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such as obesity, hypertension, stroke, depression, and cancer. Some researchers even claim that sleep is the best determinant of longevity, more important than diet, exercise, or heredity.
Americans often seem willing to give up sleep in order to do something else because “many of them never thought [sleep] was important to begin with,” Breus says. At the same time, millions of people are desperate for a good night’s rest. In its 2005 “Sleep in America” poll, the National Sleep Foundation discovered that seventy-five percent of those surveyed reported experiencing, at least a few nights a week, one or more symptoms of a clinical sleep disorder, while fifty-four percent reported a symptom of insomnia.
Lack of adequate slumber, whether for a night or over a long period of time, creates sleep debt. This is “the burden we carry when we haven’t gotten as much sleep as our brains need,” explains Mary Carskadon, a professor of psychiatry and human behavior at Brown University and director of the Chronobiology and Sleep Research Laboratory at Bradley Hospital in Rhode Island. At this point, “it’s still a puzzle” as to how the brain knows it hasn’t had enough sleep, she says. “What’s the bean counter in the brain that tells us? Is it biochemical or molecular changes, or something in the neurotransmitters?”
While the consequences of long-term sleep debt have not yet been thoroughly researched, after a few days or weeks of poor sleep, Carskadon says, “there can be short-term irritability and depression. There’s growing evidence that cognitive skills decline. The speed at which we process information slows down, and vigilance—being able to attend to your environment—is hampered, too. This plays out in activities like driving—the biggest side of the picture is the risk of falling asleep and creating some tragic outcomes.”
Avoiding sleep debt is even more important for teens than for adults, according to Carskadon, who specializes in studying teen sleep patterns and advocates later starting times for high school. This can be difficult, since teens’ internal sleep clocks tend to shift toward later hours, keeping them awake far into the night, even though they must still get up early for school. “Learning is the main task of the teen years,” she says. “New circuits are being built in the brain then, and we don’t know how much brain development is compromised by lack of sleep.”
With the introduction of new sleeping pills, such as Lunesta, Ambien, and Rozerem, the debate about the efficacy and safety of pharmacological remedies for sleep disorders has reawakened. A growing number of medical professionals advocate cognitive behavior therapy, or CBT, instead of medication as a remedy for primary insomnia, or sleeplessness uncomplicated by any other factor, such as pain, apnea, or restless leg syndrome. A recent Norwegian study, reported in the Journal of the American Medical Association, indicates that CBT works better to help long-term insomniacs sleep well more often.
In effect, while sleep medications are a crutch, CBT teaches people how to sleep, says Susan Zafarlotfi, a sleep disorder specialist at Hackensack University Medical Center in New Jersey. “CBT will reset the cognition of a person regarding sleep,” she explains. “It will change their beliefs about why they can’t fall asleep, and it will get their sleep in tune with the circadian rhythm,” the daily biological rhythmic cycle.
In many cases, preconceived notions about sleep affect the ability to sleep. For example, people often wake up in the middle of the night, which actually may be a normal sleep pattern, but apprehension about falling back to sleep can keep them awake. Then, by worrying every night about waking up too early, they create a bad habit that prevents good sleep.
With CBT, says Zafarlotfi, patients are taught a variety of techniques that help them sleep better. For instance, they are taught to go to bed only when they are ready to fall asleep, not just because it’s a certain time. This prevents the agitation generated by the fear of being unable to fall asleep. They also must learn to get up at the same time every day. So, in the beginning of their CBT, even if they are not tired enough to head for bed until 1 a.m., they must still arise at their normal time. At first, they might be sleepier than ever during the day; eventually, however, they grow tired earlier in the evening and can then sleep longer.
Sleeping pills can be used to good effect, Zafarlotfi says, but only “in a very restricted format” and when used temporarily in conjunction with CBT. Eichling, who uses both approaches in his sleep counseling, believes such medicines can be “absolutely appropriate during times of stress or when traveling.”
CBT doesn’t work for people with a clinical sleep disorder, such as obstructive sleep apnea, in which the airway closes off, breathing stops for a short time, and the brain must rouse from sleep in order to start breathing again. Other methods are necessary for cases in which a physical problem disrupts or prevents sleep, and these problems can be diagnosed and treated at a sleep lab.
In the final analysis, though, the best sleep medicine might be “night and darkness, and learning to be receptive to, invite, and allow them into our lives,” says Naiman. “I think we need to find new ways of honoring night, and, of course, that means we need to be less productive at night.
