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LIKE YOU, I HAVEN'T BEEN SLEEPING WELL
by Robert Sullivan, Reporting by Anne Hollister

Like you, I can't stand that my nights and days are ruined. Like you, I want to do something about it. Which is why, I find myself standing in a small white room on the seventh floor of New York City's Bellevue Hospital. There's a hole in the wall with wires protruding, a Naugahyde armchair next to a bed and a camera mounted in the corner. A technician enters with a fistful of electrodes.

Welcome to the New York University Sleep Disorders Clinic, one of the 3,000 such centers that have sprung up in recent years in response to a national nightmare - an epidemic of sleeplessness. I and 70 Million other Americans have trouble sleeping. We can't get to sleep, we can't stay asleep. We kick our legs and grind our teeth. We are sleepless babies, heavy-lidded teenagers, dangerously impaired night-shift workers. According to two recent polls and a congressional study, more than 20 million of us suffer from apnea or narcolepsy-serious, sometimes fatal, sleep-related diseases. An additional -- are afflicted by one of 80 other sleep syndromes. We are a nation of zombies-stressed, depressed, sometimes, even suicidal for lack of sleep.

You don't want to overstate," says Dr Neil Kavey, director of the Sleep Disorders Center at Columbia-Presbyterian Medical, also in New York City. But, yes, we have a crisis here." The cost to us as a society is stunning. Nearly two thirds of Americans say sleep deprivation affects their work, which translates into a $70 billion loss in productivity. There are wrecked careers and wrecked cars. Poor sleep is cited as at least a partial culprit in the Exxon Va/dez, Three Mile Island and Challenger disasters. An estimated 38,000 people die each year from the consequences of sleep apnea, says Dr. William Dement of Stanford University, the dean of sleep-disorder research. Another 24,000 die in accidents caused by sleeplessness.

When America has a problem of this size, it usually demands a solution. Not in this case. TV isn't going off the air after the late news, and industry isn't giving up night shifts and 24-hour trucking schedules. Moreover, in a culture where those who complain about sleeplessness are seen as so many weaklings, wimps and weenies, getting by on too little sleep is considered heroic. Jay Leno brags he gets only three or four hours a night, Martha Stewart says she needs only four, and the President can't recall his last eight-hour night. "Not good role models," says Dement succinctly.

Dement and others hope that recent research on the consequences of our national sleep deficit will persuade society to change - psychologically, culturally, even legislatively. "We need to recognize that as a culture we are exactly where we were with drinking and driving in the 1950s," says David Dinges, chief of the Division of Sleep and Chronobiology at the University of Pennsylvania. "People used to think it was O.K to drink to drunkenness, then get in a car. Finally someone said, no, enough. And we've gone all the way from having a civil issue to a serious criminal issue. We need a similar evolution recognizing another large biological impairment, the adequacy of one's sleep, which is an impairment that can afflict anybody and that plays a role in how safe we are."

"There were no sleep disorders before 1970," says Dement, and what he means is there was precious little science. Now instead of groping in the dark, sleep researchers know the nature and extent of the problem - and at least some of the solutions. They understand that pathological sleep patterns cheat a person out of needed rest; that snoring is often a sign of a dangerous sleep impairment; that a car crash without skid marks was probably caused by someone asleep at the wheel. There have also been major breakthroughs in the diagnosis and treatment of sleep disorders. Insomnia, which once was seen as a manifestation of depression to be fought with anti-depressants, is now treated with drugs that adjust neurotransmitters. Sleepwalking and night-screaming, long assumed to be psychological syndromes, are now considered physiological problems.

In the two months that I spent researching this article, I found case histories of all the major sleep ailments - just by talking to my friends. John, an investment banker, has restless-leg syndrome, which causes him to jolt awake, fall back asleep, then twitch awake again a half dozen times a night. Mike, a public defender, has
a truly god-awful time sleeping, He suspects it's stress-related insomnia. Joe, who took the pictures for this story, grinds his teeth so forcefully it wakes him. I've heard Brooks snore, and I'm sure he's one of the 20 million Americans who have apnea, or partially blocked airways. My wife, Luci, shares my problem: We fall asleep fine, then wake at three or four in the morn-ing. Luci's sister, Marie, has the opposite problem. She tosses and turns for an hour before nodding off, then has trouble waking up. For me, during the hour of the wolf - that hour before dawn, said to be the longest of the day - the pain of sleepless-ness can be unbearable. It's a maddening ache that makes me feel helpless. I'm lying there, staring at blackness. I'm trying to sleep, and the very effort is counterproductive. Yesterday becomes today, and it's time to get up.

