We are not healthy unless our sleep is healthy. Here’s how to make sure you’re not literally risking your life by not getting enough sleep — whether or not you have restless leg syndrome (RLS). From Robert H. Yoakum, author of Restless Legs Syndrome: Relief and Hope for Sleepless Victims of a Hidden Epidemic.
Sleep researchers have linked many ailments to inadequate sleep, including high blood pressure, depression, cardiovascular disease, and even obesity. As sleep expert Stanley Coren so eloquently put it, “Lack of sleep makes people clumsy, unhappy, stupid, and dead.” Another expert, Dr. William C. Dement, says there is no doubt that disordered sleep is physically and psychologically harmful. Sleep is at least as important to our well-being as exercise and good diet. “If sleep is mismanaged,” he said, “we may be risking our lives. We are not healthy unless our sleep is healthy.”
The size of the problem is evident in all studies. It’s huge, and growing. The U.S. surgeon general, Richard H. Carmona, reports that untreated sleep disorders affect 70 million Americans and cost the nation $15 billion a year in health care expenses.
Surveys conducted by the National Sleep Foundation (NSF) show that 75 percent of adults report having sleep problems a few nights a week or more. This continues an upward trend in the prevalence of sleep problems — from 62 percent who experienced a sleep problem a few nights a week or more in 1999 and 2000, to 69 percent in 2001, to 74 percent in 2002, and 75 percent in 2005. In addition, more than 40 percent of adults experienced daytime sleepiness severe enough to interfere with their daily activities at least a few days each month, with 20 percent reporting persistent sleepiness a few days a week or more.
The large 2005 Sleep in America poll, commissioned by the NSF, found that respondents were getting an average of 6.8 hours of sleep on weeknights and 7 hours on weekends.7 Over the pastseveral years, there has been a downward trend in the proportion of respondents who report sleeping 8 or more hours a night on weekdays (from 38 percent in 2001, to 30 percent in 2002, and 26 percent in 2005).Three-quarters of respondents said they experienced at least one symptom of a sleep disorder a few nights a week. Those symptoms include difficulty falling asleep, waking up a lot during the night, waking up too early and not being able to go back to sleep, waking up feeling unrefreshed, snoring, pauses in breathing, and having bothersome feelings in the legs.
Some results of sleep deprivation are predictable. For example, respondents said that not getting enough sleep made them feel more irritable, more likely to lose their patience around children, and likely to get angry while driving. Equally unsurprising, adults living with children got less sleep than those without children.
Use of sleep medicine is also on the rise. Some studies have reported that as many as 15 percent of people said they had used either a prescription or over-the-counter drug for sleep.
Age matters. Restorative, slow wave deep sleep makes up 20 percent of our sleep at the age of twenty-five but a mere 5 percent at sixty. As Dr. Sonia Ancoli-Israel puts it, “It’s a myth that sleeping less is part of getting old. It’s not the need for sleep that changes, it’s our ability to sleep well.”
Certainly sleep plays a vital role in our well-being. Some assert it is the most important predictor for longevity. Citing sleep and mortality studies, including a gigantic one conducted by the American Cancer Society, Dr. Dement concluded that “there is plenty of compelling evidence supporting the argument that sleep is the most important predictor of how long you will live, perhaps more important than whether you smoke, exercise, or have high blood pressure or cholesterol.” A California Department of Health study published in Sleep showed that people who get less than therecommended amount of sleep have a 70 percent higher death rate than those who get adequate sleep.
None of those life-span studies prove a causal relationship between longevity and amount of sleep, but as Dr. Dement observes, “the results are extremely suggestive.” He suggests the immune sys-tem may hold the answer here, since “there seems to be an intriguing and mysterious connection between sleep and the maintenance of our bodies through immune function and cell repair.”
Researchers may choose to include victims of auto accidents when citing the effect of sleep disorders on death rates. Studies have shown that drowsy drivers cause an average of 70,000 injuries every year and 1,550 deaths. The annual cost of motor vehicle accidents in the United States is $13 billion.
In the 2005 Sleep in America poll, 60 percent of respondents reported that they had driven a vehicle while feeling fatigued and often drowsy, and almost two of every ten said that they had dozed off while driving at some point within the past year. More frightening, 80 percent of regional pilots reported that they occasionally snooze in the cockpit, which, among other things, is illegal. When one adds RLS, and the stress it generates, to the effects of sleep deprivation on the immune system, the results are equally intriguing.
If too few doctors pay attention to sleep problems, there is no shortage of advice from book, magazine, and newspaper publishers. All this guidance can get confusing: one book contains seventy-five suggestions on ways to obtain better sleep.
