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Tom W. Shinder M.D.

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Asleep On Your Feet?

As children, most of us were told that it was important for us to get a "good night's sleep." When we grow up, many of us turn our backs on childhood "rules." We no longer eat our broccoli; we stop looking both ways before we cross the street -- and we think we no longer need (or have time for) the prescribed eight hours of rest and revitalization.

Recent national news articles have proclaimed in headlines that women, especially, aren't getting enough sleep. This is hardly news to the many moms, wives and career women who feel lucky to catch a quick five hours of shut-eye each night.

In our fast-paced world, there just doesn't seem to be enough time in the day to get it all done. And given the choice between letting go of some obligations or shorting ourselves on much-needed rest and regeneration, too often we choose the latter.

But what are we doing to our physical and mental health in the process? Many doctors believe that some of the most common chronic illnesses which are prevalent today are either caused by or exacerbated by lack of restful sleep. Studies of fibromyalgia patients, for instance, show that most have disturbed sleep patterns. Although it might be argued that this is a result of the disease rather than a cause, many normally healthy individuals exhibit symptoms common to fibromyalgia after several days of subsisting on only a few hours of sleep per night. And of course, most of us are familiar with research experiments which have induced full- blown temporary psychosis, along with a myriad of physical complaints, in subjects who are completely deprived of sleep for long periods of time.

Normally, we would spend from 20 to 50 percent of our lives asleep. Have you ever thought about why we "waste" so much time in what objectively might appear to be an entirely unproductive behavior? Well, appearances can be deceiving.

During sleep our bodies are really quite busy. Most active digestion takes place during sleep. The stomach and intestinal tract are at their busiest during sleep. The brain has the opportunity to redirect its energies to the rebuilding of a normal neurochemical balance after a long day. Body temperature and heart rate drop, indicating sort of an "idle" mode, intended to recover from the activities of the day. Growth hormone is released during sleep, which is important in the restoration and repair of damaged cells.

It's common knowledge in medical circles that women, more often than men, suffer from insomnia. The demands of raising a family often cut into a woman's precious sleep time. The lifestyles of busy professionals interfere with the ability to get the amount of sleep a person requires. And pregnancy, menstruation, and menopause seem to disrupt sleep patterns, as well. It's probably safe to say that few women today are getting as much sleep as they really need.

But how much sleep DO you need? There is no hard and fast rule regarding what is the "right" amount of sleep, and the range of normal sleep varies. Generally, anywhere between five to nine hours would be considered within the normal range. Problems occur when stressed and busy people try to "get by" with less than their minimal required amount of sleep.

How do you know if you've had enough sleep? Many people living harried lifestyles take pride in the small amount of sleep they get. "Sleep? I do fine with three hours a night!" Some feel that they must forego sleep in order to keep up -- but find themselves falling behind as a result of depriving their bodies of this essential component of good health. The symptoms of sleep deprivation are insidious, sneaking up on its victims without their ever knowing -- until it's too late.

In the short term, when you experience a stint of inadequate sleep for three to seven days, you'll probably notice increased irritability with a decreased threshold for frustration. You may experience a feeling of jitteriness and increased impulsiveness. These symptoms can be subtle, though, and the sufferer may not recognize them and may even believe, when someone points out the changes in their behavior, that the other person is misguided or overreacting.

These are the early signals, and unfortunately, most people in high stress situations find it easy to ignore them. Of course you're irritable and high strung --- you've got a lot to do.

If these early signals are ignored, the next stage of symptoms come to fore. Should you go without enough sleep for a period of two to four weeks, you might notice that you can't seem to concentrate as easily as usual. Memory problems, such as remembering names, dates, and places that would otherwise be easy for you, suddenly become a challenge. The subtle irritability and impulsivity worsen. Observers might even consider the person's behavior different or "bizarre". There is sometimes a sense of exhausted euphoria that goes along with this stage. Some people manifest feelings and behaviors similar to the manic phase of bipolar disorder. It is during this stage that friends and family might suspect drug or substance abuse. When confronted, the sleep deprived person reacts with astonished anger, wondering how someone could possibly think such a thing, especially when she has "never felt better" in her life.

More prolonged periods of inadequate sleep, or shorter periods with little or no sleep, can lead to behavior consistent with psychosis. Individuals will have both visual and auditory hallucinations. In addition to the hallucinations, they may experience illusions, which are misperceptions of what is actually there. Paranoid patterns of thinking are common. Self control and self awareness is at a minimum, and the person will burst out with the first thing which comes to mind, regardless of the implications of things said. The person's actions are similarly impulsive, much like those of someone with frontal lobe brain injury.

In addition to the mental effects of sleep loss are the physical consequences. Weight loss is common, fueling the speculation over whether the person has been using illegal stimulant drugs. Along with the weight loss comes depression of the immune system, and the formerly healthy person now seems more susceptible to colds, headache, muscle aches, and arthritic type symptoms.

Luckily, the effects are temporary, and usually disappear readily once a person returns to normal sleeping habits. But why such dire consequences of the lack of sleep? Why do we need sleep, anyway? To answer those questions, let's look at what happens when we sleep.