If you want to find a starting point for all this, travel back to 1879. That was when a famous short-sleeper named Edison perfected the light bulb. Over time, downtowns began to bustle after dark, shift work burgeoned, and reading into the night -then listening to the radio, then watching TV- became part of the American way of life. We altered our circadian rhythms; sleep and well-being fell victim. In 1910, Americans averaged nine hours of sleep per night. Today, it's seven. "Edison started it," says Columbia- Presbyterian's Kavey. "Now we have a hundred TV channels, all-night stores, the Internet. There's great temptation not to sleep."

Sometimes it's not just the temptations, it's the very things that define our lives, like the need to work. There are 20 million night-shift workers in the U.S. who are forced out of their natural rhythms. "It's an inherently dangerous situation," says Dinges, "particularly if their companies are dealing with a lethal substance or something that affects public health and safety." A recent study of long-haul truckers who drove 4,000 miles a week with dectrodes attached to their heads -"wired up like Martians," as a spokesman for the U.S. Transportation Department put it- proved that drivers do fall asleep at the wheel. It is estimated that such drivers may cause 1,500 road deaths a year. The Transportation Department is drafting new rules for the maximum number of hours a trucker can work in a given day. It's about time - the current rules have been in place for 60 years. But enforcement of any new limits will be a tougher deal. "The logbooks that truckers keep should be best-sellers on the fiction list," says Scott Campbell, whose Lab of Human Chronobiology at Cornell University Medical College is conducting its own study of tired truckers. "The Feds know it, and they continue the charade."

If truckers are an extreme example, it is nonetheless true that our lifestyle is vigorously, even viciously, anti-sleep from cradle to grave. And within each age-group, there is an issue. Like the one being waged over babies, right in my own bedroom! Her name is Caroline, and she's a really good baby - in fact, she's perfect - but we still have debates over how to raise her. TIME FOR HER FEEDING. Never wake a sleeping baby! THANK GOD FOR PACIFIERS. Plugsareplastt"c Satans! NICE CRIB. You'd Ferberize? You fiend!

That was the biggie: Ferberization. Dr. Richard Ferber of the Center for Pediatric Sleep Disorders at Children's Hospital in Boston is the author of the 1985 book Solve Your Child's Sleep Problems, which has sold a half million copies and brought its author (and me) a peck of trouble. Ferber says you needn't worry too much about helping your newborn, who is "getting used to being in this world and is changing all the time," rack up her 16 and a half hours of shut-eye daily. But he adds that "at around three to four months, it's important to increase your regularity so your baby will learn when to expect to go to sleep." He emphasizes that children learn new sleep habits quickly and that if you want your baby to fall back asleep by herself, it's best to let that happen. Rocking a crying baby every time she wakes only builds habits that eventually- must be broken. '

Ferber's theories have been stretched by critics (like Luci) to mean not just tough love but neglect. An article in Time last year, which recommended allowing babies to remain in their parental beds until they choose to disengage, became a flash point in the fight over Ferber-ization. It stressed the benefits of extra time spent with offspring and the encouragement of natural breast-feeding and mother-child sleep patterns. " Don't get me going on the Time article," says Ferber, who hates the term Ferberization and is at pains to explain that he encourages adaptability rather than rigor in his book. "The writer said my goal in life was to deprive children of their mothers' milk. Total non-sense."

Ferber is a mild man who sounds like Mr. Rogers. That he is often portrayed as an ogre is surprising. He knows children can have serious disorders like apnea that demand attention.
But he feels that "in many cases, if parents are willing to give their children a chance to fall asleep on their own, even if that means listening to a certain amount of crying," then these parents can help their babies sleep well in our postindustrial society.

Luci is not convinced. "I think Caroline should be with us." And so she is. Nevertheless, I remain concerned. I'm six two and ... let's say, not 150 pounds. What if I roll over? Turns out, that's not a stupid question. Last August the American Academy of Pediatrics issued a policy statement saying that in some co- sleeping situations the risk of Sudden Infant Death Syndrome could be increased. The statement pointed out that while cribs meet infant safety standards, beds do not. Other rules of thumb for co-sleeping families include: no waterbeds, no beds against the wall, no face-down babies, no smoking or drinking. And yes, if Dad or Mom is a restless sleeper who could roll onto the infant, then you might take another look at that crib.

Now, although Caroline is perfect, she already seems to have ingrained habits. She displays a Leno tendency (he's on, so is she) and a propensity to snooze after the cock has crowed. This leads me to wonder whether there are inevitabilities about her sleeping. Is she a genetically predisposed owl? "I do believe there is a genetic component to many sleep disorders, though the science isn't conclusive," says Kavey. "We know that narcolepsy can be handed down, and I wouldn't doubt that the same is true about restless legs." Dement says many sleep disorders are "familial," bred into the next generation either through genetics or the home environment. This gives me concern. I'm a short-sleeper; so is Luci. Are we turning Caroline into one? Or is she, perhaps, a natural short-sleeper? Is there such a thing?