Sleep routines and sleep needs vary. The sleep-aid recommendations below are of a general nature but are especially appropriate for people over age fifty, since the most severe cases of RLS are found in that age group. For a more detailed review, read the final chapter of Dr. Dement’s excellent 1999 book, The Promise of Sleep.
It is important, while reviewing the suggestions for improved sleep below, to keep in mind that a consistent positive routine (like getting up at the same time every morning, cutting back on caffeineand alcohol, and avoiding long naps) is the most effective sleep aid. To that end, many find bedtime rituals can be helpful — things like meditation or writing in a journal, or enjoying a cup of herbal tea or a warm bath.
The following strategies should be taken, as Dr. Dement suggests, as options — rules that can be broken if circumstances dictate. If, for example, you are a business executive preparing an urgent report, or a student cramming for an exam, you may occasionally have to stay up late. But the more regular you can be in your habits, the better success you’ll have.
Option 1. Be regular. Go to bed at the same time every night and get up at the same time every morning.
Given the relation between RLS and circadian rhythm, your legs will be grateful to the degree to which you can put your body’s biological clock on a schedule. If you miss sleep during the week, try to make up for lost sleep on the weekend. (About 10 percent of college undergraduates say they sleep eight or more hours on weeknights, but the figure rises by more than 70 percent on weekends.) The Promise of Sleep cites evidence showing it was safe to assume that people can avoid dangerously high sleep debt by adding a relatively small amount of sleep to their normal sleep schedule, and this has not been disproved as of this writing.
Option 2. Use the bedroom and bed only for sleep and sex. Ideally you should think of your bed as the most comfortable or enjoyable place in the world.
Option 3. If you fail to fall asleep within twenty minutes, go to another room, or at least to a nearby chair, and read. But nothing too stimulating. Sir Walter Scott is perfect. This kind of diversion, which can help you avoid thinking of the bed with anxiety, works best for people whose RLS is mild.
Option 4. Avoid substances that aggravate RLS.
A. It’s the caffeine, stupid! Anyone who has trouble sleeping should avoid caffeinated drinks and chocolate. There is evidence that caffeine intensifies RLS in children and perhaps in some adults. For example, Dr. Daniel Picchietti discovered, in a study of the comorbidity of ADHD and RLS, that soft drinks containing caffeine may aggravate both afflictions in children. Caffeine can stay in your system for up to twenty hours. Remember that caffeine may be included in some over-the-counter pain and cold remedies. Chocolate and many weight-loss aids also contain caffeine. If youare taking more than the equivalent of one cup of coffee a day (about 100 mg caffeine), gradual tapering off is recommended to avoid the nasty effects of caffeine withdrawal.
B. Alcohol is another culprit. Drink alcoholic beverages only moderately with dinner and not at all afterward. Alcohol exacerbates RLS symptoms and too much alcohol can bring on a rebound effect that will sabotage sleep three or four hours after the drink is consumed.
C. Nicotine can also disrupt sleep and worsen symptoms. Avoid it altogether to preserve sleep — and your life.
Option 5. It can be easier for RLS victims to nap in the afternoon than to sleep at night. But the general rule applies: avoid naps beyond midafternoon, and don’t nap for more than an hour.
Option 6. Eat your evening meal at least three hours before bedtime. Eat lightly, as nutritionists advise. A light snack may be a good idea if you feel hungry at bedtime. Hunger can wake you up.But remember, so can overeating at night.
Option 7. Exercise, but not within four hours of bedtime unless it’s related to low-energy sex. Fitness can improve the quality and quantity of sleep and is generally beneficial for mind and body,but nighttime exercise, especially the strenuous aerobic sort, not only impairs sleep but also worsens RLS. This stricture, however, wouldn’t include mild stretching of the sort that some nightwalkers find helpful.
Option 8. Don’t put your alarm clock where you can see its face; it can make you anxious. (Some people awaken periodically, worrying that the alarm may fail them. They should buy a second clock or pay for a wake-up telephone service.)
Option 9. Most people sleep best in a dark and quiet bedroom. (Use an eye mask or earplugs if necessary.)
Option 10. Try to reduce stress. That’s not easy, especially for those of us whose limbs test us nightly, but the benefits of stress reduction are manifold, especially in bed. This is particularly true for Americans, who, according to many experts, are the most stressed on the globe. Games and other forms of social interaction can also reduce stress and enhance sleep.
Option 11. Use prescription drug therapies sparingly. Anything you use for more than three months, whether prescription or over-the-counter, should be monitored by your doctor.