It’s Dangerous to Go Without Your Zzz : Medicine: Millions of Americans are tired, and that’s a major problem, according to a special research commission. Napping is urged.
Americans are sleepy people.
That is the conclusion of the National Commission on Sleep Disorders Research, which recently issued its final report. The commission, established by Congress to research sleep and its effect on society, estimated that 40 million Americans have sleep disorders and that millions more suffer from a simple lack of sleep that can have grave repercussions.
The resulting sleepiness, according to commission chairman William Dement, chairman of the Stanford University Sleep Disorders Center, “makes them extremely vulnerable to inappropriate and often catastrophic sleep episodes and undermines their intellectual and emotional capacity.”
Those episodes include serious traffic accidents caused by drowsy drivers, industrial accidents and lost productivity from employees who fall asleep on the job. The commission estimated that in 1990, sleep problems cost at least $16 billion in lost productivity, medical costs and sick leave. This does not include costs of catastrophic disasters in which sleep deprivation played a role.
The commission report said the study of sleep has been neglected and that what is available is fragmented and uncoordinated. It called for leadership in sleep research, including the establishment of a center for sleep disorders and research at the National Institutes of Health.
Commission officials said sleep disorders are commonly overlooked by physicians and their patients. They identified 17 specific disorders, including sleep apnea (repeated cessation of breathing during sleep causing numerous wakenings each night and leading to cardiovascular complications), narcolepsy (uncontrollable sleep episodes) and chronic insomnia. They estimated that 95% of cases go undiagnosed.
“A river of seriously ill sleep-disordered patients (is) flowing past the unseeing eyes of physicians, (and therefore) the lives and health of literally millions of Americans are in jeopardy,” said Dement.
But just as important, Dement and other commission members said, is “the American sleep debt,” the chronic scrimping on sleep that affects uncounted millions. The resulting fatigue can erode performance, interpersonal relations, child rearing, learning, psychological well-being and behavior, they argued.
“The sleep debt, we believe, is every bit as important as the national debt,” said commission member James K. Walsh, a special commission adviser and sleep specialist at Deaconess Hospital in St. Louis. Walsh is president of the American Sleep Disorders Assn. “Whether it is caused by sleep disorders or sleep deprivation or daily rhythm factors, sleepiness is extremely prevalent . . . and the consequences in the workplace and on the roads . . . are very costly.”
“Using any yardstick,” he said, “whether it be pain and suffering, profit and loss or life and death, our country is paying a steep price.”
The commission said 56% of night workers report falling asleep on the job at least once a week, and more than 50% of these report errors by themselves or co-workers that are caused by lack of sleep.
Sleep researcher Mary Carskadon, a member of the commission from Brown University, said the brain has an inherent daily rhythm of sleepiness that for most people falls during two periods, the main one between 2 and 6 a.m. and another during the midafternoon. Studies have shown that night-shift workers, even those who have slept well during the day, often notice these drowsy periods.
Walsh said his studies have found that someone working at night is roughly as sleepy as a day worker who had four hours of sleep the night before.
The researchers said the sleep deficits have gradually developed in this century, in large part as a response to the flexibility in lifestyle that followed the introduction of electric lights. Carskadon, who specializes in sleep problems of children and adolescents, noted that in 1910, children aged 10 to 12 averaged 10 1/2 hours of sleep a night. In 1990, the average was close to nine hours. In 1910, teens between 13 and 17 slept about 9 1/2 hours a night. In 1990, 13-year-olds got a bit more than eight hours of sleep and 17-year-olds got 7 1/2 hours.
“We do not fully know all the consequences of this chronic sleep insufficiency, but we do know about 25% of teens report falling asleep in school at least once a week and more than 10% say they’re late for school at least once a week because they’ve overslept,” she said.
“Sleepiness,” she said, “is not caused by a warm room, a dull lecture, a big meal, a long drive. These situations simply unmask or uncover the brain’s sleepiness that is already present.”
Carskadon said surveys show that fewer than half of American adults get eight hours of sleep each day and a quarter get less than seven hours. The exact amount needed varies, of course, from individual to individual, and there is a debate about the exact needs of the population as a whole.
Carskadon believes that nearly all adults require at least seven hours of sleep “to avoid accumulating a sleep debt,” and that most adults require at least eight hours.
Among the most dramatic examples of problems caused by lack of sleep cited by the commission members:
* The 1989 Exxon Valdez oil spill in Alaska, in which transportation officials found that the third mate who was piloting the ship had fallen asleep.
* The 1979 Three Mile Island nuclear plant accident, in which fatigued workers at 4 a.m. did not respond to a mechanical failure.
The commission also pointed to a more-common scenario that can be deadly--driving while drowsy. Seventy percent of all drivers report being drowsy at times, and about 3% to 10% admit to having an auto accident because of sleepiness or fatigue, the commission said. The National Highway Transportation Safety Administration cited 72,000 accidents a year involving drowsiness, but administration officials told the commission that they believe the number could be as high as 200,000.
Accidents involving driver drowsiness or fatigue are fatal 87% of the time, according to one study cited by the commission.
“The commission’s conclusion,” said Dement, “was to initiate a profound radical change in the way society deals with sleep. . . . We must have physicians knowledgeable and sensitive to sleep complaints, all managers must take sleep into account, we must all realize that a wave of drowsiness is a red alert.”
And, he concluded, “napping must be made respectable.”
