Dying to sleep

Our culture makes a virtue of 'late to bed and early to rise.' But losing out on sleep risks health and lives, JAN CORBETT reports.

If you're among the lucky and the wise you will be sitting down to read this morning's newspaper feeling refreshed and invigorated after a good seven to nine hours of blissful, uninterrupted sleep.

If not, you're probably killing yourself.

Getting a good night's sleep is not so easy, you say. There was too much to do last night. You were at the office until late, there was dinner with clients, homework from your MBA class, the children's sports clothes needed washing, and you can't kick your Internet habit. Either that or you live in Auckland where traffic gridlock forces you to get up earlier each morning and means you are getting home later each night.

Today, you will be feeling the full effects of 21st-century tiredness, with a sleep-debt of probably seven or eight hours built up over the week. You have the symptoms of a sleep-sick society.

"It's to do with people doing too much during the day and then staying up too late at night," says Wellington sleep specialist Dr Alister Neill. "And someone has put the crazy idea in our heads that successful people only need four hours' sleep each night and everyone else is lazy."

Then there are those who want to sleep but cannot. They lie awake each night with growing panic about not sleeping, which only makes it worse. Not sleeping becomes a source of embarrassment. They never discuss it at work because they know it is affecting their performance, but don't want to be considered impaired.

Insomnia is not a disease, but a symptom of some underlying cause that keeps you awake. It could be anything from a disruption to your body clock from travel, consuming too much caffeine or alcohol, stress or depression.

Resolving those issues can resolve the insomnia but, warns Green Lane Hospital sleep specialist Dr Ken Whyte, insomnia cannot be cured, only managed. People who have been severe sufferers never attain the sleep quality enjoyed by people who have never had insomnia.

In the meantime, according to health care research company IMS HEALTH, the sleepless accounted for 328,000 visits to doctors last year, they took away 325,000 prescriptions for something to help them to sleep and, overall, contributed to an annual $3 million market in this country for hypnotics and sedatives.

Whether we blame the stresses of modern life, the invention of the light bulb or a misinformed culture that makes a virtue out of staying up late and rising early, too little sleep is turning ours into a dangerously sleep-deprived society. Dangerous because sleep deprivation diminishes our life expectancy and puts us at greater risk of injuring ourselves and others.

According to Professor William Dement, America's leader in sleep research, undiagnosed sleep disorders are a leading contributor to heart attack, high blood pressure and stroke. Generally, not enough sleep makes us more susceptible to colds and flu and saddles us with an underlying physical and emotional malaise.

By Dement's calculations, we are sleeping an hour-and-a-half less each night than our great-grandparents, and half of us are mismanaging our sleep so badly we are putting our health at risk.

Yet, he thunders, the knowledge sleep researchers have amassed over the past 45 years about sleep's vital role in our well-being is banked up behind a dam of bureaucratic inertia.

"Never before in human history has a disparity between the amount of scientific knowledge and the benefit of that knowledge to society been so tragically vast," he writes in his most recent book, The Promise of Sleep.

He goes as far as accusing doctors of being wilfully ignorant about the dire effects of sleep deprivation on their patients - and themselves.

After 13 years working in Nasa's fatigue management unit, Dr Philippa Gander returned to New Zealand to become one of our few dedicated sleep researchers.

She agrees that knowledge among doctors and the public about sleep disorders and the dangerous effects of too little sleep is pitiful.

"We need a big public education campaign so people understand the risks of going without sleep and the need to reprioritise sleep," she says. "People need to stop thinking they're getting more out of life by cutting back on sleep."

She also complains of too few resources to adequately diagnose and treat sleep disorders, a view backed by Green Lane Hospital sleep specialist Dr Ken Whyte, whose waiting list is five to seven years. He also says doctors have little alternative to prescribing much-maligned sleeping pills, because there is no funding for therapists to assist the sleepless.

Although scientists now agree sleep is essential to a healthy body and mind, they don't know why. But they do have some idea of what our bodies get up to without our being aware of it.

