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Millions Ticked Off by Body Clock : A Good Night’s Sleep Has Become a National Nightmare

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The Washington Post

When the alarm starts clanging at 7 a.m., do you want to drop-kick the little time machine into the next century? Round about mid-afternoon, do you sit droopy-eyed at your desk, slurping another coffee and wishing the boss would institute an official nap time? Are you stressed and distressed with a body clock permanently punched on snooze control?

You are not alone. Meet the National Sleep Deficit, which is burgeoning almost as rapidly as those more abstract evils, the budget and foreign trade deficits. “There’s a fairly pervasive lack of adequate sleep in our society, which leads to problems with alertness and life satisfaction,” says Richard Allen, co-director of the Johns Hopkins University Sleep Disorder Center. “The quantity of wakefulness may be increased, but the quality is decreased.”

Often, daytime sleepiness stems from a bout of insomnia the night before. Occasionally, in a syndrome called delayed sleep phase, it derives from an out-of-whack body clock. And frequently, it’s just a reflection of the pressures and conflicts of daily life.

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Single Mothers Suffer

Margaret Brown, a single mother, belongs to the last group. She works four days a week at the Library of Congress, and she has an energetic little boy named George. “I pick him up from his after-school program,” she says, “and he can still take his Big Wheels around the block five times.” George doesn’t seem to need as much sleep as other kids. His mother, on the other hand, would like eight or 8 1/2 hours, but must settle for seven.

“Being tired adds to the stress of the single mother’s life. If I have enough sleep, I can be more at ease with my child, and not as strung out,” Brown says. On weekends, she’ll squeeze in a nap. The rest of the time, “I crave sleep and quiet.”

Is the National Sleep Deficit another goofy made-up trend? Assuredly not, say the nation’s top sleep researchers. And not only is it pervasive among adults, it’s infecting our young. A survey of 3,000 New England high-school students--due to be unveiled at the annual meeting of the Assn. of Professional Sleep Societies two months hence--says 30% fall asleep in school at least once a week.

Furthermore, “50% report having fallen asleep in school at some point during the last year, and most say they have recently struggled to stay awake,” says Mary Carskadon, director of chronobiology at E. P. Bradley Hospital in Providence, R.I., and the report’s author.

Educators Blamed

Is this perhaps merely a symptom of the dullness of American education? Carskadon thinks not: “There’s scientific evidence that if you’re not sleepy, you won’t fall asleep, even in an entirely soporific situation.”

Similar findings, she says, have been made in adult populations. And while no specific studies seem to have been done with the country’s 19.2-million two-earner families (or, for that matter, the 13.5-million families headed by only one, usually working, parent), much of the burden of the deficit must fall on them. Moreover, sleep reduction techniques are apparently no help.

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“There’s a persistent notion--and maybe even a group of charlatans who are exploiting the notion--that you can get along on less sleep,” says Merrill Mitler, director of research at the division of Chest, Critical Care and Sleep Medicine at Scripps Clinic and Research Foundation in San Diego. “The amount of sleep an individual needs is largely genetic. For someone to learn to get along on four hours of sleep when he requires eight makes as much sense as a guy with an 18-inch neck buying 15-inch collars.”

Carskadon, who also teaches psychiatry at Brown University Medical School, believes that the sleep deficit is prompting a lowered threshold for irritability. “You can make a case that many of the frictions of daily life are due to insufficient sleep, from the anger you feel at the driver who cuts you off to annoyance at having to wait in line at the supermarket. Everything becomes more of an effort.”

Graver Dangers Lie Beyond

Beyond irritability and coping problems lie graver dangers, from the individual catastrophic event--a bleary student obliterating the computer file containing his term paper or the long-distance driver being lulled off the road--to such major tragedies as Three Mile Island and Chernobyl, both of which have been linked to human error between 1 and 4 a.m.

“People think of sleep as either a nuisance or a luxury, something they tend to cut back on whenever necessary,” Carskadon says. “They think, ‘My life is so full, I don’t need the sleep. I can stay up late tonight, and tomorrow night, and the next night, and sleep late on Saturday.’ It’s as if I decide I don’t have time to eat on Monday, Tuesday or Wednesday, but I’ll make up for it by having a feast on the weekend.”

