In Your Dreams
Why a good night's sleep is so elusive
Photoillustration of Terry Bell by Timothy Hughes.
It is dark outside when Terry Bell arrives at work. Even in the summer when days are their longest, the Wisconsin Public Radio Morning Edition host is on air before sunrise.
Out of bed by 4 a.m. and at his desk by 4:30, Bell isn’t alone. Bell’s voice is broadcast across the state before the crack of dawn because others are awake, too. After all, hospitals never close. Police departments operate all night. Truck drivers, factory workers, airline pilots—they’re all up when the sun is down. It’s simply a fact of life, especially in America, where even gas stations and grocery stores are open 24/7. There is little that cannot be done or bought at any hour of the day.
All this adds up to a country on overdrive, and research backs it up.
The National Sleep Foundation’s Sleep in America polls show that we are getting less and less sleep all the time. Centers for Disease Control and Prevention studies also have identified this gradual erosion of shut-eye. While pre-industrialization Americans slept closer to nine hours per night, more than forty percent of us today clock fewer than eight hours. When asked about it in surveys, many of us report that we are not well rested. Centers for Disease Control data suggest that between twenty-two and twenty-eight percent of Wisconsinites admit to getting insufficient sleep for fourteen or more days per month.
For many, seven hours of sleep per night sounds like a dream come true. New parents couldn’t put a price tag on that much. Medical residents can’t remember what it even feels like. And a lot of the rest of us feel pulled in so many directions that we’re tired, too, because sleep is the only thing on our unrelenting to-do list that seems to give.
There’s also peer pressure to blame. Inadequate rest becomes the norm, and anyone who gets more seems lazy and self-indulgent. The most industrious of us soldier on bleary eyed in the name of families, careers and communities. It’s presented as responsibility, discipline and devotion. At times it hints at sacrifice or even superiority. There’s the subtle subtext we read in it: We could have it all, too, if we didn’t waste so much time sleeping.
But sleep is far from idle or nonproductive, says Ruth Benca, a psychiatrist by training and director of Wisconsin Sleep, a translational research partnership between the University of Wisconsin Medical Foundation and Meriter Hospital. Part clinic and part lab, Wisconsin Sleep treats patients with sleep disorders and conducts research on all facets of sleep. “We don’t actually understand the function of sleep,” she says, “but the brain is not simply shut off.”
Benca says scientists do know that the body goes through a process during sleep, and that process likely repairs and replenishes the body in a variety of ways and at myriad levels. Inadequate sleep shortchanges that process, which can lead to adverse health consequences such as heart disease and stroke.
On a more immediate level, our bodies just don’t function well when they’re tired. That much we all know well. After about sixteen hours of being awake, reaction times and irritability increase, and we start to make mistakes. We fight to keep our eyes open. “We do know that the brain can only stay awake so long before it starts to decompensate,” Benca says.
So despite what we tell ourselves, a full night of sleep is not a luxury; it’s a necessity. Our bodies don’t just want it; they need it.
And just how much sleep is enough? Eight hours tends to be the gold standard tossed around by experts, although many of us think we need far less. The truth, says Dean sleep specialist Dr. Kathryn Middleton, is that seven hours usually doesn’t cut it. Six certainly won’t. The vast majority of us need right around eight solid hours of sleep per night.
“It is a pretty steep bell-shaped curve,” Middleton says, “and you’re not going to vary much.”
What’s more, our sleep needs are immutable. We can train ourselves to run marathons—or even run marathons after swimming and biking ungodly distances in the heat or rain—but we cannot train our bodies to function optimally on insufficient sleep any more than we can train our bodies to function optimally on diets of Snickers bars, beer and bacon. It is simply impossible. “You are predestined,” Middleton says. “There’s no way to move, and you’re pretty consistent over your lifetime.”
That’s a hard truth to swallow for those of us who can accomplish just about anything we set our minds to. Of course we can sleep less than eight hours and be just fine. We do it all the time.
Well, part of that is true. You can regularly sleep less than eight hours. Where the experts quibble is with the feeling fine part. Benca says that while we can grow accustomed to feeling tired, we simply cannot acclimate our bodies to operate at their best on an abbreviated sleep schedule. The long-term health risks will still mount, and we will still suffer the immediate effects of inadequate sleep whether we realize it or not.
Sleep deprivation is sneaky that way, Benca says, because it affects our judgment. “People who are chronically sleep-deprived start to become less aware of their sleepiness,” she says. “Perception plateaus. They think they’re doing okay because they get used to that state of existence.”
Since people can get used to feeling tired, Middleton says it is hard to convince them to sleep more. They think that feeling tired is just part of being a responsible adult.
But some of the newer research on the long-term consequences of sleep deprivation is more compelling. Middleton says recent studies suggest that inadequate sleep can increase the risk of hypertension and stroke in normal-weight, otherwise healthy people who don’t report feeling tired or don’t display any outward symptoms of sleep deprivation. It turns out that shortened sleep duration—less than six hours per night—in itself is enough to increase risk even if no other risk factors are present.
“That’s huge and scary,” she says, but not altogether surprising. “There’s no coincidence … [Sleep] is such the essence of all creatures. From an evolutionary standpoint, what would be the advantage of having this if it weren’t essential? It’s got to be essential. Otherwise we wouldn’t be doing it.”
