By Gary Pransky, M.D.
Winthrop – Family medicine
Reading from a mobile device in bed may be comforting, but the light can prevent restful sleep.
This might sound familiar: You wake up late because you overslept. You rush to get ready, drive to work with your head still in a fog, and load up on coffee before and after lunch just to make it through the day. You have trouble concentrating and don’t get everything done, so you bring work home and stay up late to finish that report that’s due tomorrow.
Before you know it, it is tomorrow. You fall in bed at 1 a.m., exhausted and aware that in just a few short hours you’ll do it all again.
We live in a sleep-deprived society. We try to cram more hours into the day to spend more time at work, at school, with family and friends, and on hobbies. We have more and more to do, and we get less and less sleep as a result.
Many people think of sleep as a luxury — the first thing to sacrifice when we really need to buckle down and get things done. But sleep isn’t a luxury, it’s a biological requirement, just like the air we breathe, the water we drink, and the food we eat. Not getting enough quality sleep puts us at risk for many different health problems.
How much sleep do we need?
Sleep isn’t a one-size-fits-all activity. The amount of sleep I need to be healthy may be different from the amount you need.
But there are general guidelines we can use. The amount of sleep we need varies depending on our age:
- Newborn babies need 16 to 18 hours of sleep per day
- Preschool-aged children need 11 to 12 hours
- School-aged children need at least 10 hours
- Teenagers need nine to 10 hours
- Adults need seven to eight hours
That sleep needs to be consistent, and it needs to be all at night if possible. Napping during the day doesn’t provide the same benefits as healthy nighttime sleep.
How does Massachusetts measure up on sleep?
As the Centers for Disease Control and Prevention (CDC) points out, 65.2 percent of U.S. adults surveyed report getting at least the seven minimum hours of sleep per night. That means more than one-third of adults in the United States report getting less sleep than their bodies need.
Massachusetts adults are slightly better than the national average — but only slightly. In its most recent survey, the CDC reported 65.5 percent of Massachusetts adults get the minimum seven hours of sleep per night, which means 34.5 percent of us aren’t getting enough sleep. And the problem’s even worse in counties like Bristol, Hampden, and Plymouth, according to the CDC’s Behavioral Risk Factor Surveillance System survey. Nearly 40 percent of adults in each of those counties reported not getting enough sleep.
We can look at different demographic groups to get a clearer picture of the people in our commonwealth who need more sleep:
- Adults between the ages of 25 and 44 were more likely to report getting insufficient sleep compared to adults ages 45 and older
- Adults with a child in the home were more likely to report not getting enough sleep
- African-Americans and American Indians were more likely to report sleep problems compared to people of other races
- More women than men reported not getting enough sleep
- Obese people were more likely to report sleep problems compared to people who are overweight or at a normal weight
What can contribute to our lack of sleep (or lack of quality sleep)?
Several medical conditions can contribute to sleep deprivation. Some of the more common ones listed by the National Sleep Foundation include:
- Acid reflux, possibly caused by gastroesophageal reflux disease (GERD)
- Chronic pain and/or low back pain
- Neurological conditions, like Parkinson’s disease
Sleep apnea also is a major contributor to sleep problems. Sleep apnea is a condition in which the trachea (windpipe) becomes partially or totally blocked while you sleep, which can cause you to stop breathing. If you have sleep apnea, you may wake up many times during the night to restart your breathing.
The clock can contribute to a lack of quality sleep as well. People who work late shifts (truck drivers, manufacturing workers, etc.) and people whose sleep is interrupted on a regular basis (firefighters, emergency medical technicians, caregivers, etc.) often have sleep-related difficulties.
How is sleep deprivation harmful?
As noted in the 2006 book Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, sleep loss has been associated with many different cognitive (thinking/mental processing) problems. Some of the ways a lack of sleep affects your mental performance include:
- Difficulty thinking
- Difficulty paying attention
- Increased errors in work
- Lower reaction time
- Problems learning new material
- Reduced performance of tasks, especially the longer these tasks take
- Trouble with short-term memory
A lack of sleep also has been associated with several mental and behavioral health problems in several studies of high school students. These problems include depression, anxiety, behavioral problems, alcohol use, and more.
But the problems linked to not getting enough sleep don’t stop with our brains. We are at risk for many different health problems if we don’t get enough sleep, such as:
- Heart attack
- High blood pressure (hypertension)
Find the patterns in your sleep problems
One good way to figure out the root cause of your sleep difficulty is to keep a sleep diary. Write down your sleep habits for 10 to 14 days before you see your doctor about your trouble sleeping. Make sure you include information about:
- When you go to bed
- When you fall asleep
- When you wake up
- When you get out of bed
- If you take naps during the day (and when those are)
- When you exercise (and for how long – fitness trackers from Fitbit, Jawbone, and others can help with this)
- When you drink alcohol
- When you drink coffee, tea, soda, or other drinks with caffeine
Based on this information, your doctor will work with you to correct what’s keeping you up at night. When patients visit my Winthrop office, I often recommend regular exercise in the morning. It’ll reduce your stress, jump-start your body for the day ahead, and help maintain your body’s normal biological rhythms. A regular bedtime will also help train your body for a normal sleep schedule. I recommend patients avoid caffeine or alcohol at night, as these can disrupt sleep patterns.
Light up your mornings – not your nights
Exposure to light is another factor in your body’s natural rhythms. Sunlight is the body’s natural cue to be awake and alert. Regular exposure to sunlight in the morning — during a walk, for example — will help you be more alert and refreshed throughout the day. Walking in the afternoon or early evening might actually reset your biological clock and keep you awake at night because of your sunlight exposure.
A different kind of light can also contribute to our restless nights — the light from our electronic devices, that is. Smartphones, tablets, laptops, and TVs give off blue light, which Harvard researchers have linked to the suppression of melatonin (a hormone your body produces to regulate your biological rhythms). When we check our smartphones for texts and emails, read on our tablets, work on our laptops, or even watch TV in bed during the night, we’re throwing off our natural sleep rhythms and signaling our brains that it’s time to wake up. Turning off the screens (or using blue light filters or apps for our phones and tablets) can reduce our nighttime exposure to blue light.
Turning off or filtering our phones may help, but what about this classic scenario? It’s 3 a.m. You look over at the alarm clock and think, “If I fall asleep now, I’ll get two and a half hours of sleep before I have to get up.” Sleep centers have found that one simple way to improve sleep is to just turn the alarm clock around so you can’t see the time. You’ll still get up on time if you leave the alarm set, but you won’t be robbing your mind and body of precious rest by staring at the clock all night.
A consistent, healthy sleep schedule
For people who work nontraditional shifts, though, the problem of poor sleep is a greater challenge. When my patients who work second and third shift come to me with sleep problems, I tell them to keep their work schedules if they can. This is hard, because you probably want to be with your family and friends on weekends or when you’re off work. But coming off your schedule is a shock to your body, and it takes time to adjust. By the time you do, it’s often time to go back to work, so you have to adjust all over again.
My best advice is to try to get on a normal nighttime sleep schedule if possible. Our natural rhythms revolve around being awake during the day and sleeping at night. Your body never really gets used to sleeping during the day and working all night.
We may feel pressured to give up sleep to spend more time with our families or get more done for work. But we wouldn’t give up breathing to finish a report. We need to think of sleep the same way — as a requirement our bodies just can’t do without.
Tags: family health, family medicine, internal medicine, men's health, Winthrop, women's health