During the tech stock boom in 1999, the Wall Street Journal ran an article entitled “Sleep, the New Status Symbol.” The newest perk among CEOs, announced the Journal, was eight or more hours of sleep. “Once derided as a wimpish failing – the same 1980s overachievers who cried ‘lunch is for losers’ also believed sleep is for suckers – slumber now is being touted as the restorative companion.” A good night’s sleep spun as a status-related perk for players? You couldn’t find better evidence for North American culture’s departure from common sense, and our circadian rhythms, linked to the planet’s slow cycles of light and darkness.

There is a sensual aspect to falling asleep – the drift of consciousness into reverie and then comfy oblivion – that our competitive culture has always found a bit suspect. Type A personalities still tacitly regard a six hour-plus absence from productive activity as a necessary evil or, at best, a provisional state that science will eventually correct.
We spend about a third of our lives asleep. It’s a dynamic process characterized by well-defined shifts in electroencephalic activity, as we move from the rolling delta waves of deep sleep to the spiky waves of REM sleep. Sleep involves self-repair in its largest sense, of body and soul. But we’re getting less and less of it; many North American workers are toiling under a sleep deficit. Our health ends up being compromised by cumulative overdrafts on our “sleep banks.” What we lose in the process is precious: energy, mood, immunity, coordination and cognition. Many workers endanger themselves and others as a result.

In 1960, the American Cancer Society surveyed one million Americans, asking how much sleep they were getting a night. The median answer was eight hours. The number from current surveys has fallen to 6.7 hours, a decrease of more than 15 percent.

“Stress and anxiety are at a fever pitch, which limits the ability to sleep well,” according to David White, a Harvard professor of Sleep Medicine. “And there is more science than ever showing what a detriment that state is to performance and health.”

“This is a huge and intractable problem,” noted Dr. Bradford Weeks in a talk at the Nutritional Medicine Today 35th Annual International Conference on orthomolecular medicine in Vancouver. Weeks observed that 62 percent of Americans report sleep problems and that 80 percent of patients never discuss sleep problems with their doctor. He added that three out of five adults claim they have never been asked by a doctor – in their entire lifetime – how well they sleep.

In a recent study at the University of Pennsylvania, paid volunteers spent a week and a half in a dimly lit hospital ward, wired up to electrodes. Their mission: to stay awake until 4 AM. They were then awakened at 8 AM for five nights in a row. David Dinges, who directed the study, was amazed at the “cumulative impairment” that resulted from “chronic, partial sleep deprivation.” The volunteers’ ability to think quickly and remember things was worse by the first day. The second day was worse than the first, and the third worse still.

Lack of sleep can result in serious, personal risks. In a study published in the British Journal of Occupational and Environmental Medicine, researchers in Australia and New Zealand reported that sleep deprivation can replicate the effects of being drunk. Getting less than six hours a night can affect coordination, reaction time and judgment, “posing a very serious risk, “the researchers say, especially to commuting workers. They found that people who get behind the wheel after being awake for 17 to 19 hours performed worse than those with a blood alcohol level of .05 percent, the amount of alcohol someone can consume and still drive legally in most western European countries. One estimate holds there are 42,000 deaths a year in the US from people falling asleep at the wheel.

The dozing lapses of commuters are called “micro-sleeps.” They can even occur when people have their eyes open, and it takes only seconds for a vehicle to end up in a ditch or worse. Dr. Stanley Coren, a professor of psychology at the University of British Columbia, offers a colourful condemnation of sleep-deprived drivers. “It may… come to pass that someday the person who drives or goes to work while sleepy will be viewed as being as reprehensible, dangerous, or even criminally negligent as the person who drives or goes to work while drunk. If so, perhaps the rest of us can all sleep a little bit more soundly.”

