Sleep Debt: The Ticking Bomb
By Christie Keith

How sleepy are you? The answer might surprise you. A 1999 survey found that millions of Americans are suffering from daytime sleepiness that interferes with their daily activities. One of the most dangerous effects of this sleepiness is on the road. According to National Highway Traffic Safety Administration reports, “Drowsy driving causes at least 100,000 crashes in the United States each year…. In NSF survey responses, 62 percent of adults (72 percent of men and 54 percent of women) reported driving while feeling drowsy; and 27 percent (36 percent of men and 20 percent of women) said they have dozed off while driving in the past year.”

The founder of the world-famous sleep clinic at Stanford University, William C. Dement MD Ph.D., in his book The Promise of Sleep: A Pioneer in Sleep Medicine Explores the Vital Connection Between Health, Happiness, and a Good Night’s Sleep, writes, “We are a sleep-sick society. I understand this sad fact all too well. I have spent my entire career, more than 45 years of nights, studying sleep. When I first entered medical school in 1951, sleep was little more than a curiosity to the scientific world, it was almost totally ignored in medical practice. Over the ensuing decades, we have learned enormous amount about the nocturnal third of our lives. Today sleep science is exciting and diversified, utilizing all the tools of modern molecular biology and addressing great scientific questions.” Nonetheless, according to the National Sleep Foundation, 95 percent of all sleep disorders remain undiagnosed.

Sleep Debt
Dement describes the phenomenon of “sleep debt,” and says that most Americans, including teens and children, are carrying around an unpaid debt of sleep that is at the root of a large number of life-threatening health problems, including fatal heart attacks. Ignorance among the general public, even among family physicians, about the symptoms and treatment of sleep disorders, a profound dismissal of insomnia and fatigue as emotional problems, and a lack of understanding of sleep cycles and the amount of sleep people really need are responsible, he says, for hundreds of thousands of deaths each year.

“If even the basic facts about sleep had been known and understood by the general public and its doctors over the years, there’s no way of knowing how many human beings now dead- possibly millions; perhaps even relatives of yours- might be alive today. Never before in human history has a disparity between the amount scientific knowledge in the benefit of that knowledge to society concert tragically vast,” he writes.

Drowsiness Is a Red Alert
Have you ever been driving and felt very drowsy? Maybe you were close to home, so you rolled down the car window, turned up the music, and pushed on. Dement warns that drowsiness is a red alert, a sign that your body might actually fall asleep without your awareness or intent. The sense of relief that home is near can actually increase the likelihood that you will in fact fall asleep. Most people do not feel that safe driving is impaired until they feel drowsy, while in fact, according to Dement, drowsiness is a sign that you are in the very last stages of the danger zone.

“Drowsiness is a red alert! Drowsiness is an emergency and calls for an emergency nap. When you are in a dangerous situation and the eyelids start to close, you may be at death’s door,” he says.

Sleep HygieneB One of the simplest “prescriptions for a sleep sick society,” says Dement, is to improve our sleep hygiene. This is a fairly simple lifestyle change, involving an avoidance of caffeinated beverages, alcohol, and nicotine a few hours before bedtime, sleeping in a cool, dim and quiet room, and avoiding stimulating exercise, television shows, or discussions prior to going to bed. It involves figuring out how much sleep you need each night (usually but not always eight hours), and then getting that amount every night during the week. (No, you can’t “catch up” on the weekend.) It’s also crucial to get up at the exact same time every morning, all week long.

Sleep Apnea
One of the most under-diagnosed sleep disorders is the breathing obstruction known as sleep apnea, which may affect as much as 30 percent of adults. Sleep apnea is a condition that, during sleep, causes the airway to relax so much that the sleeper cannot breathe. Seconds go by, during which the sleeper is without air. Suddenly, the body rouses to a state of sufficient wakefulness to begin breathing again, although the person never realizes they stopped breathing or woke up at all. These people wake up feeling unrested, and suffer from daytime sleepiness of varying degrees. Some cases are so severe that the sleeper ceases beating thousands of times per night, literally strangling in their sleep. Sleep apnea can cause severe and fatal heart disease.

Half of all Americans have trouble sleeping, at least some of the time. For some, insomnia only lasts a few nights, and is directly linked to a period of exceptional stress. When the stress is resolved, the sleep problem goes away. Insomnia that persists for two or three weeks can be caused by stress, or can be an indicator of serious medical problems. Chronic insomnia, which can last months or even lifelong, generally has serious physiological causes. The effects of insomnia include feelings of unhappiness and confusion, poor memory, and an inability to concentrate.

How Big is the Problem?
The NSF survey found that 62 percent of Americans “experience problems sleeping a few nights a week or more. Fifty-six percent of adults report experiencing one or more symptoms of insomnia, including difficulty falling asleep, waking during the night, waking too early, or waking feeling unrefreshed.” Nonetheless, they found that only 4 percent “of adults who experience frequent sleep problems are currently seeing a doctor or healthcare provider for advice or treatment. And nearly two thirds (61 percent) of U.S. adults have not been asked by their doctor how well they sleep…. Eighty-three percent of the adult public failed NSF’s test of sleep knowledge.”

Need More Information?
For more information on sleep, call 1-888-NSF-SLEEP, or to take NSF’s on-line sleep knowledge test; visit their Web site at

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