Sleep: the missing ingredient

Sleep is one of those things, like cleaning the house: only when it’s not happening do we notice it. But then, by the time those dark circles have tattooed themselves under our eyes, we’re addled and desperate for the quickest fix: the four cups of coffee to get us through the work day, the sleeping pill, a couple glasses of wine before bed, crashing early on the couch in front of the TV. These things don’t help; in the long run, they do just the opposite.

Excuse me. I’m off to grab my second cup of coffee to get me to noon. I couldn’t write another sentence without it.

More and more of us are finding ourselves on this carousel. Americans filled a record 60 million prescriptions for sleeping pills in 2011, up from 56 million in 2008, and from 47 million in 2006. It’s bad news, and not just for co-workers who have to watch as you are reduced to tears by a printer jam. Lack of sleep is now being implicated in all sorts of grizzly, even life-threatening conditions, from depression to diabetes to cancer to obesity to dementia.

Of course, if the only time you think about sleep is when you’re not getting it, and when you’re not sleeping well your brain is foggy and your short-term memory is shot, it can be near impossible to pull yourself out of the quagmire without a little help. So Dirt sought out three professionals – a holistic healer, a health counselor, and the director of a hospital-affiliated sleep study center – to find out what’s keeping us up at night, and how we can get back to feeling human, even before that second cup of coffee.

The 12 days Fran Sussman was without power after Hurricane Sandy were the best nights of sleep she’d had in years. Sussman, a holistic healer, was going to bed when it got dark because there was nothing else to do. “I work ‘til 8:30 most nights, so I can’t really do that. But the more we can stick to the natural cycle, the better we feel,” she said.

“That whole early to bed, early to rise thing makes sense. Our systems haven’t evolved to keep pace with the fact that we can have life and light 24 hours a day.”

That sounds nice, but who can do that? Even if you had no obligations or social life, no laundry to fold or spouse to eat dinner with, it would be embarrassing to go to bed at 7pm. Right?

“Part of the problem is cultural,” said Sussman. “We see the need for sleep as weakness, and the ability to get by on four hours” as a badge of honor. For some reason, we’ve also decided that we need less sleep as we get older, which is categorically untrue. You need the same amount of sleep – for most of us, that’s between seven and nine hours – you got when you were a kid. Your sleep may become more fragmented as you age, but that doesn’t mean you don’t need the shut-eye.

Sussman and I are chatting in her home-office in Chester, NY over a cup of English rose tea, Sussman with her rescued toy terrier Lucy on her lap, snoozing. Lucy, all ten or so pounds of her, provides a counterpoint to the modern day overworked, overweight, over-stimulated American. She doesn’t care if people think she’s lame because she’s sleeping in the middle of company. Granted, if Lucy were human she’d probably be labeled narcoleptic, but the point is, she’s a paragon of chill.

People are coming into Sussman’s office “wired and tired.” Either they are exhausted but so stressed that they can’t fall asleep at night, or they crash, only to wake up over and over. At first, Sussman told them not to use electronics for 90 minutes before bedtime. “The light you get from phones, computer screens close to your face, activates the brain in a way that makes it hard to fall asleep,” she said.

But she soon found out that “people can’t do 90 minutes. It feels like their world is falling apart. I’m trying 45 now.”

How’s this for motivation? In a recent study, English researchers had one group of test subjects sleep for six-and-a-half hours and another sleep for seven-and -a-half hours. After just a week, blood tests showed that in those who slept an hour less, genes associated with heart disease, diabetes and cancer became more active, as did genes linked to inflammation, immune response and response to stress.

“We call that hyper-vigilance,” said Sussman, of the stress response. “We all have stress in our lives, it’s how you react.” Hyper-vigilance, what a concept. Imagine: Sorry I smashed the jammed printer with a baseball bat, I was feeling hyper-vigilant because I was up all night with the baby. Or: That raving lunatic in the left lane who just flipped me the bird? I bet he’s acting hyper-vigilant because he didn’t get his eight hours.

But here’s the real ace in the hole, one that was reaffirmed by each of three sleep authorities we talked to: Not getting enough sleep makes you fatter. Sleep deprivation decreases your metabolism and biochemically creates cravings for crappy food, the one-two punch. “The old lizard part of your brain that’s supposed to be running in the background takes over for the prefrontal cortex,” said Sussman. “It wants quick sugars and carbs.”