Meanwhile, there are the millions who desperately want sleep but can’t get it. Some studies report that as many as 33% of the population believe they suffer from insomnia. The disorder, however, tends to be a catch-all complaint for problems that occurred during the night.

Insomnia can involve either inability to get to sleep, waking frequently during the night or waking up unwillingly but permanently at 5 a.m. The cause can be medical, environmental or psychological; it can be provoked by a nightcap or lack of exercise. It’s also possible that someone who thinks he’s an insomniac just doesn’t need very much sleep in the first place.

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“Sometimes people have a misperception about the amount of sleep they’ve gotten,” explains Helene Emsellem, an associate professor of neurology at GWU Medical Center and director of the university’s Sleep Studies Center.

“We’ll monitor them in the lab, and then they’ll say they slept for two hours. Yet their studies may show seven hours of beautiful sleep. One possible reason they may think they’re sleeping poorly is because their arousal threshold is lower than that of others. They wake up more readily, but they do get the sleep they need.”

Four Major Centers

The GW Sleep Studies Center is one of four major sleep labs in the area. The others are the Hopkins center; the National Capital Sleep Center (affiliated with Suburban Hospital) and the Georgetown University Sleep Disorders Center. The GW program studies 200 patients a year overnight and sees 300 more on a clinical basis.

While insomnia can cut across all ages and groups, it appears to be most prevalent among people between 30 and 50. “Part of being a high-powered young professional is being intolerant of imperfect body performance,” Emsellem says.

“We want perfection from ourselves--we have lots of things to do and don’t have time for sleepless nights that make us inadequate the next day.”

Tension and strain are also big factors. “To a large extent,” says professor Carskadon, “many of the people with insomnia are having it in response to the stresses of modern life, ranging from the demands of a job to the difficulties of traveling to and from work to the requirements of being a single parent.”

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For Marta Tanenhaus, insomnia just showed up one day, like one of those unpleasant relatives who says this is just a short visit but brings three suitcases and a trunk. If no insomniac is typical, Tanenhaus is at least representative.

Funding Ran Out

Two years ago, the government funding for her job ran out and she confronted unemployment. Not unexpectedly, she spent some anxious nights. After less than a month, she found a new job as a think-tank analyst. The insomnia, though, never left. “David Letterman has been great, I must admit,” she says. Still, she’d rather be watching him on tape.

Last Monday night, Tanenhaus dreamed of a problem at work. She woke up five times and was exhausted by morning. Tuesday, she knew she’d have problems, so she took a sleeping pill. No problems. Wednesday, she turned her lights out at 1:24 a.m. In what is a typical pattern, she woke at 6, went back to sleep in five minutes, woke at 7, went back to sleep in five minutes, woke at 8; went back to sleep until 8:45.

Thursday, it was much the same. Tanenhaus turned her lights off shortly after midnight. At 5:18, she woke up. The next time she remembers looking at the clock, it was 5:50. She woke again at 6:35; fell asleep within two minutes; woke at 7:12; fell asleep within two minutes; and woke at 8--”which is when I wanted to wake up all along.”

And so the nights unravel. “It seems,” says the 32-year-old Tanenhaus, “I can’t get more than five hours of uninterrupted sleep. Once I’ve woken up that first time, sleep is never restful.”

She has talked to her doctor about this. “I don’t think it’s diet or lack of exercise or a psychological problem. Somewhere along the way, my body stopped being able to turn its energy levels off and on at the right times.

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“I used to go to work and work hard, work out afterward, go out with friends, go home, catch the news, read a book for 20 minutes and fall asleep. My life style is still the same, but after I turn the lights off, I still have the kind of energy and pizazz I had during dinner.” The next day, as a result, she’s a little tired.

Tanenhaus thinks her condition may be hereditary. In high school, she remembers, she used to be working on papers late at night when she’d hear these tell-tale footsteps. “It was dad, with his insomnia. It’s possibly an inherited thing, and it just kicked in at a certain age.”

