Insomnia

As a resident decades ago in a large inner-city hospital and later in private practice, I learned what it was like to be up at all hours of the night and then have to work the next day. I can honestly say that I spent years deprived of the 7-8 hours of sleep recommended for good health.

Sleep deprivation is a serious issue: Some researchers believe that it carries health risks approaching that of cigarettes or heart disease. The mental and physical deterioration that sleep deprivation causes can break you: So much so, that it’s been used as a method of torture. The CDC estimates that up to 50-70 million Americans suffer from some kind of sleep disorder.

What does this have to do with medical preparedness? In the aftermath of a major disaster, you can be certain that sleep disorder problems will increase in number and severity, negatively affecting your chances of survival.

(Note: Is there a difference between insomnia and sleep deprivation? Yes. Insomnia refers to the inability to sleep adequately despite being given the opportunity. Sleep deprivation refers to lack of sleep due to some restriction of the chance to sleep (for me, nights on-call). As the health risks are similar, I’ll address them together in this article.)

How would sleep deprivation worsen your chances of succeeding in an emergency? The parts of the brain involved in alertness and attention (the thalamus) and the area that controls many higher-level thought processes (the prefrontal cortex) are especially vulnerable to lack of sleep.  If the brain doesn’t get enough rest, judgment may be impaired and you may become incapable of putting events into the proper perspective. This causes mistakes that can be costly.

Scientific studies bear this out. The British Medical Journal suggests that the effects of 17-21 hours without sleep is the equivalent, in terms of affecting behavior, of having a blood alcohol level close to the legal limit for intoxication. A number of articles that evaluated the performance of medical residents show that those getting less than 4 hours of sleep made more medical errors that residents who slept 7-8 hours a night. This has led many teaching hospitals to change the workload and hours of many of their interns and residents. (If you’re one of them, please let me know what your schedule is like)

What about the elderly? Don’t older folk naturally sleep less hours and less deeply? Studies show that that the elderly do get less sleep, but it’s not necessarily because they need less. Sleep could be affected for all sorts of reasons: sleep apnea, arthritis pain, heart issues, etc.

Those in their later years also might develop something called “advanced sleep-phase syndrome”. In this instance, there is an inability to stay awake until normal bedtime and staying asleep until the desired wake time. (to paraphrase Ben Franklin, too early to bed, too early to rise?)

The failure to get 7-8 hours of sleep every night causes a whole set of symptoms, none of which are particularly good in natural disasters or other survival settings. Here are just some:

• Irritability
• Depression
• Tremors
• Bloodshot, puffy eyes
• Headaches
• Confusion
• Memory loss
• Muscle aches
• Hallucinations
• Worsened control of diabetes and high blood pressure
• Blackouts lasting up to 30 seconds (also called “microsleeps”)

There are a number of people that seem to function just fine with less than the average number of sleep hours. No one is quite sure why this is so, but it appears to involve about 5% of the population and may be related to genetics.

There are things that you can do to get a few more hours of shut-eye each night. The best start is to consider a concept we’ll call “sleep hygiene”.  Sleep hygiene involves adjusting your behavior to maximize the amount of restful sleep you get.  Consider:

• Sticking to a standard bedtime and wakeup time
• Making your bedtime environment as comfortable as possible
• Avoiding Nicotine, Caffeine, and Alcohol before going to bed.
• Staying away from heavy foods for at least 2 hours before going to sleep
• Exercising regularly, but not right before going to bed
• Eliminating as much light as possible in the room at bedtime
• Keeping your mind clear of stressful issues at bedtime

Many of the above strategies, by the way, work well for those struggling with working night shifts.

Of course, there are drugs like Ambien and Halcion on the market, but a better alternative to start with might be some form of natural sleep aid.  Some alternative remedies for sleeplessness include the following teas:

• Chamomile
• Kava Root
• Lavender
• Valerian Root
• Catnip

Good nutrition is important for general health, but some foods are also thought to be helpful in promoting a good night’s sleep.  They contain sleep-inducing or muscle-relaxing substances like melatonin, magnesium, or tryptophan. Some examples:

Oatmeal – melatonin

Milk – tryptophan

Almonds – tryptophan and magnesium

Bananas – melatonin and magnesium

Whole wheat Bread – helps release tryptophan

Yoga, massage, meditation, and even acupuncture are thought by some to be effective in dealing with sleep deprivation.

Staying healthy, whether in normal times or in the aftermath of disaster, involves not only maintaining good physical hygiene but maintaining good sleep hygiene as well. To be at 100% efficiency, get some rest!

Joe Alton, MD