Edison claimed he could live on catnaps, but he couldn't. All of us, from Edison (who would crash for 18 hours after a work binge) to Einstein (who routinely got 11 hours a night), need sleep. And while some people require less, they are rare. According to James Walsh, executive director of the Sleep Medicine and Research Center at St. Luke's Hospital in St. Louis, no more than 5 percent of adults function well on less than six and a half hours of sleep. Take the President. "Just look at him," says Walsh. "He admits that every significant mistake he's made has been due to the fact that he's been tired." Adds Kavey: "You never find an Olympic swimmer saying, 'The Games are coming up, I've got to start getting five hours a night.' No. They need eight to be at their peak. Same with poets and Presidents. With more sleep, Clinton would be more decisive, less hesitant."

Having talked with the experts, I realize it's not a good thing for Caroline to be raised as a short-sleeper. Luci and I resolve to mend our ways and set a proper example so that by the time our daughter is a young girl, she'll be sleeping soundly each night and be well rested for school. Or will she? If you think there's a lot of talk about baby sleep these days, try teenage sleep. Last year, responding to studies showing teenagers were getting too little sleep, and much of it at the wrong time for their biological clocks, the Edina, Minn., school district agreed to move its start time at the high school from 7:25 a.m. to 8:30 a.m. "I hope it's the beginning of a trend," says Kavey.

Teenagers require more than nine hours of sleep a night to maintain optimal alertness. Moreover, while they do very well in the evening and early night, they drag in the morning (like that's a big secret). A perfect-world scenario would feature a school day beginning as late as 10 a.m. This isn't going to happen, of course: Parents want their kids in school during their own work hours. But the consequences of forcing teens to fit s<.'11001 into the wrong circadian slot can include poor grades, trouble at home and, worst of all, car crashes. In a recent study, David Brown of the Center for Sleep Evaluation at Optima Health in Manchester, N.H., found that 17 percent of 166 high school drivers reported having fallen asleep at the wheel and 64 percent believed that sleep deprivation worsened their school performance.

With my teenage kids, I stress sleep even more than nutrition," says Kavey. "If they call from the Cape and are driving back to New York, I tell them to sleep in, then do the driving. If a teenager is tired and driving, he's been robbed of his greatest asset, his coordination. A teenager's concentration is never really great, so if his coordination is impaired, he's in trouble. " You know," says Kavey, "that's the third time this week I've told someone about my kids and their sleep. Sleep is such a universal. I can't go to a party anymore and tell people what I do, because I'm inundated with questions." "Me, too," I say. And I tell him briefly about John the legtwitcher, Mike the stressed-out lawyer, all my other friends with sleep problems- and their remedies.

John's problem, I've learned, probably doesn't have a solution this side of drugs. He could take Sinemet, a new prescription drug that limits nighttime leg movements, but he'd probably have to take it for life. Even that might not be so bad. Dement says most medicines prescribed for sleep disorders are safe and effective, and this includes most sleeping pills: "ff you can't deal with a problem any other way, and you want to not be miserable, they're an answer." Popular prescription medicines these days include Ambien and Halcion, which are short-acting. That is, by and large, a good thing. A drug like Ambien, whose effects last about four hours, is better for those who are tired by day, awake at night. Over-the-counter pills with anti-histamines do have sedative qualities, but they can create lingering drowsiness. "Some peak at eight hours," says Walsh, "so you're sleepier in the morning than you were shortly after taking the medicine."

As for Mike: He tried mdatonin for a week last year, then gave it up. "It wasn't for me," he says. "It made me feel weird. Drowsy, yes, but I still couldn't sleep." As with all drugs, mdatonin -which was once thought to be a miracle cure, the Prozac of Zombie Nation- affects people in different ways. "A year ago, everyone was raving about it," says Cornell's Scott Campbell. "Now everyone hates it. The rebound is just as idiotic as the original 'magic bullet' thinking. The thing is, what works for you might not work for the next guy. It's like eatiQg foods with tryptophan -such as turkey and bananas- that are supposed to make you sleepy. For some
they're godsends, for others they don't help a bit."

Other friends have a few drinks before bed. Not a good idea, Walsh explains: "A small dose of alcohol is unlikely to cause major problems, but with a larger dose - say, three to five glasses - sleep will be fragmented after the first few hours because alcohol is a sedative in your body at first, then as its effect wears off, you'll have a rebound excitation of your nervous system. If you drink alcohol and caffeine in moderation, quit for three or four weeks and see if your sleep gets better."

