To sleep: perchance to dream: ay, there's the rub: Sleep Deprivation

By Bob Balkam

All too many of us Well Spouses carry a monkey on our backs.  The monkey is called Sleep Deprivation.  Every morning I am reminded of mine when, after breakfast, I do the Relaxation Response to keep my blood pressure down.  At one or more points during the fifteen minutes, I fall asleep, if only a little catnap.  It is telling me: œNo, Balkam, you have not paid off the total of your sleep debt accumulated over recent days (and nights).

My situation is, as far as I can see, better -- often considerably better -- than all of you I have ˜met™ on our Forums.  Since I am experiencing it and from the comments I have seen in a number of posts, I feel pretty certain that a significant portion of our members must be familiar with the condition as well.

Having had Restless Legs Syndrome (see http://www.rls.org/) since 1993 I have already experienced enough lost sleep to last me the remainder of my life.   The first place I recognize it -- after many yawns and the all too familiar feeling of penetrating exhaustion -- is in short term memory loss. 

œWell Spouse Caregiver is to me a definition of Sleep Deprivation.  If it also afflicts the IS, which is more than likely,  it is a serious combination. 

Unfortunately, we live in a culture which largely denies any benefit for sleep.  It is often the subject of ridicule.  If even not spoken, the message generally is:  œSleep is a waste of productive time.  The macho thing is to say:  œI can get by on four hours a night!  People rarely discuss their sleep habits - or problems --  with their doctors (who most certainly experienced it during their residency.)

In sharp contrast to the prevailing attitudes: 

The Harvard Women™s Health Watch suggests six reasons to get enough sleep:

1. Learning and memory: Sleep helps the brain commit new information to memory through a process called memory consolidation. In studies, people who™d slept after learning a task did better on tests later.

2. Metabolism and weight: Chronic sleep deprivation may cause weight gain by affecting the way our bodies process and store carbohydrates, and by altering levels of hormones that affect our appetite.

3. Safety: Sleep debt contributes to a greater tendency to fall asleep during the daytime. These lapses may cause falls and mistakes such as medical errors, air traffic mishaps, and road accidents.

4. Mood: Sleep loss may result in irritability, impatience, inability to concentrate, and moodiness. Too little sleep can also leave you too tired to do the things you like to do.

5. Cardiovascular health: Serious sleep disorders have been linked to hypertension, increased stress hormone levels, and irregular heartbeat.
6. Disease: Sleep deprivation alters immune function, including the activity of the body™s killer cells. Keeping up with sleep may also help fight cancer.

Harvard MedicalSchool Family Health Guide: Repaying your sleep debt

Medical evidence suggests that for optimum health and function, the average adult should get seven to nine hours of sleep daily. But more than 60% of women regularly fall short of that goal. Although each hour of lost slumber goes into the health debit column, we don™t get any monthly reminders that we™ve fallen in arrears.

In fact, the greater the sleep debt, the less capable we are of recognizing it: once sleep deprivation ” with its fuzzy-headedness, irritability, and fatigue ” has us in its sway, we can hardly recall what it™s like to be fully rested. 

And as the sleep debt mounts, the health consequences increase, putting us at growing risk for weight gain, diabetes, heart disease, stroke, and memory loss.In some cases, sleep debt results from insomnia or other underlying conditions that may require medical attention. But most sleep debt is due to burning the candle at both ends ” consistently failing to get to bed on time and stay there until we™ve slept enough.  It may take some work, but you can repay even a chronic, longstanding sleep debt.

How we sleep

We need sleep, and, in a sense, we™re programmed to be sure that we get it. The body summons sleep in two ways: by boosting circulating levels of the neurotransmitter adenosine and by sending signals from the circadian clock, which controls the body™s daily rhythms. Together, these two systems establish an ideal bedtime for each of us.

The circadian clock regulates all body functions ” not just the pattern of sleeping and waking during the 24-hour cycle, but also fluctuations in body temperature, blood pressure, and levels of digestive enzymes and various hormones. Most of us experience a major œsleepiness peak between 12 a.m. and 6 a.m. and a minor one between 2 p.m. and 4 p.m. Of course, individuals vary.

Why we need sleep

Although sleep doesn™t trump food and water in the hierarchy of physical needs, we can™t live without it. Given the ethical limits on research involving human subjects, scientists have no direct evidence on how extended sleeplessness ” that is, beyond a few days ” affects human beings. Laboratory rats, however, have been deprived of sleep for long periods, and after a week or two, the results include loss of immune function and death from infections.

In a landmark study of human sleep deprivation, University of Chicago researchers followed a group of student volunteers who slept only four hours nightly for six consecutive days. The volunteers developed higher blood pressure and higher levels of the stress hormone cortisol, and they produced only half the usual number of antibodies to a flu vaccine.

The sleep-deprived students also showed signs of insulin resistance ” a condition that is the precursor of type 2 diabetes and metabolic slowdown. All the changes were reversed when the students made up the hours of sleep they had lost. The Chicago research helps to explain why chronic sleep debt raises the risk of obesity, heart disease, stroke, and diabetes.

If you have read this far, you are probably saying: œThat™s fine but how can I do anything about it with the life I am leading?  That is a very fair question.  Let™s start an answer.

• - Appreciate just how beneficial, even necessary, sleep is for ˜the life you are leading™.
• - Whenever you recognize that you have a sleep debt, get sleep whenever you can -- day or night.
• - Anticipate the situations where you have lost sleep in the past and minimize them as far as you can.  
• - Can you get help -- more help?
• - Is it possible to make a Respite Weekend? 
• - Is it possible to change one or more necessary routine(s)?

The Next Step

Please send any comments, suggestions or questions to the Forum Help and Healing Discussion:  To sleep: perchance to dream: ay, there's the rub;

John W. Winkelman, M.D., Ph.D. is an Associate Professor of Psychiatry at Harvard Medical School and Medical Director of the Sleep Health Center of Brigham and Women's Hospital in Boston, Massachusetts.  He comments on the above article.

"I like this very much and I am sure it will be of significant benefit to the readers.  I would only add that sleep disorders are common in the general population, and become more prevalent with increasing age.  These include obstructive sleep apnea, insomnia, restless legs syndrome, and circadian rhythm disorders.  If anyone suspects that they may have one of these, due to inability to sleep given adequate opportunity, or inability to stay awake when they have enough sleep at night, they should consult their primary care physician or a sleep specialist.