If you don't snooze, you lose

A national trend toward less sleep has serious public health ramifications.

Vahid Mohsenin, MD, director of the Yale Center for Sleep Medicine, and colleagues are studying sleep apnea, a disorder characterized by pauses in breathing during sleep. Left untreated, it can increase the chances of high blood pressure, heart attacks and stroke as well as work-related and driving accidents.

As grueling as these presidential primaries are shaping up to be, the candidates’ toughest challenge may not be mud-slinging opponents or a muck-raking journalists, but sleep—or the lack thereof. 

Just last week, Bill Clinton, serving as his wife’s surrogate, was caught dozing during a Martin Luther King Day service. Hillary Clinton, running on three hours of sleep a night before the New Hampshire primary, got teary eyed in response to a voter’s question. Rudy Giuliani blamed exhaustion for the headaches that sent him to the hospital, and Mike Huckabee offered his “apologies” for the assassination of former Prime Minister Benazir Bhutto of Pakistan rather than his “sympathies.” 

None of these incidents surprises Vahid Mohsenin, MD, director of the Yale Center for Sleep Medicine. They’re the kind of things that happen when you endure “chronic sleep curtailment,” he says. And nobody, with the possible exception of new parents, medical and surgical residents, and rescue workers, subsists on less sleep than presidential candidates and their campaign workers.

But even if you aren’t a presidential candidate, your sleep time is probably under assault. Since the advent of electricity, television stations that no longer sign off at midnight, home computers, Netflix and other 24/7 diversions, sleep curtailment has become a feature of modern society and a badge of honor in some circles. Surveys have found that in 1960, Americans got an average of 8 ½ hours of sleep a night. Today, that number has dropped to between six and seven hours, with women about 10 percent more likely than men to be sleep compromised.

“People don’t tend to look at sleep as an essential, like food, water, or air, but it’s absolutely essential,” Mohsenin says. “We spend about a third of our lives sleeping. There must be a good reason.”

Sleep needs vary widely from person to person, Mohsenin says, but most people will start to show signs of serious impairment if they are deprived of sleep for even a few days.

Some of those problems include:

• Difficulty with higher-level problem solving
• Mood changes, including a lack of tolerance
• Increased appetite and weight gain. (A spike in incidence of obesity during the second half of the 20th century coincides with an average 1 ½- to 2-hour reduction in the amount of time people sleep, suggesting that sleep loss plays a role in the obesity epidemic.)
• Glucose intolerance. (This suggests that sleep loss is involved in an increased risk for type 2 diabetes.)

From what Mohsenin has seen of the presidential candidates, he thinks they’re handling the lack of sleep fairly well, but he suspects that if he were to observe them up close, the signs of impairment would be obvious. The key, he says, would be to ask them something they should know or be able to calculate easily, but that they hadn’t memorized or rehearsed in advance.

When Mohsenin tests on-call residents at the end of their shifts, he asks them to calculate a patient’s anion gap, a piece of lab data that involves simple arithmetic. “It takes them forever,” he says. “They can’t do it in a timely manner.”

People have come up with many home remedies to fight fatigue: coffee, Jolt Cola, NoDoz, loud music and cold showers. The trouble, Mohsenin says, is that, eventually, these measures stop working. “There’s really only one remedy that works: sleep,” he says. “We have an internal drive to sleep. No other counter-measure is going to work.” However, if a period of sleeplessness is inevitable, Mohsenin recommends taking short power naps. 

People need to be protective of their sleep time, he says. As the presidential candidates are learning, “nothing is more detrimental than being tired.”