleep. During this time, the body physically restores itself, including muscle growth and hair growth. As sleep gets shallower throughout the night, the body enters into a cycle known as Rapid Eye Movement (REM). This is when the muscles are paralyzed but the sleep is shallow. We dream in REM because this is when the body goes through cognitive restoration, processing emotions and memories, storing or discarding them. The longest period of REM occurs at the end of sleep. This is why we remember our dreams so vividly.

If the body is deprived of either one of these cycles, the result is not just physical impairment but cognitive and emotional impairment as well. In short, a person is tired, moody, lacks judgment and patience and can’t concentrate. Worse, the body can’t make up for sleep loss, either. Sleep debt occurs and is banked every time we lose sleep in a 24-hour period, according to the National Sleep Foundation, an organization dedicated to educating and advocating for better sleep.

“One night of sleep loss is the same as driving over the legal limit,” says Susheel Patil, clinical director of The Johns Hopkins Sleep Medicine Program in Baltimore. Three thousand patients sought help from JHU’s sleep center last year; 1,500 of them were new patients. JHU had one of the first sleep labs in the country, founded in the late 1970s.

For a small percentage of people, about 1 percent of Americans, sleep isn’t about habits, or stress, or being parents of a newborn baby. Conditions like sleep apnea (interrupted breathing during sleep), narcolepsy (uncontrolled sleep attacks) and idiopathic hypersomnia (requiring an inordinate amount of sleep, perhaps 13 to 15 hours a day, to function) are physiological problems and have specific treatments involving medication and equipment to aid in breathing and sleeping. But that’s not where the majority of Americans fall.

“We sacrifice our sleep so we can do more, especially as we move into a 24/7 society,” says Patil.

Conversely, having chronic insomnia is considered a personal failure by some, leading to embarrassment or job loss, such as in the case of a commercial driver needing to renew his or her license every two years or repeated tardiness to work.

Whether sleeplessness is a physiological problem or the result of years of stress, anxiety or just poor sleep habits, there is help.

James’ story

A 37-year-old engineer living in Carroll County, James started suffering from insomnia four years ago. That’s when several family members were ill and the stress took its toll on him.

“My brain just went into overdrive thinking of all the things that could go wrong,” he says. He had trouble falling asleep and staying asleep. At its worst, he was getting only two to three hours of sleep each night. He tried several medications but wasn’t satisfied.

“I used to dread going to sleep,” he says.

Two years ago he decided to try cognitive behavioral therapy with Wickwire. After a sleep study showed no physiological problems, like apnea, James began seeing Wickwire once a week. Together they discussed James’ sleep routine, his personal history and diet. James had to keep a journal.