There are five recognized phases of sleep, number one through four, with the fifth one called "REM". The first three stages would be considered mild to moderate sleep. The fourth level, or stage four sleep is also known as "Deep Sleep". It is during this time that most of the restorative functions of sleep take place. From the strengthening of the immune system, to the repair of damaged cells and growth of new cells, these vital body functions are bolstered during stage four sleep. That's why lack of sleep results in weakening of our overall physical condition.

But the more immediate effects of sleep deprivation are mental. This is where the absence of REM (rapid eye movement) sleep comes in. When a person is in REM sleep you can see his eyes moving back and forth under the eyelids. The person is completely paralyzed and limp during this phase of sleep. (the phenomenon of "sleep paralysis" refers to when a person suddenly is awakened out of REM sleep and is aware of a momentary paralysis).

Many studies by sleep researchers have shown that if a person is allowed to sleep normally until REM sleep, and then is wakened every time he starts to go into REM sleep, within just a few days he will exhibit the early symptoms of psychosis, with attendant hallucinations, illusions, delusions, and paranoia. Is it any wonder those who are lacking sleep seem a little "cranky," or even a bit "crazy?"

Now, what can you do to avoid falling down the slippery slope of sleep deprivation?

First, take a look at some of your lifestyle factors that lead to the inability to sleep. Do you drink caffeinated beverages within four to five hours of your bedtime? If so, stop. Even small amounts of caffeine hours before bedtime can disrupt the normal stages of sleep.

Many over the counter drugs contain caffeine or other stimulant substances such as ephedrine, pseudoephedrine, and phenylpropanolamine. Nose drops and other medications which use the words "decongestant" almost always contain stimulant type substances. Avoid these if at all possible.

Avoid alcohol prior to bedtime. This might seem to be a paradox because alcohol leads to an initial sleep induced state. However, the sleep you get afterwards is not normal because there is a decrease in the amount of both stage four and REM sleep after drinking alcoholic beverages. Also be mindful of any medications which contain alcohol. Check those labels!

Protect your sleep! Many women today hold down full time jobs and then come home to another, having to fulfill the roles of mother, wife, house- keeper, laundress, cook, et al afterhours. Some of you work night shifts -- or worse -- rotating shifts, as nurses or doctors, police officers or dispatchers, or in other 24-hour service occupations. How can a person like you, whose duties require the sharpness and alertness that come with proper rest, get the sleep you need when all these obstacles stand in the way?

You must protect your sleep periods from intrusion. Take the phone off the hook. Place yourself in an environment which is completely dark, whether or not it's nighttime. Try to go to bed, and wake up at the same time each day, regardless of whether you have to work or not.

Perhaps the biggest enemy in the war against sleep disorders is the weekend. People, often sleep deprived during the course of the week, or even if not sleep deprived, will sleep much longer than they need to on the weekend either with the thought that they will "catch up", or that they just don't have to get up, so why should they? Avoid this behavior if at all possible, else you'll never break out of the sleep disturbance trap. Sleeping late on Sunday morning inevitably leads to tossing and turning and the inability to get to sleep on time Sunday night -- which sets you up for another work week "hung over" from lack of sleep.

Insomnia is the most common, but not the only problem related to sleep. Two unusual sleep disturbances are somnambulism (sleep walking) and narcolepsy. The neurological aspects of sleep walking are not well understood, but are believed to represent a problem with the "paralysis" controls during REM sleep. The function of the paralysis during REM sleep is that it prevents you from acting out physically those events you experience during your dreams. Those who sleep walk are not subject to this inhibition, and therefore do to some extent act on those events. This behavior typically is seen during childhood, and usually fades away as the brain matures during adulthood.

Narcolepsy is a rare disorder. Actually, narcolepsy should be considered a disorder of wakefulness, rather than a sleep disorder. People who suffer from true narcolepsy can be speaking normally one moment, and then suddenly, and without warning, fall asleep. Then after a few moments to hours, they wake again (these episodes are known as "sleep attacks"). However, to fulfill the diagnosis of narcolepsy, the person must also have episodes of paralysis during periods of strong emotion (laughing or crying), and experience paralysis and hallucinations during the onset of sleep. Narcolepsy can be treated with medication, so if you have these symptoms, see a doctor. Most of the time, however, falling asleep during the day indicates not disease, but deprivation of the sleep you should be getting at night.

So, you thought sleep was a simple matter? Hopefully, I've helped you appreciate that your sleeping life is as important as your waking life and you should take good care that you get the quantity and quality of sleep you need. Women are learning to stand up for their rights in other areas of their lives -- it's important that they learn to also insist on the right to a good night's sleep.

by Tom W. Shinder M.D.

Thomas W. Shinder, M.D., M.C.P. is a neurologist-turned-computer systems engineer who practiced medicine in Texas, Oregon and Arkansas before moving to his present home in the Dallas-Fort Worth, Texas metropolitan area.

E-mail Tom at:

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