That doesn’t stop us from trying. Dr. Aaron Henkel, a naturopath with Family Clinic of Natural Medicine, says he had a patient call after falling asleep on a riding lawnmower. He wanted strategies to train his body to need less sleep so that he could get more done. “You can’t,” Henkel says emphatically. Like Middleton, he struggles with convincing his patients that they are going at their fatigue from the wrong angle. “The goal is not to learn how to get less sleep. It’s how to get more.”
Benca says chronic sleep deprivation is far more widespread than we realize. It’s certainly endemic to certain industries, such as transportation and even medicine, but it is not limited to shift workers.
Since perception is an unreliable measure, Benca offers a few more objective ways to determine whether you might be shortchanging your sleep: “If you need an alarm clock to wake up in the morning, you’re probably not getting enough sleep. If you sleep in significantly longer on days when you’re not going to work or school, you’re probably not getting enough sleep. If you fall asleep doing low-stimulus activities, you’re probably not getting enough sleep,” she says.
But who hasn’t fallen asleep watching TV? Who can wake up at 4:45 without an alarm clock? Perhaps what is most alarming about these measures is how familiar they are. “It’s hard to get a reliable estimate [of sleep deprivation],” Benca says, “but we know it’s very widespread.”
And it’s getting worse. The National Sleep Foundation’s 2005 Sleep in America poll found that the percentage of Americans who get eight hours of sleep per night fell from thirty-eight percent in 2001 to just twenty-six percent in 2005.
What’s more, that lack of sleep accumulates, and individuals who routinely restrict their sleep to six hours or less actually grow more impaired over time. So you function worse in week five than you did in week four, even if your amount of sleep remains constant over that period.
It’s the concept of sleep debt: The lost sleep adds up and the burden gets heavier as you go. Eventually the body demands that you catch up. If you don’t carve out time on your own, your body will snatch minutes back in microsleeps, or brief periods when you nod off while doing low-stimulus activities such as watching TV, reading a report at work or driving on rural roads.
Other times carrying a heavy sleep debt can lead to insomnia. This is just one of the body’s ironies: to be so tired that you can’t sleep.
It seems counterintuitive, but there are a variety of ways it can happen. For example, if you are overly tired, you might rely heavily on caffeine to stay awake during the afternoon or evening. But then at bedtime, the caffeine can delay or disrupt your sleep, even if you feel very tired. If you self-medicate with alcohol to fall asleep, you could further exacerbate the problem because it, too, interferes with sleep quality. You’re still getting a mere six hours of sleep, and now those inadequate six hours are also less fruitful than they used to be. You’re even more tired than before.
It’s enough to keep you up at night—and for some of us, it does. We know we need to sleep, and we start to worry about all the deleterious consequences we will face if we don’t get enough. “If you put a lot of pressure on yourself, it’s usually going to make things worse,” says Dr. Meredith Rumble, a clinical psychologist and director of the behavioral sleep medicine program at the UW Center for Sleep Medicine and Research.
Rumble sees it in patients all the time, and it is one of the things that gives her pause about articles like this one. She doesn’t want to alarm her patients into that proverbial vicious cycle in which they simply can’t get the sleep they need to feel refreshed, no matter how tired they are or how hard they try.
Middleton says insomnia in people who overly restrict their sleep is not uncommon, and yet many of her patients fail to recognize the role their abbreviated sleep schedules play.
She says the very early risers—the people like WPR’s Terry Bell—often fall into this camp. They think they have acclimated to less sleep or that they get more sleep than they really do. They cope for a while but then something stressful happens and they have trouble falling asleep. Or they get busy and start pushing back the bedtime in small increments. Then they turn to caffeine or alcohol. The next thing they know, they’re feeling tired all day and come looking for some other factor, some kind of ailment, that is causing them fatigue.
“A lot of these people have extremely early wakeup times. These are people getting up at 4 or 4:30, and it’s very hard to get to sleep as early as you should for the very early wakeup times,” Middleton says. “They’re the ones that say, ‘I’ve been doing this forever and that can’t be what it is,’ but basically it has caught up with them and it is what it is.”
It sounds very familiar to Bell. A journalist, he has heard all about the risks of his schedule, and they do concern him. But he loves his work. “This is by far the best job I’ve ever had,” he says, despite the schedule.
He is rather vigilant about his 8:30 bedtime during the week, yet he admits that it can be hard to fall asleep even when he goes to bed on time, and sometimes he lets his social life interfere with his sleep schedule. Still, he knows that the science isn’t on his side. “I do foresee the day when I have a more traditional schedule,” he says. “It’s probably not too healthy to keep these hours indefinitely.”
Middleton says it is imperative to make sleep a priority. When patients do that, she adds, a lot of the stresses that keep them awake or compel them to work harder or do more might magically melt away. While they might not have more hours in the day, the hours they have will be more productive. They will make fewer mistakes that they have to spend time correcting. They will have more patience for their spouses, their coworkers and their kids. They will feel better and want to make better choices about diet and exercise.
Because just as bad sleep can harm virtually every aspect of our lives, good sleep can profoundly improve our health, our work, our relationships and more—even for the chronically sleep-deprived people who have yet to realize how tired they really are.
“Everything is going to be so much better,” Middleton says, “if you just get more sleep.”
Jennifer Garrett is a Madison-based freelance writer. She blogs about wellness in Health Kick.