Sleepless in America

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You snooze, you lose. It’s the 21st century mantra as many Americans espouse a high-living, fast-track, buzzing and humming lifestyle. The business owner, the corporate executive, the manager, the professional — many are burning the candle at both ends. No one wants to miss a beat. However, medical experts agree: America is sleep deprived.

Dr. Mark Pascual, a doctor of pulmonary medicine, is the director of the Penrose/St. Francis Sleep Disorder Laboratory. He said no one in the United States gets enough sleep. “It’s by nature of what we do – there is too much to do,” Pascual said.

Dr. James Pagel, owner of the Rocky Mt. Sleep Disorder Center and the medical director of the Sleepworks Laboratory in Colorado Springs, is the president of the Colorado Sleep Society and Pascual’s predecessor. He is board certified in sleep disorders and has been practicing sleep medicine for 30 years. “The level of stress in our society is much higher than it used to be,” Pagel said. “We are constantly pushing and pushing our employees. It pays to use them up. We work longer hours, and we work harder here than anywhere else in the world.”

According to the National Sleep Foundation, about 70 million people in the United States experience sleep-associated problems. Almost 40 million Americans suffer from chronic sleep disorders, and an additional 20 to 30 million are affected by intermittent sleep-related problems.

The foundation’s 2001 national “Sleep in America” poll reported that almost seven out of 10 Americans experienced frequent sleep problems, and that most were undiagnosed. The same poll in 2003 found that 67 percent of older adults had frequent sleep problems and only one in eight had been diagnosed.

And a sleepy America is costly. Foundation research indicates that sleep deprivation and sleep disorders account for $100 billion each year in lost productivity, medical expenses, sick leave and property and environmental damage. The National Institute of Health says that $14 billion is spent annually on medical treatment for insomnia.

A lack-of-sleep trend can be dangerous to oneself and others. The National Highway Traffic Safety Administration estimates that drowsiness accounts for 100,000 police-reported automobile crashes each year. The National Sleep Foundation reported that a 1996 study by Knipling and Wang showed that car accidents related to sleep deprivation resulted in more than 1,500 fatalities and 71,000 injuries and almost $12.5 billion in diminished productivity and property loss.

Although the financial statistics and highway traffic reports indicate a sleep-denied society is disconcerting, the long-term effects related to an individual’s health status are unknown. “It’s hard to know what happens to humans,” Pascual said. “We do know that sleep deprived rats become wasted, fatigued and eventually die.”

Too little shut eye – less than six hours – can cause not only fatigue but also depression. “If you take 100 people and limit their sleep to less than six hours a night for a certain period, 90 percent of them will meet the criteria for depression,” Pagel said. He and Pascual agreed that many of those who don’t adhere to normal sleep routines turn into daytime caffeine hounds.

What is normal?

Before Edison invented artificial light, Americans slept an average of 10 hours a night, a luxury today. Experts say seven to nine hours is a sufficient amount to restore the body. In a non-scientific poll of about 25 CSBJ readers, the average amount of nightly slumber for Springs business people is six to seven hours. And most of those polled are sleeping one-to-two hours longer on the weekends. Many admitted to ongoing or occasional patterns of insomnia.

Pagel said 80 percent of people experience what he referred to as transient insomnia for at least two weeks per year. He said 15 percent of Americans are chronic insomniacs, of which 50 to 55 percent is related to psychological factors, including stress, and 45 percent is connected to underlying problems like sleep apnea, depression or chronic pain.

Pagel said, despite the calming scenery, the Springs is a breeding ground for stress. “There is a lot of high stress and pressures here, depending on the types of jobs,” he said. “And driving pressures have increased. When I talk to my patients in Pueblo and ask them to rate their level of stress from one to 10, they say anywhere between four and five; when I ask my La Junta patients, it’s usually between two and three; and when I talk to my Springs patients, they say 20.” Stress, anxiety and depression are the most obvious causes of insomnia, said Dr. William Orr, also board certified in sleep medicine and the medical director of the Colorado Institute of Sleep Medicine. Orr, who has worked in sleep medicine for 25 years, said, “America is pushing itself to sleep less than what is needed.”

Even traditional medical schools are awakening from a deep sleep that ignored the needs of interns. The New England Journal of Medicine recently published a study about doctors’ sleep habits. The conclusion: Doctors who sleep more make fewer medical errors. Seems like a no-brainer. But the sleep-deprived are not quick to admit to any shortfalls in their work productivity.

“Sleep needs are individual,” Orr said. “Each person needs enough sleep to allow them to be awake and alert during the daytime (without stimulants). You have to be the judge.” He said a change of sleep habits on the weekends is a clue to whether the individual is sleeping enough during the week. “Eighty percent sleep more on the weekends,” Orr said.

Older adults tend to have more fragmented sleep times, Orr said. It’s a myth that the older we get, the less sleep we need.

Although he, too, said there is no data measuring sleep habits to good health, Orr said a lack of sleep can cause health problems down the road.

And health problems, such as obesity, can cause sleep problems. And contrary to its immediate sedative effects, alcohol is not a sleep aid. “Alcohol may put you to sleep, but after it is metabolized, the by-products wake you up and cause fitful sleep,” Orr said. Studies indicate that solid foods like hamburgers interfere with sleep more than liquid foods like Jell-o or soup, he said. Regardless, a big meal right before bedtime is off limits for those who want unconscious peace as they nod off.

Do Type-A people sleep less? No, said Sarah Josephson, a lead sleep technician with Memorial Hospital’s Sleep Disorder Center. Insomnia is not associated with personality types, she said. “People today don’t even know how fatigued and tired they really are,” Josephson said.

But others, who suffer from sleep disorders such as restless leg syndrome, a movement disorder that causes a creepy crawly feeling in the limbs; narcolepsy, a neurological disorder that creates uncontrollable “sleep attacks;” or sleep apnea, a breathing disorder that causes sleep interruptions, cannot function without medical intervention.

The National Sleep Foundation reports that 18 million Americans have sleep apnea.

Bradd Hafer is a public relations associate with Memorial Hospital. He turned to the sleep center after his wife noticed that he stopped breathing during intervals of disturbed sleep. Hafer spent a night being monitored at the center and was eventually diagnosed with a milder form of sleep apnea. “I would be sleeping – half in and half out – and then I’d get this feeling that I was drowning,” Hafer said. “It’s like being in a state of paralysis, like being in a bubble and not being able to move. I never wanted to go to sleep because I didn’t want to get those images. I was constantly tired.”

Josephson said Hafer’s sensations are real. Most sleep apnea disorders are connected to physical problems such as airway collapses, a deviated septum or sinus congestion, she said.

Can the sleepless in America play catch up on the weekends?

Josephson said that sleep debt is difficult to pay back, even on the weekends, if the debt is too big. “People are perpetually taking out and putting back in
,” she said.

One of the sleep myths is that reading a book or watching television in bed is conducive to a sound sleep. Not true. Josephson said bedtime activities subconsciously and technically disrupt sleep.

The bedroom is reserved for sleep and sex only, Josephson said. All local experts agreed: Developing good “sleep hygiene” is conducive to optimum productivity and overall wellness. No snooze, you lose.

- Marylou.Doehrman@csbj.com