Excuse me while I un-wrap this Milky Way. It’s Monday, and it’s almost four p.m. You understand.

People think they need more willpower, when in fact they just need more sleep. “I tell my clients: Get eight hours of sleep and you’ll lose a few pounds,” Sussman said.

The less sleep you get, the more you’re likely to weigh. The more you weigh, meanwhile, the worse you’re likely to sleep. An example: Gale Lordy, a holistic health counselor in Warwick, has a client whose “weight was in the 400s, and he had sleep apnea due to that.” Like most of Lordy’s clients, he had come to her to lose weight. His doctors were encouraging him to get lap band surgery and to go on medications, but he didn’t want to go that route.

Five weeks into his bi-weekly sessions with Lordy, “his biggest thrill,” she said, “was he was able to get into bed. He had been sleeping in a chair. He’s a young man. This will change his whole life.” To fix his weight problem, he first had to fix his sleep.

That inextricable relationship between sleep and weight is probably why business is booming at sleep centers. The population is heavier than ever, and suddenly you can’t find a sleep center that isn’t “newly expanded” and “state of the art.”

The Sleep Disorder Institute of St. Anthony Community Hospital moved off-campus in 2013 and doubled in size. Now it’s like a mini hotel, a four-bedroom affair with a good looking lobby on Main Street in Florida, NY. Between 30 and 40 people spend a night here each month, where they are hooked up to a web of sensors that record brain waves, breathing, blood oxygen, leg and eye movements.

One room has a special bed that can accommodate a patient up to 700 pounds, another has a crib-bed for babies and kids. Although the official line is that the bedroom should only be used for sleep and sex, there are TVs in the sleep study bedrooms, a concession to the real world. (The remote gets taken away at 11pm).

People come in for sleep studies for all sorts of reasons – chronic fatigue syndrome, periodic leg movements, narcolepsy – but the most common by far is sleep apnea, which is when the back of your throat relaxes and closes up during the night, and you actually stop breathing from a few seconds to as long as a minute. Sleep apnea is a “silent killer,” stressing your heart and eventually putting you at higher risk of stroke. Signs you might have sleep apnea include not having refreshing sleep, snoring, significant weight gain, heart disease, or if someone has heard you pause in your breathing while you sleep.

According to the official data, about two percent of women and four percent of men now have obstructive sleep apnea, but Dr. Deogenes DeLeon, the medical director at the sleep center, thinks that number is low. “The number of people with sleep apnea and related disorders seems to be increasing,” he said. “Most are weight related, as the population gets heavier.”

DeLeon pours himself a Keurig coffee and sits down on a couch in the lobby of the sleep center. [I’ll have a cup, too, thank you.] He should by all rights be tired, since his three-week-old baby is sleeping in a crib near his bed. But he doesn’t appear frazzled. He sleeps great, which he laughingly attributes to excessive work in the daytime.

Along with obesity, DeLeon points to the economy as an obstacle to sleep. “I see an awful lot of people that work nights, or people that have more than one job,” he said. “They don’t sleep more than a few hours, and then it’s fragmented, too. The kids wake up… If you have interruptions, that’s when people run into problems.”

Then there are the bright lights of our gadgetry, “which have a tendency to move your circadian clock, that tells you when it’s supposed to be bedtime.”

Still, obnoxious kids and iPads pale in comparison to the more insidious effects of weight gain, which can cause fatty tissue to build up in the back of the throat and lead to as many as 30 blockages an hour in severe cases of sleep apnea. Imagine being disturbed every other minute.

In the 1970s, the treatment for sleep apnea was a tracheotomy, so, needless to say, it went mostly untreated. Now, the condition can be treated by wearing a mask at night that blows air into your nose and keeps your airways open. About a third of his patients hate the device so much they won’t wear it, DeLeon said. Another third don’t like it but put up with it.

The contraption, though, is just the beginning of the treatment. The next step is a literal one, perhaps on the Stairmaster. “I tell everybody to lose weight,” said DeLeon. “I treat the sleep apnea so the energy level’s good, so they can lose weight.”