Originally published in Body Sense magazine, Spring/Summer 2005.
Copyright 2005. Associated Bodywork and Massage Professionals. All rights reserved.
For the most part, we are a sleep-deprived nation. We rush through weekdays, operating on too little sleep and crash on weekends in an attempt to recover. And even for those of us clocking the requisite hours, sleep may be interrupted for a variety of reasons. According to Ralph Pascualy, M.D., medical director of the Swedish Sleep Medicine Institute (SSMI) in Seattle, Wash., both the quantity and quality of our sleep directly affect our health.
While nutrition and exercise have been considered the foundation of health, Pascualy says, "Research is showing that sleep has to be the third leg of that three-legged stool. Sleep seems to affect health through several channels. If you are sleeping less than eight hours per night, you have chronic sleep debt, and it cannot be paid by catching up on the weekend."
The consequences of sleep deprivation include irritability, problems with concentration, and fatigue, Pascualy says. Learning -- the ability to retain and consolidate long-term memory -- is affected along with metabolism. "Sleep that is disturbed and broken may appear to be long enough, but poor quality will prevent sleep from completing its biological task. So it looks like disordered sleep can affect the way insulin works in the body and can further affect body weight."
Why is this? Experts don't have all the answers, but research has identified two distinct types of sleep that alternate in a four-stage cycle repeated throughout the night. Rapid eye movement (REM) sleep, the more active phase we associate with vivid dreams, becomes progressively longer as the cycles repeat. Interrupted or inadequate length of sleep interfere with the continuity of the cycles, resulting in deprivation of REM sleep. For reasons as yet unknown, REM sleep is vitally important to our bodies and may play a key role in processing emotions.
Equally essential is the quality of non-REM sleep, the more quiet stage some say is related to body repair and restoration. But the key point, Pascualy says, is the refreshening effect on brain chemistry. The brain seems to require sleep more than any other organ. "We also know for sure that growth hormone is secreted during stages three and four of sleep." As for emotional benefits, he says researchers aren't entirely sure how the structure of sleep affects them, "but sleep loss results in irritability and overexaggerated stress response. People in this state are at risk of negative cardiovascular outcomes."
Minor sleep disturbances -- the occasional insomnia or restless night -- are inconvenient to say the least. But more chronic and severe disorders, such as sleep apnea, sleepwalking, and narcolepsy, can put health, and even life, at risk. An estimated 30 million Americans suffer from sleep apnea, a condition heavily associated with snoring, in which breathing is blocked and completely stops. While the majority of cases occur in men, Pascualy says there has been a rise in identification of sleep-related breathing problems in several groups previously undiagnosed, such as children and post-menopausal women.
With the growth of sleep research and availability of specialty sleep centers throughout the country, disorders like sleep apnea can be successfully evaluated and treated. SSMI, one the country's premier sleep centers, offers a multidisciplinary approach to patients, combining a team of physicians, respiratory therapists, and other sleep specialists with high-tech equipment. As in most centers, evaluation may include an overnight stay at the sleep laboratory. With an accurate diagnosis in hand, treatment is pinpointed specifically to the patient's needs and the problem is resolved.
But, according to Pascualy, many physicians are dropping the ball, either by not asking patients about their sleep health or simply prescribing drugs in lieu of a thorough evaluation. Similarly, people who are unable to sleep or are tired may not bring it to the doctor's attention, tending instead to self-diagnose by attributing their problems to stress or other factors. "There should be a diagnosis and evaluation," he emphasizes. A Good Night's Sleep
Pascualy says the two most important contributions to a good night's sleep are maintaining a consistent sleep schedule and preparing properly for bedtime.
Go to sleep and rise at the same time every day of the week. "You should sleep eight hours and be done with it," he says. Oversleeping on weekends throws your body rhythm off, making it more difficult to get back into a routine Sunday night, and does not improve your function or help you recover from sleep debt. Allow yourself time for winding down in the evening so that when you hit the pillow, your body is not in a hyperactive state.
To enhance relaxation, avoid coffee or other stimulants close to bedtime. Even alcohol can disrupt sleep patterns and, along with food, should not be consumed within a few hours of your scheduled bedtime. Whatever calms your mind -- a hot soak in the tub, quiet music, meditation -- can serve to prepare your body for sleep. The important thing is that you establish a routine and stick to it. Using techniques that reduce anxiety and stress will facilitate your success.
While alternative therapies should not be considered stand-alone treatment for sleep disorders, some (e.g., receiving regular massage and bodywork) can be appropriate complements to a good sleep routine. SSMI's team includes a wellness coordinator trained in meditation and relaxation techniques. Pascualy points out the importance of hands-on education for patients, rather than referring them to reading materials.
"One place where all of those practices play a great role is in good sleep hygiene -- good preparation for sleep, where you quiet your mind," he says. As part of a comprehensive plan, all contribute to maintaining a healthful lifestyle.
Whether you're sleepless in Seattle, Dallas, or New York, there is hope. You may need nothing more than a few changes in your sleep routine to wake up refreshed each morning. But if chronic sleep problems plague you, affecting your health and happiness, a thorough evaluation at a sleep center is long overdue. You could be losing more than just sleep. Shirley Vanderbilt is a staff writer for Body Sense magazine.