Americans often seem willing to give up sleep in order to do something else because “many of them never thought [sleep] was important to begin with,” Breus says. At the same time, millions of people are desperate for a good night’s rest. In its 2005 “Sleep in America” poll, the National Sleep Foundation discovered that seventy-five percent of those surveyed reported experiencing, at least a few nights a week, one or more symptoms of a clinical sleep disorder, while fifty-four percent reported a symptom of insomnia.
Lack of adequate slumber, whether for a night or over a long period of time, creates sleep debt. This is “the burden we carry when we haven’t gotten as much sleep as our brains need,” explains Mary Carskadon, a professor of psychiatry and human behavior at Brown University and director of the Chronobiology and Sleep Research Laboratory at Bradley Hospital in Rhode Island. At this point, “it’s still a puzzle” as to how the brain knows it hasn’t had enough sleep, she says. “What’s the bean counter in the brain that tells us? Is it biochemical or molecular changes, or something in the neurotransmitters?”
While the consequences of long-term sleep debt have not yet been thoroughly researched, after a few days or weeks of poor sleep, Carskadon says, “there can be short-term irritability and depression. There’s growing evidence that cognitive skills decline. The speed at which we process information slows down, and vigilance—being able to attend to your environment—is hampered, too. This plays out in activities like driving—the biggest side of the picture is the risk of falling asleep and creating some tragic outcomes.”
Avoiding sleep debt is even more important for teens than for adults, according to Carskadon, who specializes in studying teen sleep patterns and advocates later starting times for high school. This can be difficult, since teens’ internal sleep clocks tend to shift toward later hours, keeping them awake far into the night, even though they must still get up early for school. “Learning is the main task of the teen years,” she says. “New circuits are being built in the brain then, and we don’t know how much brain development is compromised by lack of sleep.”
With the introduction of new sleeping pills, such as Lunesta, Ambien, and Rozerem, the debate about the efficacy and safety of pharmacological remedies for sleep disorders has reawakened. A growing number of medical professionals advocate cognitive behavior therapy, or CBT, instead of medication as a remedy for primary insomnia, or sleeplessness uncomplicated by any other factor, such as pain, apnea, or restless leg syndrome. A recent Norwegian study, reported in the Journal of the American Medical Association, indicates that CBT works better to help long-term insomniacs sleep well more often.
In effect, while sleep medications are a crutch, CBT teaches people how to sleep, says Susan Zafarlotfi, a sleep disorder specialist at Hackensack University Medical Center in New Jersey. “CBT will reset the cognition of a person regarding sleep,” she explains. “It will change their beliefs about why they can’t fall asleep, and it will get their sleep in tune with the circadian rhythm,” the daily biological rhythmic cycle.
In many cases, preconceived notions about sleep affect the ability to sleep. For example, people often wake up in the middle of the night, which actually may be a normal sleep pattern, but apprehension about falling back to sleep can keep them awake. Then, by worrying every night about waking up too early, they create a bad habit that prevents good sleep.
With CBT, says Zafarlotfi, patients are taught a variety of techniques that help them sleep better. For instance, they are taught to go to bed only when they are ready to fall asleep, not just because it’s a certain time. This prevents the agitation generated by the fear of being unable to fall asleep. They also must learn to get up at the same time every day. So, in the beginning of their CBT, even if they are not tired enough to head for bed until 1 a.m., they must still arise at their normal time. At first, they might be sleepier than ever during the day; eventually, however, they grow tired earlier in the evening and can then sleep longer.
Sleeping pills can be used to good effect, Zafarlotfi says, but only “in a very restricted format” and when used temporarily in conjunction with CBT. Eichling, who uses both approaches in his sleep counseling, believes such medicines can be “absolutely appropriate during times of stress or when traveling.”
CBT doesn’t work for people with a clinical sleep disorder, such as obstructive sleep apnea, in which the airway closes off, breathing stops for a short time, and the brain must rouse from sleep in order to start breathing again. Other methods are necessary for cases in which a physical problem disrupts or prevents sleep, and these problems can be diagnosed and treated at a sleep lab.
In the final analysis, though, the best sleep medicine might be “night and darkness, and learning to be receptive to, invite, and allow them into our lives,” says Naiman. “I think we need to find new ways of honoring night, and, of course, that means we need to be less productive at night.
