To Sleep, Perchance to Dream: For Those Dogged by Sleepless Nights and Weary Days, a Leading Expert Offers Some Practical Insights into Getting a Better Night's Sleep

Article excerpt

Do you toss and turn when your head hits the pillow? If so, you're not alone. More than 70 million Americans suffer from various forms of sleep disorders, according to the American Academy of Sleep Medicine. While many of us experience an occasional restless night worrying about a spat with a spouse or a work deadline, others suffer from one of various sleep disorders--ranging from insomnia to narcolepsy, from sleepwalking to sleep apnea--that require the expertise of a sleep specialist.

According to a poll by the National Sleep Foundation, nearly one third of adults logged in less than the recommended seven hours of sleep on a weeknight. Researchers know that abbreviated sleep not only inhibits productivity, but can also lead to more serious health consequences and jeopardize not only your safety but also that of individuals around you. in fact, experts believe America's sleep deficit may contribute to increased risk of motor-vehicle accidents, diabetes, heart problems, even obesity.

"While it's hard to determine cause and effect, some people believe that one contributing factor behind our society's increasing problems with obesity relates to the decline in sleep hours over the last 40 years," says John W. Winkelman, M.D., Ph.D, assistant professor of psychiatry at Harvard Medical School and medical director of the Sleep Health Centers at Brigham and Women's Hospital. "When you experimentally deprive individuals of sleep for short periods of time--for instance, allowing them four hours of sleep for six days--levels of hormones that regulate hunger (leptin and ghrelin) change, becoming more oriented toward hunger and less toward satiety. Finally, our ability to handle glucose changes. These normal volunteers who were sleep deprived appeared prediabetic, in terms of response to oral or intravenous glucose."

While requirements do vary, sacking slumber eventually exacts a toll.

"Individuals vary in the amount of sleep and rest required, but just as there's a minimum number of calories required to maintain weight, health, and homeostasis of the body, there's a certain amount of sleep that nearly everybody requires," Dr. Winkelman told the Post. "For optimum functioning, we estimate that seven to eight hours is required, but data suggest that more may be even better."

But can you train the body to operate on less sleep?

"I think not," clarifies Dr. Winkelman. "This is just what our bodies need. However, there is variability in other aspects of sleep, which may be genetically programmed. For instance, there does appear to be a genetic preference for so-called owls and larks--people who stay up late and sleep late and people who do the opposite."

In addition to genetics, gender affects sleep. Women more often experience Insomnia--difficulty falling and maintaining restful sleep, while men more frequently suffer from obstructive sleep apnea. Aging is another factor.

"From careful studies, we find that sleep in many respects deteriorates with age," Dr. Winkelman explains. "The ability of the brain to generate slow-wave sleep--the deepest stage of sleep that commonly occurs within the first couple of hours of the night--is substantially impaired with age. Also, older individuals more commonly experience frequent awakenings and difficulty maintaining sleep during the last third of the night."

Many conditions associated with aging are also relevant, including medical illnesses, psychological functioning, medications, exercise, and isolation, among others. While there is no treatment for aging, experts do have treatments for medical and psychiatric illnesses, including depression, linked to sleep deprivation.

"Like many medical issues, sleep problems and depression are correlated, but it's not clear what direction the arrow of causality points--probably in both directions," suggests Dr. Winkelman. "Depression can cause sleep problems and insomnia, but increasing evidence from many studies shows that people with insomnia over the years who didn't have depression when first evaluated have an increased risk of developing new-onset depression. …