Sleep Vital To Health and Longevity, Especially for Third-Shifters

What do these disasters have in common?

• March 24, 1989: The Exxon Valdez tanker runs aground, spilling oil across pristine Alaskan waters and land and killing countless wild animals.
• April 25th, 1986: The Chernobyl nuclear reactor in the Ukraine has a meltdown, spewing out radioactive clouds whose toxic effects will be felt for generations.
• January 28, 1986: The Challenger space shuttle explodes, resulting in the deaths of seven American astronauts.

It turns out that sleep deprivation could have contributed to fatal mistakes made in each case, says Rose Franco, MD, Assistant Professor of Pulmonary/Critical Care Medicine and Associate Director of the Sleep Disorders Program at the Medical College of Wisconsin. Dr. Franco practices at the Froedtert & The Medical College of Wisconsin Pulmonary Medicine Clinic.

People can go without sleep for surprisingly prolonged periods of time, but the sleep deficit cuts into their productivity and effectiveness in the short run and injures their health in the long run, she stresses. "Adequate sleep is as important as a good diet and good exercise for good health. It's especially important in kids, because the growth hormone is secreted during sleep."

While there is some variance in the sleep different individuals require, an ongoing failure to get enough sleep actually shortens one's lifespan, Dr. Franco states.

"The number one sleep disorder we face is simply a shortage of time for sleeping," observes Dr. Franco. "The average person needs at least 8 hours in bed to produce six to six-and-a-half hours of sleep."

Yet the pressures of longer work hours and shrinking time off the job in the US are speeding up the pace of life and making a good night's rest expendable for many people. This trend is also visible in young people, affecting their ability to learn and their capacity to drive safely or operate machinery because they are tired.

Third-Shift Workers at Higher Risk
Along with long work hours in general (US workers average far more hours per week than their counterparts in other advanced nations); working the third shift is especially ruinous to sleeping well. "Over a week-long shift, the average third-shift worker loses a whole night's sleep," she says.

This loss of sleep takes an emotional and physical toll on both third-shift workers and their families. "They are more likely to be emotional and impulsive rather than patiently working things out with family members. On top of their work responsibilities, they may also have care-giving obligations to children or elderly relatives. They tend to withdraw from social commitments. They experience more heart problems, more doctor visits, and a shorter lifespan."

Given the serious stakes involved in third shift work, Dr. Franco recommends that third-shifters follow a rigorous schedule to make certain that they get the sleep they need. "You need to keep the same schedule seven days a week, including weekends, and do it 365 days a year," she notes. "To begin with, you need to free up the entire day for sleeping. When sleeping, wear earplugs or make sure your house is well sound-proofed," she says.

The third-shifter's routine should also include wearing dark wrap-around sunglasses on the drive home. "If it gets light out at the wrong time, the sunlight has a powerful effect in waking you up. It's part of the circadian rhythm we were born with.

"And when you get home, you should delay errands and chores and focus on unwinding and relaxing before heading off to a quiet, dark bedroom"

Another important step for third-shift workers is getting bright light at work "If you have full spectrum light of 5,000 lux, it improves your alertness." Also, there is some evidence that taking the hormone melatonin (available over the counter) on a specific schedule might help shift workers fall asleep during the day.

"Essentially, you need to apply cognitive behavioral therapy," where you react to your problems by processing them mentally rather than simply reacting emotionally.

Short-Term Insomnia
Insomnia is another major kind of sleep disturbance, but fortunately, short bouts of insomnia don't carry the same potential for damage that third-shift work does. "Insomnia doesn't carry the same morbidity, because the brain will eventually catch up and get the sleep it needs. On what is called the 'recovery night' after a night of poor sleep, your body recaptures the deep sleep it needs."

But in the short term, the sense of exhaustion resulting from insomnia can be frustrating. Usually, "There is some trigger like social stress or financial worries that lead to a cycle of worry." The worry leads to an inability to fall asleep, which feeds a new anxiety about not sleeping, and the cycle continues.

Dr. Franco warns against placing too much faith in sleeping pills as a regular solution. "Worry actually produces more adrenaline than running," she says. "A sleeping pill doesn't fix the cycle of worry over the long-term."

Instead, she recommends setting aside some time about an hour before bedtime to lay out your worries and go through them realistically, analyzing what is genuinely likely to happen rather then dwelling on improbable worst-case scenarios. "It's a good idea to take time out of the day to pause and organize your thoughts and get yourself feeling in control of the next day. In effect, you need to set aside some 'worry time.'

Chronic Insomnia
"If you have an underlying insomnia, then you need to approach things differently and not internalize your problems," Dr. Franco suggests. "Essentially, you need to apply cognitive behavioral therapy," where you react to your problems with by processing it mentally rather than simply reacting emotionally.

For those with long-standing insomnia, Dr. Franco offers additional advice:

• Reserve the bedroom for sleeping and other traditional bed-time uses. Don't watch TV or read in the bedroom if you find that reading is stimulating rather than something that helps you doze off. The central notion here, she explains, is to build up a strong association of the bedroom with sleep.
• Don't go into the bedroom and lie down until you feel tired. "You need to re-strengthen the association between bed and sleep, so go to bed only when drowsy and sleepy."
• If you go to bed tired but then find that you're feeling tense, try to settle down mentally through deep breathing and "progressive relaxation." That refers to the practice of concentrating on relaxing a specific part of the body like the feet and legs and then moving upward until your body is completely relaxed.
• If you find that relaxation techniques are not working after 20 minutes, then get up and engage in relaxing activity like reading or listening to music. "The activity should be relaxing and not high-energy," she cautions.
• Avoid eating too close to bedtime and stay away from certain foods and additives. "Alcohol, caffeine, and nicotine all contribute shallow sleep rather than the deep sleep that is truly restful. Caffeine in particular should be avoided after noon.
• Exercise regularly, but avoid doing so within four hours of bedtime because of the stimulation activity can create. "Studies have shown that 60 minutes of walking will add 30 minutes to your ability to sleep," she notes.
• Keep in mind the timing of taking your medications. Some drugs for high blood pressure and arthritis can increase your difficulty in falling asleep.

Perhaps falling asleep is sometimes difficult because it is far more complex than originally thought. There are various stages of sleep, ranging from a light, nap-like phase as well as the deeply restful "delta" phase.

"Every 90 to 120 minutes in the delta phase, you cycle into Rapid Eye Movement (REM) sleep, where your body is as active as when you are awake," explains Dr. Franco. "You are using up as much energy in REM sleep as when you are awake." While more is being learned about the REM phase of sleep, its function remains unclear. "We still don't know its purpose," says Dr. Franco.

Dreams during the REM phase are the ones that are remembered, Dr. Franco notes. "If you awake without remembering your dreams, it means that you are probably not giving your brain enough rest."

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.