Sleeping Baby

They say that laughter is the best medicine, but I will respectfully disagree. Sleep is.

A lot of things are going on during that one third of our life when we look like we are not doing very much at all. There is physical rejuvenation and resting of muscles, and nutritional resources get moved around.

Dreaming plays a vital psychological and neurologic function. When dreaming we are actually paralyzed to prevent our very active brains from moving the body that is trying to rest. At night, the liver ramps up some processes and shuts down others. Many important things are happening during sleep, and we even know what a few of them are.

Sleep is influenced by our internal circadian rhythms, or clocks if you will, that cause release of melatonin, change body temperature and make us start to feel that drowsy feeling. Our emotional state and habits, or learned behaviors, also play important roles.

Then there is the culture we live in. Americans are stereotypically driven to be up early, work late and sacrifice sleep. If you have ever walked around town in Spain or South America in the early afternoon and wondered where everybody is at, you would have seen that others have different views.

We know that on average humans need eight hours of sleep. Some individuals need less, some surprisingly little, and some more, like children and teenage boys. Lack of sufficient sleep – whether voluntary to go dancing, last minute preparing for that midterm test or big presentation at work, or involuntary, due to pain from a broken leg or back injury that just will not let you rest – decreases alertness and cognitive function, slows memory and messes up coordination. It affects us much like intoxication, and while it lags behind alcohol as a cause of traffic accidents, it right up there with texting. However, unlike alcohol, which given enough time will metabolize away, the only cure for sleep deprivation is to sleep.

There are some things that you can do to get good restful sleep without any chemistry involved. First, get on a good schedule and stick with it. Have a regular bedtime and set the alarm for the same time every day (pretty soon you will not really need the clock), even on weekends. Avoid working out too late in the evening and have the same routine as you prepare to sleep. Make sure your bedroom is comfortable for you and is dark or at most has faint indirect light. Don’t discount those eye masks; they work great in barracks or if you have roommates.

Evict the television! That used to be one of the worst sleep disruptions; now it shares that distinction with tablets, laptops and smartphones. That is because there is a physiologic stimulation from the blue spectrum of the screen lights as well as the mental stimulation of the content. Most new devices have a setting that will dim and decrease the blue light component. Use it in the evening! If you must use those devices, do not do it in bed. Even reading old-fashioned paper books should be in a comfortable chair, not in bed.

As much as we do not yet know about sleep, there is a whole branch of medicine to treat the maladies of that one-third of our lives. In my years of practice in many circumstances, sleep problems are incredibly common. One of the most common is Obstructive Sleep Apnea, and we can blame gravity and how some of us are built.

As we fall asleep we relax, and that includes our tongue and jaw muscles. Then gravity pulls them down into our airway, obstructing the flow of air when we inhale. Since we still need oxygen when we are asleep, we have autonomic reflexes that kick in when we don’t get it. They start to wake us up part way until the muscle tension in the jaw builds back up and lifts it out of the airway and the flow of sweet air is restored: mission accomplished. The body goes back to a deeper sleep state, but unfortunately the law of gravity has not been repealed and the process repeats itself.

This really disrupts the architecture of sleep, prevents dreaming and resting. One awakes feeling unrefreshed and sleepy during the day and is plagued by other effects of sleep deprivation and hypoxia. Obstructive Sleep Apnea is treated by resisting gravity with airway pressure, but that is a whole other discussion.

If you feel tired and it is too easy to fall asleep or your alertness is suffering, look at your sleep.  If you can’t seem to fix it yourself, don’t be afraid to mention it to your doctor. You won’t be the first, and there is something that we can probably do something about it.

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