Hitting the Hay: The Value of Sleep | Cover Story

The value of a good night’s sleep has become a hot topic once again for the American public, emerging at the forefront of the news cycle thanks to Huffington Post co-founder Arianna Huffington’s new book, “The Sleep Revolution,” which bowed April 5 to the expected fanfare.

Huffington became a de facto crusader for proper shuteye after she famously collapsed in 2007 and suffered facial injuries as a result of exhaustion.

“We are in the midst of a sleep deprivation crisis,” she wrote. “And this has profound consequences – on our health, our job performance, our relationships and our happiness. What is needed is nothing short of a sleep revolution. Only by renewing our relationship with sleep can we take back control of our lives.”

No one is immune to the deleterious effects of ignoring a good 40 winks.

The negative consequences of sleep deprivation are legion – from the inability to concentrate, to irritability, on up the spectrum to increased risk of cancer, heart disease and Alzheimer’s to an early demise – and people are finally getting hip to this.

And 90 percent of young people are running on a lack of sleep, according to the Huffington Post.

Dr. Thad Golden is a pulmonary and critical care physician with Carolina Health Specialists and is board certified in sleep medicine. He is also medical director of the Coastal Sleep lab in Myrtle Beach. He said that sleep medicine dovetailed with pulmonary care because of breathing issues and the nocturnal sleep disorders that go along with it.

“I have a particular fascination with sleep,” he said. “It’s amazing to me that we spend a third of our lives doing it. If you think about it, somewhere around 25 years of our lives are spent sleeping, and yet we treat it generally with much disregard.”

One of the reasons that sleep deprivation has become a problem, according to Golden, is that folks are sleeping on average an hour less than previous generations.

“There are a lot of proposed reasons for that, and probably the largest is just the increase in things that intrude on our sleep,” he said.

The onslaught of electronic devices and other digital stimuli vying for our attention is staggering, and Golden asserted that these things disrupt sleep in ways we have not seen before.

“Young people are living in a world where they have never known anything different than that,” he said, adding that Coastal Sleep Lab [www.coastalsleeplab.com] gets referrals constantly for kids because they are not doing well in school or are displaying behavioral issues.

“It turns out that a lot of that relates back to the fact that their sleep hygiene had become so polluted that they are not sleeping well during the night. This creates ripples such as irritability and behavioral issues in children – and not to mention the other trickle-down things in adults like increased automobile accidents, increased absenteeism and effects on our immunology and health.”

There are people who will discount this phenomenon as overblown, but Golden believes the consequences of sleep deprivation are far reaching.

“The more common things you hear are things like, ‘I’ll sleep when I’m dead.’ That always surprises me, and the more I learned about the importance of sleep in our general health, it became sort of a personal quest to help people with it,” he said.

Huffington wrote that what she learned in today’s world is that the path of least resistance is the path of insufficient sleep.

“Unless we take specific and deliberate steps to make it a priority in our lives, we won’t get the sleep we need. Because today a full night’s rest has never been more difficult to come by. With the demands of work and family and our ubiquitous and ever-growing arsenal of glowing screens and buzzing devices, we’re hyperconnected with everyone in the world—often from the second we wake up to the second we finally fall asleep. But unless we’re vigilant, we can become disconnected from ourselves.”

REM: NOT JUST A BAND

Webster’s dictionary defines REM sleep as “a state of sleep that recurs cyclically several times during a normal period of sleep and that is characterized especially by increased neuronal activity of the forebrain and midbrain, depressed muscle tone, dreaming, and rapid eye movements.”

Golden said that the best description of REM sleep is an awake brain in an asleep body.

“Our first REM cycle is somewhere between 45 minutes to an hour and a half, and that’s very short. Throughout the night, we go in and out of REM – on a repeating cycle – with our largest REM period seen early towards the morning,” he said, adding that if a person splits sleep time into two separate four hour blocks, this is absolutely not as good as eight hours of solid, continuous sleep.

“The reason why is that you have not achieved those deeper sleep cycles,” he said.

And while Golden would be the first to tell you that all of the physiological reasons for this are not yet known, it is known that deep sleep cycles are restorative – and the average adult needs between seven and nine hours of sleep per night.

But it has somehow become fashionable for some folks to consider a lack of sleep as tantamount to some sort of misguided heroism – as if sleeplessness makes one a willing martyr to the daily grind.

“You always hear things like, ‘Benjamin Franklin only slept 5 hours a night.’ We ascribe a super power to a lack of sleep,” said Golden. “It’s just the opposite. If somebody needs nine hours, we consider them lazy – and someone who goes to bed at 10 o’clock, like, ‘Oh my God – you go to bed at 10 o’clock’ – as if it’s something bad.”

Golden said It’s most important to know what is your optimal amount of sleep is and to try and achieve that.