“Dreaming permits each and every one of us to be quietly and safely insane every night of our lives,” noted sleep researcher William Dement. The implication being that if we don’t get to sleep properly at night, with an opportunity to descend into our nocturnal dream worlds, we may go a little nuts during the daytime. Activity in the amygdala – the place in the brain where rage originates – is normally processed through the frontal lobes, which modulate and often override the primitive signals from the amygdala. But laboratory subjects deprived of sleep display “a hyperactive brain response” similar to that found in people with major psychiatric disorders. Road rage, anyone? It’s no surprise that during the morning and afternoon commutes, unknown numbers of sleep-deprived drivers going ballistic over the minor and major lapses of other sleep-deprived drivers. From what we know of the neuroscience of sleep, you’d expect it.

Dr. Stanley Coren points out that that sleep-deprived workers were a common factor in the 1989 Exxon Valdez oil spill off the coast of Alaska, the 1979 near-nuclear meltdown at Three Mile Island in Pennsylvania, along with several other nuclear power plant incidents. The Chernobyl disaster followed a similar template, says Coren, in his book Sleep Thieves: “we have a case of rotating shifts, some crew members working extra long hours, and the bodies and minds of the plant operators winding down in the bottom of the daily alertness cycle, when the pressure to sleep is the greatest.”

More recently, the assistant captain who crashed the Staten Island ferry into a pier, killing 11, admitted that he felt exhausted prior to the accident.

Sleep debt leaves its mark on bodies as well as minds. Perhaps the most dramatic health deficits from sleep deprivation are found in shift workers. Night-shift workers have a 40 to 50 percent increased risk of heart disease compared with day workers, according to various studies. It’s also common for these workers to get only five hours of sleep, making them 50 percent more likely to be obese than normal sleepers. Female night-shift workers have higher rates of miscarriage, pre-term birth and low birth-weight babies. Night-shift workers also suffer greater rates of breast and colon cancer.
A raft of studies has recently been released tying sleep loss to weight gain as well. The explosion of obesity among working North Americans may have as much to do with sleep deprivation as diet. The latest studies now link sleep loss to an increase in diabetes.

Even electric light is implicated in sleep-related health problems. Animal studies have shown that exposure to dim light during the night can substantially increase tumour development. This is why sleep doctors counsel against down time with computers, cell phones or television right before sleep. The artificial sources of light can fool the pineal gland (the third eye of mystical lore) into reducing melatonin, the sleep-enhancing neurochemical associated with natural circadian rhythms.

Modern medicine has had a strangely ambivalent role in the understanding of sleep, as if there is some institutional wall between the research on sleep and the actual practice of medicine. Bradford Weeks cites cases of “iatrogenic insomnia,” or sleeplessness caused by prescription medicine, in particular SSRI antidepressants (selective serotonin reuptake inhibitors) such as Prozac and Paxil.

One recent, widely-publicized study holds that SSRI medications have little more than a placebo effect on all but severe cases of depression. Previously, juvenile suicides have been linked to the widespread prescribing of SSRIs to youth. With doctors dispensing antidepressants like candy over the past decades for mild to moderate cases of clinical depression, the public debate has now moved from debating these drugs’ benefits to debating their potential threats.

In his presentation at the Vancouver orthomolecular conference, Dr. Weeks, M.D., cited the Prozac case of Kelly Silk. One evening, this young mother – allegedly in her sleep – attacked her family with a knife and then set the house on fire killing all but her 8-year-old daughter, who ran to the neighbour’s home. As she stood bleeding and screaming for help, she explained: “Help! Mommy is having a nightmare!”

“Out of the mouths of babes we will understand these nightmares for what they are,” noted Weeks. “She understood that this was something her mother would do only in a nightmare, never in reality. This terrifying new public health hazard is known as a REM Sleep Behaviour Disorder. According to sleep specialists who interpret polysomnograms (recordings of EEG tracing during sleep), in 86 percent of these cases the patients are on SSRI meds. These sleep doctors can even see “Prozac eyes” (erratic movements) in people who are asleep and taking the medication.

Dr. Weeks mused that pharmaceutical companies are engaged in a massive social experiment, interfering with health consumers on the deepest level, at the level of their dreaming minds. Contacted by email, he elaborated further on the health risks. “The fact of the matter, and I tell patients to ask their sleep doctors if they don’t believe me, is that SSRI drugs disrupt sleep physiology and interfere with the restorative aspects of deep sleep. And that is a very, very dangerous thing to do – for reasons we are only now beginning to realize – but which Kelly Silk’s daughter knows all about.”

