There have been reports from time to time about the dangers of going without sleep. More recently, there was a report about the dangers of sleeping medicine. According to that report, there was a greatly increased risk of death in people who used sleeping medicines frequently over a period of only a few years.
I will not try to summarize the scientific studies on sleep deprivation since the literature is extensive. Let me suggest a way of looking at this problem: the risk of going without sleep for short periods of time is greatly exaggerated. People can still function well intellectually on little sleep. Even when a subject is kept up purposely for a period of days ( not easy to do since people tend to fall asleep over and over again in those circumstances) the principal intellectual deficit that person exhibits is some difficulty doing rote tasks (adding numbers, for instance.) When I was a medical interne, I, and my colleagues, stayed up routinely all day, all that night, and all the next day to deal with medical problems. If someone claimed that he made a mistake because he was sleepy, he would have been laughed at or admonished by the attending physician. The principal bad effect if not getting enough sleep is to be sleepy the next day. Of course, driving while sleepy should be avoided.
On the other hand, there are obvious medical problems that come from the chronic lack of sleep. The poor and interrupted sleep caused by sleep apnea, for instance, is associated with hypertension. Similarly, certain mental disorders such as bipolar disease or schizophrenia can be provoked by even relatively short periods of time without sleep. It is not prudent for someone to set up a work schedule that makes it impossible to get enough sleep.
Chronic lack of sleep has a number of causes:
1. pain. Back pain in particular is a common cause of insomnia.
2. depression. People suffering from a major depressive disorder develop a characteristic sleeping pattern, in which they usually fall asleep readily but wake up intermittently during the night and then too early in the morning. This is likely to happen day after day and week after week. This condition requires drug treatment.
3. the fear of insomnia. Most long-term difficulties falling asleep fall into this category. Some people have developed the idea that it is critically important for them to get enough sleep–otherwise, they may say, they will have panic attacks the next day, or get upset readily, or be “unable to function.” Insofar as these things are true, they are likely to be true because the individual believes them. However, their whole life experience confirms these ideas to them, so that it is for the most part impossible to convince them that they are wrong. In any case, feeling desperately that they must get to sleep, they become too anxious to fall asleep readily.
This last group of insomniacs will improve if they agree to the following changes of sleep habits
1. Turn the clock to the wall at night. There is no reason anyone has to know the time in the middle of the night. Often, insomniacs look at the clock in the middle of the night and get upset because they are not sleeping–which wakes them up more. They see the clock say 3 A.M., then 3:10, then 3:20 but do not recognize that they are often asleep between those times. Everyone sleeps more at night then they realize, although that person may not have good sleep. It had been amazing to me to discover that people are resistant to making this simple change. “I have to know what time it is in the middle of the night!” one patient exclaimed to me before storming out of my office. Another patient I saw the same week cured his life-long insomnia in the space of a few days by this simple expedient
2. Don’t spend any time in bed except when sleeping. For the most part, this means not watching television or reading (unless reading is part of a ritual that puts you to sleep within a few minutes.) People are a little like parrots. If you cover their cage, they go to sleep. They associate the dark with sleeping. Similarly, people should associate going to bed with sleeping.Going to bed should make you sleepy.
3. No coffee after 3 P.M. The caffeine can last for a long time, and some people are particularly subject to its effects. No alcohol after 7 P.M. Alcohol puts people to sleep, like a sleeping pill, but wakes them up after a few hours.
4 No naps. Someone who naps during the day is less likely to fall asleep readily at night.
5. (Most difficult of all) Someone with sleeping problems should get up at the same time 7 days a week. Even if he is out partying Saturday night to two in the morning, he should still get up at his usual weekday awakening time. Otherwise, if he sleeps late Sunday, he will have trouble falling asleep Sunday night.
These are rules for people who complain of insomnia. Otherwise, I see no reason why most people should not nap, for example, or sleep late.
I don’t recommend any mental measures, like relaxing exercises, or counting sheep, for falling asleep. I think, for the most part, they require paying attention and are likely to wake you up. I also don’t think it matters whether or not you sneak up on falling asleep by limiting your activities in the evening.
Sleeping medications
The chronic use of sleeping medications, like the chronic use of laxatives, is likely to make the underlying condition worse. Sleeping medicines should only be used occasionally, since the body develops tolerance to them quickly.
After using any of these drugs for only three nights in a row, the fourth night, if the person skips his medication, will be marked by delayed onset of sleep and interrupted sleep. For that reason, I recommend that persons used to these drugs try to skip every fourth night. It is very difficult for someone accustomed to taking these drugs to stop. Often, I have to prescribe them in very slowly lessening amounts for a patient to break this undesirable habit. The benzodiazepines, (Xanax, Clonopin, Ativan and Valium) should not be prescribed for sleep for college students, since they interfere with memory. Otherwise, I think there is little to recommend one sleeping medication over another. Over the counter Benadryl works as well as some of the newer and more expensive drugs. Obviously, any drug that is long-lasting enough to make you sleepy in the morning shold be taken in lesser amounts or avoided altogether.
I think the occasional use of sleeping medications is sensible in those situations where someone is upset right before going to sleep by something that cannot be dealt with properly until the next morning.