The sleeping brain releases hormones and chemicals that stimulate cell activity, sometimes appearing more active than when we are awake. We consume more oxygen while we are dreaming than we do on any other activity.

In the first four hours you slowly descend into deep sleep. Breathing, pulse and brainwave activity slow, blood pressure and body temperature drop and the eyes roll slowly from side to side.

The final four hours of sleep is when we enter the rapid eye movement (REM) stage. Not only does eye movement dramatically increase but this is the stage when we dream and our muscles relax entirely, preventing us, the theory goes, from acting out those dreams. Although dreams, like sleep, are considered important for our mental health, again no one is certain why.

Right now the only thing most of us know about sleep is what it feels like not to do it.

Many of us mistakenly believe sleep is something the body imposes on the mind, rather than being an essential part of life the brain demands. We tend to make a virtue of getting by on small amounts of sleep and exalt the likes of Thomas Edison and Margaret Thatcher, who claimed to need only three or four hours each night.

In our ignorance we abhor sleeping late or napping as hallmarks of the lazy and unmotivated. The lesser known fact about Edison is that he would fall asleep in board meetings the next day, often for five hours at a time.

What is known is that like alcohol, sleep deprivation slows reactions, impairs judgment and concentration, and lowers our ability to deal rationally with stressful situations.

The more you stray from your normal sleep requirement - which for most people is between seven and nine hours each night - the more determined your brain becomes to put you to sleep even if it is at inconvenient moments like when you are driving, operating heavy machinery, or the chief executive is addressing the staff on this year's budget round.

Which is why tiredness is now not only thought to play a role in alcohol-related car crashes, but fatigue among crew and management has been accepted as the root cause behind the grounding of the Exxon Valdez in Alaska's Prince William Sound and the explosion of Nasa's Challenger spacecraft.

In New Zealand, the Land Transport Safety Authority attributes 8 per cent of fatal crashes and 5 per cent of injury crashes to fatigue. It puts the social cost of death and injury on the roads caused by fatigue at $200 million yearly.

Even so, LTSA spokeswoman Tui Patterson thinks fatigue-related road crashes are under-reported in this country because the police are not trained to recognise the signs of it - like a crash on a straight piece of road with no skid marks from one set of tyres, meaning that driver was probably asleep.

The Traffic Accident Research Foundation is financing Wellington Medical School's sleep investigation centre to study the role of sleep disorders in traffic accidents.

In the meantime the LTSA is launching its own project to establish whether the rules covering commercial drivers are adequate to ensure they are not on the roads while dangerously sleep-deprived without necessarily knowing it.

Occupational therapist Fiona Johnston says while few people realise when they have had too much to drink, even fewer recognise when they haven't had enough sleep.

Researcher Gander says that because sleep deprivation is a health and accident risk, it would be cost-effective for New Zealand to have a systematic approach to dealing with sleep disorders. So she is involved in a Wellington School of Medicine study into New Zealanders' sleep patterns.

In the pilot study of 600 adults last year, 42 per cent said they rarely or never get enough sleep. Half said they seldom or never wake feeling refreshed. Moderate daytime sleepiness affected 12 per cent and 4 per cent said they had a severe problem.

Some of those will be suffering from one of the 80 or so sleep disorders now identified, and the list is growing. Others will either have developed bad habits or live a lifestyle common to a sleep-unfriendly culture.

Not only are we sleeping less than our ancestors, but we are either working longer or at times our bodies say we should be asleep.

Since the advent of the Employment Contracts Act, allowing for more flexible working hours, one-quarter of us now have contracts that allow for shiftwork, a particular threat to a good night's sleep.

Gander and Otago University's Associate Professor Anne-Marie Feyer are looking at the effects of longer and more flexible working hours on our sleep, and ultimately our health. The idea is not to oppose flexible working hours, but to give us better information about the effect they have on us so we can manage our sleep better in response.

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