Considering what science knows of sleep deprivation, it’s truly astounding that hospitals across North America continue to push interns on sleep-deprived rounds, potentially endangering the lives of patients. In a 1990 study published in the Western Journal of Medicine, four standard tests of cognitive function were given to 23 university hospital house staff. A statistically significant deterioration occurred in three of the four tests after a night on call. Even physicians acclimated to sleep deprivation on a regular basis showed functional impairment. As for cases of physician-caused deaths due to sleep-deprived staff, we obviously have little to go by than anecdotes.

I have one anecdote of my own. In 2002, a doctor in internal medicine on staff at a Canadian hospital told me, over lunch and off the record: “… my team has killed people.” He then qualified that statement by saying the patients were in bad shape and probably would’ve died shortly anyway. He went on to describe one sleep-deprived surgeon next to him pulling on an anaesthetized patient’s gluteus maximus with forceps and then falling backwards onto the floor into unconsciousness, forceps still in hand. I didn’t ask what happened to the patient’s posterior in the process.

One estimate of so-called “Deaths by Modern Medicine,” in the US alone, is over 700,000 a year. This comprises deaths from medical error, bedsores, infection, malnutrition, outpatient adverse reactions, unnecessary procedures and surgery-related complications. One has to wonder how many of these deaths had sleep deprivation as a complicating factor, not just among hospital staff but the patients themselves.

Perhaps our bodies are smarter than most physicians trained in western medicine have been willing to credit. There’s plenty of scientific evidence of an intelligent system inherent in our own physiology. In 1932, Walter Cannon’s book The Wisdom of the Body popularized the idea of “homeostasis,” a fifty-dollar word meaning self-regulation. In his now out of print work, Cannon examined the ways in which the body, through feedback loops, keeps itself on an even keel, maintaining glucose concentrations, body temperature, acid-base balance, and innumerable other equilibria. “Homeostasis does not occur by chance, but is the result of organized self-government,” Cannon insisted.

Homeostasis is old hat to physicians, but it’s rather odd how many have failed to understand its significance. Given exposure to a natural environment, with environmental stressors minimized, the body is far more likely to perform in an optimal way. All our bodies need to express their innate wisdom is for us to get out of the way. Among the most important barriers to remove are those to a good night’s sleep – artificial light sources, lifestyle drugs, sedentary living and poor nutrition.

“We term sleep a death, and yet it is waking that kills us, and destroys those spirits that are the house of life,” wrote the English poet Thomas Browne in 1643. It may well turn out that a host of diseases are traceable, at least in part, to sleep-deprived lifestyles. The problem does not lie with the wisdom of the body, but with the foolishness of our hyper-caffeinated culture, in which pill-popping wage slaves are, quite literally, working themselves to death.

Sleep is still regarded in some quarters as only a degree’s separation from sloth. Luckily, attitudes are changing. There is increased awareness in the public and greater media attention, on the fundamental necessity of a good night’s sleep. It’s what makes the motto of BC’s Work Less Party, “Alarm clocks kill dreams,” as seductive as it is subversive.

In Sleep Thieves, Coren quotes a busy manager of mutual funds, expressing a viewpoint that is already starting to sound dated. “Sleep is a waste of money. The only way to make money is to be awake, all the time. That way you are ready when opportunity comes, and you can make the right decision at the right moment.”

Coren offers a more sensible counterpoint: “Sleepiness is a waste of money. The only way to make money is to be rested enough so that you are actually awake when the opportunity comes. Only then can you logically select the right alternative at the right moment.”

In the end, it was said best decades ago, by Brave New World author Aldous Huxley: “That we are not much sicker and much madder than we are is due exclusively to that most blessed and blessing of all natural graces, sleep.”

So go ahead and slap that snooze button; your deeper self will thank you.

mwiseguise@yahoo.com