“By shorting yourself, what you really do is chop off the end of your sleep cycle, which is primarily made up of REM sleep,” he said, and noted that sometimes he talks about patients being REM-deprived rather than sleep deprived.

“That can be kind of insidious, and has other deleterious effects.”

Going without sleep in the short term is doable, but Golden said by doing so, you are living off your body.

“When you are sleep-deprived, you have higher cortisol levels,” he said. “Your adrenal glands are working harder, and we know that isn’t good. These are stress reactions – the same reactions you are put under if you are put under any kind of physiological stress.”

A person can only get by with this for so long.

“There is no question in my mind that cutting the corners like that has more serious ramifications and long-term effects than we recognize.”

LIGHT AND THE INTERNAL CLOCK

A circadian rhythm is basically an internal clock.

“It’s a little longer than 24 hours, and it’s constantly being reset by stimulation of the pineal gland by light,” he said, and the fact that we have incandescent and other artificial light sources has likely made an impact on our sleep patterns.

“We think it really doesn’t matter now because we can turn on lights. There are certain spectrums that seem to be worse, but obviously natural sunlight was meant to reset our clocks.”

He said that folks who say they sleep better with the television on have trained themselves to do that, and if anything, reading with an indirect light source before bedtime is optimal. And if you have an e-reader, take heart.

“They really don’t throw out a lot of light, so that’s probably a reasonable alternative. I don’t think I would tell somebody to throw out their e-reader and go buy a paperback.”

PLAYING CATCH-UP AND THE VALUE OF THE NAP

Don’t expect to catch up on sleep. It just doesn’t work that way.

“Say you are REM-deprived. You’re doing that thing where you have been sleeping for a couple of hours in the morning and a couple of hours in the evening or nights – and then you get your day off and sleep for like 12 hours. We see REM-rebound, where we have a huge amount of REM – and those are the days where you wake up and feel absolutely exhausted. You feel like you have run a marathon.”

The so-called power nap is always an option for its restorative effects, but don’t expect to sleep for long. Twenty to 30 minutes is the goal.

“We have a lull in our circadian rhythms in the early afternoon, and a short nap is a really huge benefit,” he said. “The reason for 20 to 30 minutes is because you don’t want to get into that first REM cycle. You want it to be light sleep. It’s absolutely restorative for a period of time.”

Indeed, Golden cited that even lying down for the same length of time can be restorative, even if you don’t actually sleep.

Huffington likens our relationship with sleep to an on-again, off-again relationship with an ex who has never moved out.

“Sometimes it’s healthy and supportive of everything we do while we’re awake, and sometimes it’s wildly dysfunctional and destructive. To paraphrase Tolstoy—who himself was fascinated with sleep—every unhappy relationship with sleep is unhappy in its own way. But whether we embrace it or resist it, one way or the other, we’re all dealing with sleep every day, every night, all the time.”

SLEEP STUDIES

Coastal Sleep Lab’s center manager Michelle L. Canup is a registered polysomnographic technologist, or RPSGT, licensed to perform sleep studies and score the data. She says 95 percent of patients suffer from some sort of sleep deprivation and are looking for the cause of the problem.

“Numbers are increasing because of awareness,” she said. “People are seeing and hearing more and more about sleep disorders and question how they feel and function on a daily basis. People sometimes think they are tired because they work so much or because they are getting older. We have found that if you are sleeping and are not feeling rested something else may be going on.”

Diagnostic tests are performed by a polysomnogram, or sleep study.

“We monitor their brain waves to determine wake, sleep and which stages of sleep they achieve,” she said. “We monitor muscle tone, body position and movement, breathing patterns and oxygen levels, and their ECG [electrocardiogram]for heart rate and any abnormalities they may have. A snore mic is used to measure severity of snoring.”

And just how does anybody sleep while hooked to leads, sensors and wires?

“Most of our patients are sleep deprived so they have no problem falling asleep with all the wires on them,” she said. “We try to put the wires on them in a manner that they are comfortable with and still able to move around as normal. Once we complete the diagnostic polysomnogram we will be able to determine what is causing them to be sleep deprived and treat the cause.”

As the Latin proverb goes, forearmed is forewarned – and although Huffington had to learn the hard way, she has become a champion for sleep.

“Scientists are resoundingly confirming what our ancestors knew instinctively: that our sleep is not empty time. Sleep is a time of intense neurological activity—a rich time of renewal, memory consolidation, brain and neurochemical cleansing, and cognitive maintenance. Properly appraised, our sleeping time is as valuable a commodity as the time we are awake. In fact, getting the right amount of sleep enhances the quality of every minute we spend with our eyes open.”

This story was originally published April 13, 2016 at 1:00 AM with the headline "Hitting the Hay: The Value of Sleep | Cover Story."