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Why can't we sleep?

Knight Ridder/Tribune Business News


March 11--Why are 70 million Americans having trouble getting a good night's sleep? Let us count the ways:

We are over-caffeinated (coffee, soft drinks, energy drinks, snacks) and over-medicated (prescription and over-the-counter drugs, including alcohol), wreaking havoc with slumber patterns.

We are over-wired (video games, Web browsing, social media, texting) and overstressed (money, work, relationships, overloaded schedules), making us too restless to doze off when we should.

We are overworked (longer hours, night shifts incompatible with our biological clocks) and overweight (perhaps a chicken-or-egg deal, as different studies have found that one leads to the other).

And then there's societal pressure, what nationally recognized sleep expert Dr. Mark Mahowald calls "the pervasive, erroneous attitude that sleep is not a biological imperative, that it is negotiable. We have raised sleep deprivation to a badge of honor."

The effects might outnumber the causes, and are hardly as benign as many of us might think. "Any degree of sleep deprivation will impair performance: behind the wheel, in the classroom or workplace," Mahowald said.

He added that the Bhopal, Challenger, Exxon Valdez and Three Mile Island disasters "all are officially attributed to problems from sleep deprivation. But the biggest risk of sleep deprivation is car crashes, period."

No wonder the number of accredited sleep centers has risen nationwide by 630 percent in just 15 years. And while sleep study results have been all over the map and sometimes contradictory, experts such as local doctors Mahowald and Michael Schmitz know a lot more than researchers did even a decade ago.

The lowdown

--Insomnia victims have trouble falling or staying asleep in a setting with adequate conditions for sleep; this becomes chronic insomnia if it lasts more than three weeks. Sleep deprivation is caused by behavioral or situational factors that curtail or mitigate the ability to get enough sleep time.

--Most adults need seven to nine hours of sleep a night. The amount a person needs is genetically determined, Mahowald said. "Some people might need four hours on the short end, up to 10 on the high end. We have absolutely no control over this."

--Anyone who uses an alarm clock "is by definition sleep-deprived," Mahowald said, "because if the brain had received the amount of sleep it wanted, you would have woken up before the alarm went off."

--Melatonin is a hormone, secreted daily by the brain's pineal gland, that helps maintain the body's sleeping cycle. A nonprescription synthetic melatonin pill is sold in the United States and is widely used. The FDA does not test or regulate melatonin because it doesn't consider it a drug.

--Larks and owls: "Some people are early to bed, early to rise; others late to bed, late to rise. We have very little control over that," Mahowald said. "So you see a lot of problems when an owl marries a lark and each one thinks the other is being stubborn."


--With sleep deprivation, some glucose metabolism problems might predispose one to diabetes. And if so, a consequence could be heart disease and stroke.

--With insomnia, there is no evidence of long-term physical problems or links to other diseases. But insomnia results in poorer quality of life and work absences and can lead to depression.

--There is some evidence that severe sleep apnea can lead to hypertension, heart problems and a higher risk of strokes.


--Improving sleep hygiene -- avoiding late eating and drinking, keeping the room cool and dark, winding down before bedtime -- can improve or resolve transient or acute insomnia but probably not chronic insomnia.

--For chronic insomnia, cognitive behavioral therapy is equally as or more effective than medications. Medication often is useful for acute insomnia.

--Naps can help -- except when they don't. "We discourage napping when anyone has problems falling or staying asleep at night, which might be an untreated sleep disorder," said behavioral sleep specialist Schmitz. "We encourage power naps, 30 minutes or less, when folks can't stay awake or will have late-night events."

--See your doctor if: You have had difficulty falling and staying asleep for more than a week. Or if you snore, have frequent awakenings and are reporting sleepiness during the day. Anyone with apnea symptoms should seek treatment.


One third of Americans suffer from insomnia at some point in their lives.

14 to 15 hours of sleep a night is recommended by the Mayo Clinic for infants, 12 to 14 hours for toddlers and 10 to 11 for school-age children.

84 classifications of sleep disorders have been found.

2,365 U.S. sleep centers are accredited by the American Academy of Sleep Medicine. In 1997, there were 374; in 2006, there were 1,000.

2 million U.S. children suffer from sleep disorders.

18 million Americans probably suffer from sleep apnea, with more than half of them ndiagnosed.

$15.9 billion is added to national health care costs by sleep problems, according to the National Commission on Sleep Disorders.


(c)2012 the Star Tribune (Minneapolis)

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