Seriously Afflicted

While millions have problems sleeping, the nation’s 150 accredited sleep centers see only the most determined or seriously afflicted. Some insomniacs, concludes GW’s Emsellem, don’t bother to seek help because they “know darn well why they’ve got it. They realize they are under a great deal of stress or are overworked, and they spend time lying in bed worrying rather than relaxing and falling asleep.” These folks sometimes find they can resolve this impasse by getting out of bed and putting on paper a list of their anxieties.

Waiting to fall asleep in general can be worrisome, Emsellem notes. She tells her patients to spend no more than a half-hour in pursuit of slumber before getting out of bed and doing something else.

“Some researchers feel a vicious cycle can be created while lying in bed each night looking at the same surroundings,” she says. “The surroundings can become a trigger for insomnia in a Pavlovian sense. So when you’re not sleeping, you shouldn’t be in bed.”

And that means no slipping under the covers with a copy of People magazine or “The Bonfire of the Vanities.” “The insomniac’s bed,” Emsellem makes clear, “should be used for two things: sleep and sexual activity. Nothing else.”

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Good morning? Beatrice Moore never knew the meaning of the phrase. She would start winding down about 1 a.m.--watering the plants, paying the bills, doing a little laundry. She’d get to bed by 2 and sleep perfectly. It’s at the other end of the cycle that the trouble began.

“It was always touch-and-go to get someplace on time in the morning,” Moore says. “Given a choice between going to the hairdresser in the morning or at night, I’d go at night. But you don’t have that opportunity with work. As I’ve gotten older”--she’s 54--”I have less stamina.”

Generally, she would make it to her post at the Department of Health and Human Services by 9:30 a.m. She’d dash in at the last minute and would feel wretched all morning. Nevertheless, she decided she wanted to start both coming in and leaving earlier.

She couldn’t do it.

“It felt downright alien to set my clock for 5:15. Finally, at 6, I’d throw myself out of the bed. But I was so foggy and funky I would lose the time, and all of a sudden it would be quarter of 8. I was almost in despair.”

Then salvation arrived in the form of an experimental program at the National Institute of Mental Health. Delayed sleep phase syndrome had been classically misunderstood as simple laziness. Its victims were lucky if they could work late shifts or indulge in free-lance pursuits; those tied to a 9-5 schedule, like Moore, constantly struggled to cope.

“These are people who cannot get to sleep at conventional times,” says the director of the program, Norman Rosenthal. “If they were to lie down at midnight, they would have hours of insomnia, because their body clocks run differently. And if they wait to go to sleep until their body clock permits them to do so, they will sleep very soundly until 9 or 10. That doesn’t fit in with the workday world.”

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It’s unclear how many people suffer from the syndrome. Rosenthal will say only that “it is by no means a rare entity,” based on the fact that “when we began to look for people to take part in the program, we got hundreds of responses.”

In addition, it seems particularly acute among high school and college students. Generations of mothers have endeavored to send their adolescents to bed, never succeeded, and then had an impossible time getting them up the next morning.

It isn’t necessarily truculence or even hatred of school that makes kids this way: It could be merely the presence of delayed sleep phase syndrome. A preliminary, arbitrary sample of 30 adolescents by Rosenthal’s collaborator, Richard Allen of Hopkins, showed that 40% did not become fully alert until after 10 a.m.

Treatment for Beatrice Moore and the other patients in the NIMH program involves tinkering around with their light and dark cues in an attempt to reset their body clocks and body rhythms. For an hour after she wakes up, for instance, Moore now wears a special helmet that shines a diffuse light on her eyes. At about 4 in the afternoon, she puts on “dark, wraparound glasses that look kind of cool.” Her day thus begins earlier; so does her twilight.

“I now go to bed around 11:30, but I can do better. My goal is to stop watching the 11 o’clock news,” she says. Because of the helmet treatment, she still doesn’t get to work a whole lot earlier than she used to. But 6 a.m. is no longer the night of the living dead, and she no longer feels under assault when she gets to the office.

“I used to not get rolling until 11. Now I feel lighter, more wide awake, and generally my mood is lighter,” Moore says. “It’s not that I don’t still love sleep, and not that I don’t miss getting a lot done at night, but this way I’m more in tune with things.”

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