Sleep Sickness

0 Comments | Insight on the News, May 28, 2001 | by Timothy W. Maier

Americans increasingly are suffering from sleep deprivation, with very serious consequences at work and at home. Insight uncovers the latest research on sleep.

There's trouble in dreamland as more than 40 million Americans are turning tired eyes to Mr. Sandman without relief. They are sleepless in America. Serious undiagnosed sleep disorders may be the cause for many of these sleepless nights, say sleep specialists. Others, they report, may suffer restlessness by choice, refusing by force of will to make time for the recommended eight-hour snooze.

The economic and health consequences are staggering. The National Institute of Health's National Commission on Sleep Disorders Research says sleep deprivation results in direct annual costs of $15.9 billion, with more than $100 billion in indirect costs, such as diminished work productivity, accidents and injuries.

The U.S. Department of Transportation reports that fatigue in the United States contributes to more than 100,000 highway accidents, producing 71,000 injuries and 1,500 deaths each year. More-recent studies indicate that sleep deficiencies directly are related to blood and heart problems, as well as lower standardized test scores. Early NASA studies of fatigue as part of the astronaut programs showed that sleeplessness impairs judgment, mood, motor coordination, reaction time, reasoning skills and the ability to recognize mistakes. More-recent studies indicate that cases of chronic insomnia may lead to increased vulnerability to medical and psychiatric disorders and greater absenteeism.

Three Mile Island, Chernobyl and the Exxon Valdez disasters might have been prevented if employees were not sleep-deprived, says G. Vernon Pegram, director of the Sleep Disorders Center of Alabama at Healthsouth Medical Center in Birmingham. "This is a tragic impact of sleep deprivation," he says. But don't expect Uncle Sam to break the bank to study our sleep deficit until society changes its attitude about sleep, says Pegram. So grab another cup of joe and live with it -- because, right now, the message is clear: Snooze and you lose.

"Sleeplessness has become a badge of honor," says William C. Dement, the so-called "father of sleep" who is founder of the Stanford University Sleep Disorders Center. As a society, "we encourage people not to sleep," he says. Everyone is targeted nonstop by 24-hour marketing, even children. Why else is there a 24-hour Cartoon Network seven days a week? Is Bugs Bunny at 3 a.m. really must-see TV?

The all-nighter has become a rite of passage to adulthood for high-school and college students cramming for the final exam. If you pull an all-nighter you boast about it -- that's the American way. Call it good training for corporate America, which also praises the employee who burns the midnight oil and still manages to make the next day's early-morning meeting. Those working stiffs are loyal, dedicated, committed -- and dead tired.

Why do we need sleep anyway? That is not an easy question to answer, the experts say. Some advise recharging the brain or body with sleep as if it were a battery. But we really don't know why we sleep, says Carl Hunter, director of the National Center of Sleep Disorders Research at the National Institutes of Health. "All living organisms need sleep," he says. "Why is not clear. We do know that totally sleep-deprived animals die. Sleep is essential."

Indeed, tests have shown that staying awake for a 24-hour stretch impairs cognitive and motor skills to the same degree as having a blood-alcohol level of 0.1 percent -- above the legal limit for driving drunk in most states. Would a legally drunk person be allowed to treat a patient in a hospital? Then why is it regarded as a sign of dedication for an emergency-room resident to work 48 hours without sleep? Deadly mistakes happen.

In 1999, the Institute of Medicine revealed that 98,000 hospitalized patients die each year as a result of medical errors, most of them preventable and many unreported. While the study hardly mentions fatigue as a factor in mistakes by the nation's 100,000 interns and residents, the omission may have to do more with those not wanting to buck the indoctrination that doctors must be taught to transcend fatigue. However, a 1991 survey published in the Journal of the American Medical Association shows that 41 percent of 145 residents in one study cited fatigue as causing their most serious mistake, and in nearly one-third of these cases the patient died as a result of the error.

John Winkelman, medical director at the Sleep Health Centers at Brigham and Women's Hospital of the Harvard Medical School in Boston, says: "I don't think people respect sleep disorders and sleep deprivation," and that includes the medical community, which encourages residents to work those 48-hour shifts. "We are not teaching them the respect they need for patients who have sleep disorders," he says.

Sleep doctors say American managers and professionals often are too busy advancing their careers to note that sleep deprivation has affected their health, marriages or families until it is too late. No one on their deathbed ever has been known to say, "I should have spent more time at the office," they say, but our culture seems to encourage guilt among those who don't work long hours.