Joe the teeth-grinder won't be sleeping better soon. His syndrome, known as bruxism, is related to stress and is incurable. It is best treated by orthodontists who make devices to protect the teeth. Since the grinding is many times more forceful than chewing, sufferers need these plastic night-guards to keep their teeth from drifting or even breaking.

Another colleague, Anne, my teammate in the reporting of this story, is an uneasy sleeper. While I was mulling over whether to approach a sleep lab with my complaints, Anne was trying one home cure after another-all of them non-medicinal. She says her sleep improved; Kavey's not surprised: "It's common for patients to find the solutions simple and to say, 'If I'd known I could manage my problem this easily, I would've done it years ago.'"

Then there's the friend of a friend-a case history I did not tell Kavey about. This man had a sleeplessness problem and developed an enervating physical condition caused by the Epstein-Barr virus. Despairing of finding rest, he put padding on the walls of his apartment and shuttered the windows. Nothing worked. Three years ago, he committed suicide.

Most of my buddies were about 40 when they started to notice their sleep deteriorating. That's right on schedule: Sleep is naturally, inevitably and always negatively influenced by aging. "Just as hair tums gray, sleep falls apart," says Kavey. Apnea hits hardest in men 30 to 60, and the prevalence of insomnia increases for both sexes. The only thing that is known to induce deep sleep, naturally - exercise - is something we get less of as we get older, and our sleep becomes increasingly shallow and fragmented. We wake up early, fall asleep at the movies. The restorative effects of sleep on our endocrine and cardiovascular systems diminish in turn.
A study by the National Commission on Sleep Disorders Research found that sleep disorders may affect more than half of all persons over 65 and can precipitate certain mental and physical illnesses.

The more you gaze at the curious land of sleep, the more it sobers you, even spooks you. Then you look at your infant daughter, who's going to need your energy, and you reach for the phone. There are now 365 sleep-disorder clinics accredited by the American Sleep Disorders Association -up from 92 in 1987- plus some 2,600 others that aren't accredited. Most of them are doing an ever-increasing business as people like me finally make the call. By monitoring brain waves, REM patterns, heart rates and breathing, sleep specialists can usually diagnose a syndrome in a single night - and recommend proper treatment. Sleep experts say that if you nod off while driving during the day, have chronic trouble falling asleep or have a serious sleepwalking problem, then a visit to a clinic is a good idea. They add, however, that caution should be exercised when approaching such a fast-growing, unregulated enterprise as sleep-disorder analysis. "The important thing," says Walsh, "whether it's in a clinic or at a hospital, is to find a doctor trained in sleep medicine."

Tonight at New York University's sleep clinic, the three rooms are all occupied. My sleepover mates are patients who are participating in an ongoing study of apnea. A person with apnea starts and stops breathing as many as 500 times a night and may be getting far less sleep than he thinks. If a relaxed tongue gets sucked against the back of the throat, blockage occurs, breathing stops, and things can get serious. Possible remedies include weight loss, procedures to reshape the airway, and appliance therapy - the wearing of dental pieces or a nasal "continuous positive airway pressure" device.

I watch my two sleepover colleagues bed down and hope I do not share their affliction. I hope, further, that I don't have narcolepsy. One in 1,000 Americans suffers from this neurologic condition, which causes daytime sleep attacks. Narcolepsy is currently incurable, though increasingly treatable. Test results of modafinil -which helps patients stay alert but is not a heart stimulant- have shown the drug to be "significantly effective" in treating the condition. Modafinil is not yet on the market, but FDA approval is expected. "Narcolepsy isn't lethal in and of itself," says Kavey, "but it's very lethal when your car hits a tree."

Andy, who will be monitoring me through the night, approaches with his electrodes and goop. Once wired, I turn out the lights and try to sleep. It's been a long day, and I'm out within a half hour. Even with all the attachments, I get what seems an ordinary night's sleep - six hours, the first four of them pretty good, the last two fitful. Andy undoes the wires. I shower, shave and am at my desk early. I have a couple of cups of coffee, work a longish day, hen go home to Luci and Caroline.

The next morning, I return to work and, amid the faxes, find the preliminary results from the lab. It seems I slept five hours that night -305 minutes- not six as I'd thought. My sleep efficiency was 87.1 percent, which is "within normal limits for my age. " My "sleep architecture" was "essentially normal, although two 20-minute episodes of increased fragmentation occurred without obvious cause." The news was, finally, pretty good: "No significant respiratory abnormality……no cardiac abnormalities."

There were several recommendations as to how I might improve my "sleep hygiene": lighter and earlier dinners, 30 minutes making a to-do list as closure to the day, no checking the clock in the middle of the night. I'm going to adopt them. When Caroline wants to toss that ball around, I want to be ready.