The Health Hazards of Sleepiness
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The Health Hazards of Sleepiness

Desperately seeking a good night's sleep? Stress is the No. 1 sleep thief, and women are the biggest sufferers. Here, help with all your sleep problems -- from bad beds to snoring husbands.

Sleepless in America

Dana Greenia's worries about her job have begun to invade her dreams -- that is, when she actually gets to sleep. On too many nights, the 43-year-old university administrator in Orange, California, spends hours staring at her bedroom ceiling, endlessly running over her lengthy mental to-do list, then dragging herself to work the next day after only about four hours of shut-eye. Her punishing schedule doesn't afford any lulls that would allow her to refuel. In addition to overseeing a 100-person academic department, she's the mother of two kids under 4, she commutes in rush-hour traffic for up to two hours a day, and she somehow squeezes in laundry, grocery shopping, and cooking.

"I'm exhausted all the time," Greenia says, "and there never seem to be enough hours in the day."

The former nurse limits her caffeine fix to two cups of coffee a day, but when she's beat, she recharges with a late-afternoon Frappuccino so she won't fall asleep at the wheel on her long drive home. "But then the caffeine will keep me going until after we've put the kids to bed," says Greenia, who hits the sack by 10 but is often up until 2 waiting for sleep. "Then the alarm goes off at 6," she says, "and it starts all over again."

Like many of us, Greenia is trapped in a self-perpetuating cycle of sleeplessness caused by the relentless stress of our 24-7 lives. Being sleep deprived makes us even more stressed because we're often unable to perform simple tasks competently, leaving us scrambling to catch up -- and worrying we won't be able to sleep the next night.

"Stress is the primary reason why people have difficulty sleeping -- it's the most powerful disrupter of sleep, even more so than caffeine," says Gregg D. Jacobs, PhD, a sleep expert at Harvard Medical School, in Boston, and author of Say Goodnight to Insomnia (Holt, 1999). Stress can turn us into chronic insomniacs, he adds, "because after days of sleeping poorly, we can become preoccupied with not sleeping," which can make sleep even harder to come by.

In fact, half of adult Americans say stress and worry keep them up at night, according to a 2004 Harris Interactive poll. Indeed, seven out of 10 adults get fewer than six hours of sleep most nights, when between seven and nine is considered optimal. But being terminally tired doesn't just sap your energy and make you dim-witted and ill-tempered. Shortchanging yourself of restful slumber may have serious health consequences. It also compromises safety by increasing the risk of industrial and automobile accidents.

"There's no substitute for getting a good night's sleep on a regular basis," says Carl E. Hunt, MD, director of the National Center on Sleep Disorders Research of the National Heart, Lung, and Blood Institute, in Bethesda, Maryland. "Sleep is just as important to our overall health and happiness as exercise and a nutritious diet."

Wired and Wide Awake

Women seem to have a harder time than men getting a good night's rest. In fact, almost two-thirds of women suffer from insomnia, according to the National Sleep Foundation, whether their trouble lies in not being able to fall sleep, waking up several times during the night, or rousing early and being unable to fall back to sleep. Part of the reason is that women suffer more from stress-related conditions that prevent sleep, such as migraines and tension headaches. As we get older, our bodies' chemical balance subtly shifts, too: We produce less estrogen, which normally lengthens the duration of restorative slow-wave and REM sleep. Levels of progesterone, a hormone that helps us fall asleep and stay asleep through the night, also drop, according to Joyce A. Walsleben, PhD, former director of the Sleep Disorders Center at New York University School of Medicine, in New York City. "Women also tend to ruminate more than men," she says. "All of these factors contribute to not getting enough sleep."


Even if we do manage to fall asleep when our heads hit the pillow, stress can prevent rest from being sufficiently restorative to make us feel refreshed and alert. Normally, levels of the stress hormone cortisol fluctuate throughout the day, rising in the early-morning hours to rouse us from our slumbers, and steadily increasing throughout the late morning and early afternoon before slowly dropping in the evening as our day winds down. But when we're stressed-out, cortisol levels remain high, says Dr. Hunt. The extra surge of cortisol -- that second wind that helps us power through our chores at home after a long workday -- disturbs our natural sleep cycle and prevents us from achieving the deep slow-wave sleep the body needs in order to be replenished. As a consequence, we wake up feeling like zombies, and the cycle starts all over again.

