Sleep


While some sleep disturbances may be linked to biological changes associated with aging or certain physical diseases, especially those that cause pain, others may be associated with a mental health disorder such as depression or anxiety. Poor sleep may also stem from "bad" habits such as napping too long or too late in the day, or doing shift work. When you're pushed for time, as many people are, the first thing that usually goes is sleep. However, when you sacrifice hours this way, you frequently end up paying for it in terms of decreased productivity and an increased risk for errors in judgment and accidents.

Lack of sleep and its link to accidents--automobile and on-the-job--now appears to be a problem of far greater magnitude than previously believed. Fatigue leads to diminished mental alertness and concentration. Shift workers are especially prone to this problem. Their biological clock is ticking at the wrong time, and they typically drive home after work when they're extremely tired. Young males under 25 also have a disproportionate number of auto accidents related to sleepiness.

What about napping? In some countries, a siesta or short daytime rest is a respected, time-honored daily ritual. With older people in particular, napping is a good practice. Because their sleep is fragmented and they get less of it at night, they typically make up for it with naps during the day. Napping works; it can increase productivity and help restore your ability to think.

What about waking up too early, like before the birds' first chirp? While such "early morning awakenings" may be a sign of depression or other treatable emotional disorder, the passage of time may be the culprit. As you age, your biological clock ticks at a slightly different rate. Because of this, you run into people with an advanced sleep syndrome--they go to bed early and then wake up too early. In some cases, going to bed a bit later may help reset your biological clock and allow you to sleep later.

What problems does lack of sleep cause?

• Road accidents and work injuries - fatigue is the number one preventable factor in these accidents.
• Stress and depression - many people who feel chronically stressed blame their workload - yet the real problem may be lack of sleep.
• Heavy snoring and breathing difficulty in sleep may increase the risk of high blood pressure, stroke and heart disease.

How do you know you're not getting enough sleep?
Common symptoms are:

• Irritability
• waking up unrefreshed
• problems with short term memory and concentration
• heavy snoring with choking episodes.

When can sleep problems be a sign of depression?
Sometimes people who are depressed may fall asleep easily, then wake up in the early hours of the morning, unable to fall asleep again. On the other hand, some people with depression may spend a lot of time sleeping. Consult a doctor if you have one of these sleeping patterns, together with symptoms of depression such as:

• feeling very sad
• crying a lot
• difficulty with concentration or memory
• thinking about ending it all (i.e. suicide).

How can you improve sleep?

• Keep lights low before bedtime. To feel sleepy your brain needs to produce a chemical called melatonin, a natural sedative. But being in a brightly lit room or in front of the computer makes it harder for your brain to produce melatonin, and this delays the drowsy feeling that helps you sleep.
• Try to get up at the same time each day. Sleeping in can make it harder to get to sleep at night. You should expose yourself to bright light as soon as you get up to 'reset' your 'body clock'.
• Avoid things that keep you awake including coffee, tea and cola drinks (they contain caffeine), and nicotine. Nicotine, like caffeine, is a stimulant.
• Be wary of alcohol. Although it can make you relax and fall asleep, the relaxed feeling wears off, making you wake up in the early hours of the morning, feeling alert. Alcohol can also cause snoring which can disturb your sleep and that of others.
• If you're doing work at home, allow one hour to unwind. A hot bath or shower helps you to relax. Follow the same bedtime routine, such as having a warm drink or a light snack, reading or listening to music: let your body know you're getting ready to sleep.
• Don't watch TV or read in bed. Although these things help some people sleep, they can also give your brain the idea that bed isn't just for sleeping - and this can keep you awake.
  l If you can't sleep, get up, go into another room and do something relaxing until you feel sleepy. This is another way of 'training' your brain to associate bed with sleep.

Should you take sleeping pills?
Sleeping pills prescribed by a doctor are okay occasionally - to help you sleep during a crisis, for instance, or help break a cycle of sleeplessness. However, because they have side effects and can reinforce poor sleeping patterns, sleeping pills are not good in the long term. When you stop taking sleeping pills it may be harder to fall asleep for 2 or 3 nights, but don't worry; your body will let you get the sleep you need.

If you have a problem with sleep, see your doctor.

For more information on managing your sleep and shift work, check out Circadian.

Information adapted from A Good Night's Sleep? Merely a Dream for Millions
by Jan Ehrman (http://www.nih.gov/news/WordonHealth/jun98/story02.htm)

Reprinted with kind permission of American National Library of Medicine
August 2001