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Sleep. Its importance for good mental and physical health can't be stressed too strongly. Without enough of it, we're like photos out of focus — things just aren't as clear as they should be.

As vital as it is on a nightly basis, many of us don't get nearly enough sleep nowadays. Babies, for example, require about 16 hours a day, teenagers about nine hours, grade-schoolers between 10 and 12, and adults about eight hours.

"It's not a coincidence that we spend one-third of our day sleeping. There's a real need for it," said Eric Frajerman, Psy. D., a licensed psychologist on staff at Friends Hospital, Philadelphia, and in private practice in Philadelphia and Lower Bucks County.

"Sleep is important for restorative factors for the body and for the brain to regenerate and reorganize itself. Sleep impacts memory, learning, concentration, focus, metabolism, the immune system and motor skills, so it's all quite cyclical.

"A lack of sleep messes with our natural rhythms, and can lead to anxiety and depression, and can compound those problems if they exist already."

Indeed, he added, a lack of sleep over an extended period can make people psychotic as well.

Why we don't get enough sleep has a lot to do with our perceptions, he said. People will convince themselves they've gotten their eight hours, when, in fact, they've slept for only five or six, but the perception is that it's enough.

However, for some people, fewer than eight hours a night is adequate, Frajerman said. "But most of us try to do too much today, often on much too little sleep."

There are proven ways to improve sleep, he noted, including going to bed at a regular time each night — excluding special occasions and vacations, when we're up later usually. Other sleep steps, he said, are to keep the bedroom dark, shutting out even ambient or indirect light, keeping the noise level down, not exercising before bed, avoiding a big meal and having no caffeine and alcohol for at least six hours before bedtime.

Another sleep aid, he advised, is to establish a relaxing bedtime routine that might include either a cup of soothing decaffeinated tea or listening to soft music. "The idea is to get into a pattern of good sleep hygiene. Just as there is good dental hygiene, we need to sleep well also to have good health. We learn that being in bed is a place for a lot of other activities, such as reading and eating, but it's not a place for alert activities; it's the place for restful sleep," Frajerman stated.

"An atmosphere and sleep setting that promotes Rapid Eye Movement (REM) sleep, or deep sleep, the most vital sleep stage, when many of the regenerative processes occur, is what we all need, at every stage of life."

Babies, for instance, need 50 percent REM sleep, adults 20 percent and adults age 60 and older, just 15 percent.

If REM sleep is not happening, the cause could be related to either stress or a medical condition, and should be treated either by a medical doctor or psychologist, he recommended.

Once in bed, if sleep doesn't come within 20 minutes, get up, get out of bed and do something calming. But, he said, if this pattern persists over time, seek professional help: "There are treatments that work, such as behavioral therapy and cognitive behavioral therapy, that incorporates the first and takes a look at the role of our thoughts."

Sleeping pills should be avoided until all other means have been explored, he commented, and then used cautiously.

'Vital to Optimal Functioning'
According to Rodgers Wilson, M.D., medical director of Friends Hospital, the value of sleep is underrated in our culture. "It turns out that sleep is as vital to optimal functioning as good diet and exercise," he said.

In a global environment, where it's always daylight somewhere in the world, he continued, people are obligated to respond to the daily demands of life no matter what the local time.

"Add to that the prevalence of stressful lifestyles, substance abuse, and mood and sleeping disorder, and you wind up with a lot of tired people, who are functioning below capacity, at times endangering themselves and others," Wilson said.

Statistics from the National Highway Traffic Safety Administration show that driver drowsiness accounts for nearly 100,000 motor vehicle accidents and 1,500 deaths each year in the United States. Studies demonstrate that sleep-deprived people perform either as poorly as or worse than intoxicated people on hand-eye coordination tasks, and in driving-simulation tests.

Because of accidents, on and off the job, $100 billion is lost to the U.S. economy annually, Frajerman added.

"Chronically overtired people can expect to experience difficulties in their relationships, in mental functions, including memory, reaction time and judgment, and in their ability to fight infection," Wilson said.

The common practice in Western industrialized nations of "burning the candle at both ends" has created so much sleep deprivation that what is really abnormal sleepiness is almost the norm now, he remarked.

Among the most common behavioral health disorders known to disrupt sleep and contribute to the sleep-deprivation picture is depression, which can cause frequent waking up either during the night or in the early morning hours. "Anxiety disorders that include Post Traumatic Stress Disorder, panic disorder and obsessive compulsive disorder all interfere with normal sleeping patterns," said Wilson.

"A lot goes on while we're sleeping. Deep sleep in children and young adults, for example, is related to the production of growth hormones; while the cell regeneration and repair that goes on benefits people of all ages."

'A Basic Biological Drive'
Should the widespread lack of sleep nowdays be taken as a sign that our times are especially stressful? "While our pressures are great today, and this generation tends to pack more and more in every day, every generation has had its share of problems," said Frajerman.

At Abington Memorial Hospital, Albert Wagman, M.D., a sleep disorder specialist, who is on staff at the hospital and is part of its sleep center, noted how "sleep is a basic biological drive shared by humans, animals and — it's thought — even by lower forms of life, such as amoebas, that slow down to regenerate."

A break to restore energy and rebuild the body is exactly what is needed for a healthy lifestyle. Without it, people simply can't deal effectively with the demands and pressures of life since a lack of sleep makes them "more irritable, bad tempered and unable to perform," he added.

For those who don't sleep well, Wagman suggested they take a look at what they eat and drink — such as coffee and other sources of caffeine — and especially when they do so. "Sleep is a learned activity, because over time we learn a routine for it, including a regular time, just as we learn what to eat and what not to eat," he said.

"We respond to these clues, and when we vary them greatly because of a trip, for example, we can wind up with a sleep problem."

Children need the most sleep, and while a lack of it won't interfere with their growth spurts, he noted, it can make them grumpy and inattentive in school. "In this country, it seems we have 498 ways to avoid going to bed, whether it's late-night TV or playing a game," continued Wagman. "The problem is that a lack of sleep is cumulative. It's like going to the bank to withdraw money — a deficit builds up — and when a sleep deficit builds up, it can make someone feel as drowsy as if they've had two martinis." 



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