by Brian Kim, MD, MS
“… Sufficient sleep is not a luxury—it is a necessity—and should be thought of as a vital sign of good health.”
– Wayne H. Giles, MD, Centers for Disease Control
“I think sleeping was my problem in school. If school had started at four in the afternoon, I’d be a college graduate today.”
– George Foreman
A few months ago, while rounding the floor of the medicine wards, I stepped into the room of a patient who had been admitted the previous night. A successful businesswoman in her 30’s, she had managed to ascend the corporate ladder with ease, despite being, to the surprise of her close friends and family, a high-functioning alcoholic. That is until, one day, she (and her liver) stopped functioning. She had a laundry list of medical problems, a number of which could have taken her life in a matter of weeks to months. And, yet, the only issue that seemed to be on her agenda that morning (or at least the only one she wanted to talk about) was how poorly she had slept last night and wanted to know what I could do about it. We talked about her sleep every morning for the next 30 days, until she was finally discharged from the hospital.
It seemed incongruous, maybe even absurd, to have spent so much time discussing an issue that ranked #11 on my list of 13 problems for this patient. But, as I have seen with countless patients, both in and out of the hospital, there are few concerns (other than pain and constipation) that are voiced as consistently as poor sleep.
According to the National Sleep Foundation there is no “magic number” when it comes to how many hours you should sleep each night. Not only do sleep needs change with age (generally, the younger you are the more sleep you need), but they are also individual. While you may function best after sleeping seven hours, another person of the same age and gender might require eight or nine hours to avoid falling into “sleep debt” (our medical term for not getting enough sleep).Why is a good night’s sleep so hard to come by? It is certainly one of the most preserved habits across the animal kingdom (yes, fish do sleep). For the first few months of life, besides eating, pooping, and being adorable, it’s just about all we do! The cynic in me wants to believe that insomnia simply did not exist before 2007, when the FDA approved Ambien for the treatment of insomnia. But, realistically, insomnia (in addition to anxiety and stress) has probably been around since the day we became capable of worrying about our existence and all of the problems (first-world and others) we inherit with it. It’s a side effect of our developed frontal lobe. At some point in our lives, sleep goes from being something we do, to something we try desperately to do. As a country, and perhaps as a species, we are not doing a great job at it; and it may be costing us our health.
For me, nothing captures the idea of sleep debt quite like my years as a college student. In a story that repeated itself weekly, if not daily, I would squander my days soaking up the “college experience” (details spared) and spend all-nighters cramming, only to find myself wandering through a suffocating mire of brain fog as I walked into my exam the next morning. Research has supported what I learned firsthand: that sleeping too little (or not at all) can inhibit your productivity and ability to remember and consolidate information. Basically, the brain needs dedicated down time to neatly organize, categorize, and file away new facts you learn throughout the day. This organizational process makes it easier for you to locate, and remember, those facts in the future. More recent studies have shown that increasing the amount of sleep that kids get (in one study, by delaying the start time of high school students), can improve their mood and behavior. Pretty intriguing stuff.
Another emerging area of sleep research is in athletes. Despite the dedication to conditioning, strength training, and nutrition, very little attention has been paid to an athlete’s sleep habits. Some of the earliest adopters of change, however, are found in the running world. Here coachers and trainers routinely emphasize the importance of rest days and sleep as a part of, and not an alternative to, a successful training regimen. Just as your brain needs down time to consolidate information, your body needs down time to allow muscles, bones, and supporting structures to heal and to consolidate training gains. In fact, during the final few weeks of race training (i.e half-marathon, 10K), when you typically “taper” down the weekly mileage, sleep may become the most important part of your training routine.
The benefits of sleep may seem intuitive in a general sense, but if you put on your science goggles for a second, you’ll see why this makes sense at the biological level. We’ve discovered that growth hormone is preferentially released from the pituitary gland during the third and fourth stages of the sleep cycle (known as “deep sleep”). Although it has gained notoriety as a performance-enhancing drug, growth hormone (in its natural form) plays a key role in building and repairing muscle tissue and bones, and acts as a catalyst for the body to use fat as fuel. When a person is chronically sleep deprived, their level of HGH decreases. Remarkably, even a few consecutive days of decreased sleep has been shown to disrupt glucose metabolism and glycogen synthesis, curtailing the supply of one of the body’s major fuel sources during exercise.
On the flip side, extending the numbers of hours an athlete sleeps (easier said than done) may actually enhance athletic performance. In a study of players on the Stanford men’s basketball team, extending sleep hours over a 6 week period to a minimum goal of 10 hours a night was associated with more accurate shooting, faster reaction time, and improved overall ratings of physical and mental well-being. Not bad, considering the study took place over 10 weeks during a rigorous NCAA basketball season. Despite these promising results, an obvious shortcoming of the study is that the Stanford team has not made the NCAA tourney since 2008 (we couldn’t resist the jab).
Perhaps the most important application of sleep research, however, is the effect of sleep deprivation on our nation’s youth. In a study of high school athletes, researchers found that kids who slept less than 8 hours a night were 70% more likely to sustain athletic injuries than their well-rested peers. For years, researchers have known that adults who under-sleep are at a higher risk of being overweight, and now we are finding that children who under-sleep (less than 10 hours a night) may be at risk for weight gain as well.
Losing just a couple hours of sleep for a few nights in a row can lead to almost-immediate weight gain, as you start to overeat carbohydrates to compensate for the lost sleep. This is all in spite of the fact that sleep deprivation may actually increase a person’s metabolism in the short-term. The extra energy burned while awake longer is no match for the sleep-deprived appetite.
So where do we go from here? It doesn’t take a great deal of arm pulling to convince people that sleep is good. I wouldn’t be surprised if a near-majority of people admitted to under-sleeping every now and then. The question is, “How do I do it?” Before you start chasing that dreamy green butterfly from the Lunesta commercial, follow medicine’s ultimate mantra: First, do no harm. When it come to sleep, this translates to: First, do no pills. At least not until you try these alternatives, courtesy of the National Sleep Foundation:
- Establish consistent sleep and wake schedules, even on weekends
- Create a regular, relaxing bedtime routine such as soaking in a hot bath or listening to soothing music – begin an hour or more before the time you expect to fall asleep
- Create a sleep-conducive environment that is dark, quiet, comfortable and cool
- Sleep on a comfortable mattress and pillows (invest in sleep; think about how much time you spend in bed)
- Use your bedroom only for sleep and sex (keep “sleep stealers” out of the bedroom – avoid watching TV, using a computer or reading in bed)
- Finish eating at least 2-3 hours before your regular bedtime
- Exercise regularly.
- Avoid caffeine and alcohol products close to bedtime and give up smoking
If you are faithfully doing all of the above and you still find yourself struggling to get the sleep you need, it’s time to bite the bullet and talk to your doctor about medications to help you sleep. But don’t be a sucker for clever pharmaceutical marketing (the names of nearly all new sleep pills contain the letter Zzzz…) and expect a painless quick fix. Yes, they are somewhat safer than the previous generation of sleep aids (notably benzodiazepenes and barbiturates), but they are not without side effects, including amnesia, daytime sedation, parasomnias (like sleep walking) and, rarely, hallucinations. You can also develop a dependence to these medications; and, perhaps, as a nation, we already have (in 2011, Ambien was the 12th most commonly prescribed pill in the US.
Take your sleep, and your health, seriously. Time to find out what a good night’s sleep can do for you…and your 10K time. Be your best…in bed.
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Dr. Kim’s Training Log