Many women have so many responsibilities that they sacrifice sleep to fit in all their daily tasks. For example, Sue Watts, a 45-year-old mother of two from Deep River, Connecticut, works part-time as a landscape architect. She leaves for work by 6:15 a.m. on Mondays and works 12 to 14 hours that day. The rest of the week she works mostly at night, sometimes until 1 a.m. This schedule frees up her days so she can pitch in with the reading groups at her daughter's second-grade class, ferry her kids to ballet, horseback riding lessons, and soccer, and do household chores. But she's lucky if she gets five to six hours of sleep a night.

"I run on too little sleep most of the time," says Watts, who attends aerobics classes five times a week for "their energizing boost." While her routine is admittedly draining, "being tired all the time is a small price to pay," she says. "I have all these things I want to do, and I can't see wasting time sleeping."

But shorting oneself of sleep is self-defeating, say experts, even for high-octane types like Watts. When we're tired, we're not as efficient. "The irony," says Dr. Hunt, "is that we can get just as much done -- perhaps even more -- when we're feeling refreshed and alert."

Sleep Deprivation and Health Problems

The mental toll of skimping on slumber can be serious. A 2002 survey by the National Sleep Foundation found that more than nine out of 10 people said that not getting enough sleep can erode their performance at work and increase the risk of injuries. Nearly two-thirds felt that lack of sleep can muddle their thinking, rendering it more difficult for them to make decisions and listen carefully, and making them more prone to mistakes and to flying off the handle when faced with routine annoyances. Even their mental outlook was dampened: Short sleepers were nearly three times as likely to feel angry as were those who got plenty of shut-eye.

Serious sleep deprivation can also cause uncontrollable sleep attacks -- dozing off for three or four seconds without even feeling the "microsleep" coming on, according to Hans Van Dongen, PhD, a sleep researcher at the Pennsylvania University School of Medicine, in Philadelphia.

"You will wake up almost immediately, which isn't such a problem if you're at home or sitting at your desk," he says. "But if you're behind the wheel, it can be deadly."

Sleep experts feel this is as important to be aware of as not driving drunk, a comparison that a 2000 Australian study bears out. Researchers looked at people who were awake for up to 20 hours straight and found that some scored worse on tests of their reaction time than those with a blood alcohol concentration of 0.1 percent, which is considered legally drunk in every U.S. state. And like drunk drivers, the sleep deprived are a real on-the-road menace. Each year they're responsible for more than 56,000 car crashes, resulting in 40,000 injuries and 1,550 fatalities, according to the National Highway Traffic Safety Administration. Indeed, 12 percent of women admit to having dozed off at the wheel, according to a 2002 National Sleep Foundation survey.

Lack of sleep can be hazardous in other ways, too. It may throw off the body's production of cytokines, immune molecules that help you fight infections, says Dr. Walsleben. And white blood cells called natural killer cells, which attack tumors and viruses, have been found to decrease with sleep deprivation, says Jean K. Matheson, MD, a neurologist and medical director of the Sleep Disorders Center at Beth Israel Deaconess Medical Center, in Boston.


Moreover, a 2003 Harvard study showed that women who slept for five hours or less a night were 45 percent more likely to develop heart disease than women who slept eight hours. One reason too little sleep may tax the heart, doctors believe, is by spiking levels of the stress hormone cortisol, which can elevate blood pressure.

Severe sleep deprivation may even set you up for diabetes and becoming overweight, according to a 1999 University of Chicago study. During the 16-day experiment, 11 healthy young men were in bed eight hours per night at first, then four hours the second week and 12 hours the third week. In the week they were sleep deprived, their sympathetic nervous systems became more active, which prevented their pancreases from producing enough insulin, the hormone the body requires to turn sugar into fuel.

In other words, too little sleep for just one week put the test subjects into a pre-diabetic state. Researchers also noticed that volunteers experienced a 20-percent drop in leptin, a hormone that signals feelings of fullness. This drop can trigger cravings for fat and complex carbs, which may contribute to weight gain.

"We still don't know for sure," says Dr. Walsleben, "but lack of sleep may be a risk factor for insulin resistance, which can lead to diabetes, high blood pressure, and obesity."

The best way to stave off these risks is by making changes to be sure that you get enough shut-eye. "We need to make sleep a priority," says Dr. Hunt. "As we ratchet down from seven to six to five hours of sleep a night, studies consistently show that we're paying a heavy price." And while occasional bouts of insomnia are normal, if sleep problems persist for more than a month, say experts, you should see your doctor for help.


Originally published in Ladies' Home Journal magazine, October 2004.